Geeta Koppikar

Impact of an International Nosocomial Infection Control Consortium multidimensional approach on central line-associated bloodstream infection rates in adult intensive care units in eight cities in India

OBJECTIVE To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach on central line-associated bloodstream infection (CLABSI) rates in eight cities of India. METHODS This was a prospective, before-and-after cohort study of 35650 patients hospitalized in 16 adult intensive care units of 11 hospitals. During the baseline period, outcome surveillance of CLABSI was performed, applying the definitions of the CDC/NHSN (US Centers for Disease Control and Prevention/National Healthcare Safety Network). During the intervention, the INICC approach was implemented, which included a bundle of interventions, education, outcome surveillance, process surveillance, feedback on CLABSI rates and consequences, and performance feedback. Random effects Poisson regression was used for clustering of CLABSI rates across time periods. RESULTS During the baseline period, 9472 central line (CL)-days and 61 CLABSIs were recorded; during the intervention period, 80898 CL-days and 404 CLABSIs were recorded. The baseline rate was 6.4 CLABSIs per 1000 CL-days, which was reduced to 3.9 CLABSIs per 1000 CL-days in the second year and maintained for 36 months of follow-up, accounting for a 53% CLABSI rate reduction (incidence rate ratio 0.47, 95% confidence interval 0.31-0.70; p=0.0001). CONCLUSIONS Implementing the six components of the INICC approach simultaneously was associated with a significant reduction in the CLABSI rate in India, which remained stable during 36 months of follow-up.

The impact of the International Nosocomial Infection Control Consortium (INICC) multicenter, multidimensional hand hygiene approach in two cities of India

The fundamental tool for preventing and controlling healthcare-acquired infections is hand hygiene (HH). Nonetheless, adherence to HH guidelines is often low. Our goal was to assess the effect of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach (IMHHA) in three intensive care units of three INICC member hospitals in two cities of India and to analyze the predictors of compliance with HH. From August 2004 to July 2011, we carried out an observational, prospective, interventional study to evaluate the implementation of the IMHHA, which included the following elements: (1) administrative support, (2) supplies availability, (3) education and training, (4) reminders in the workplace, (5) process surveillance and (6) performance feedback. The practices of health care workers were monitored during randomly selected 30-min periods. We observed 3612 opportunities for HH. Overall adherence to HH increased from 36.9% to 82% (95% CI 79.3-84.5; P=0.0001). Multivariate analysis indicated that certain variables were significantly associated with poor HH adherence: nurses vs. physicians (70.5% vs. 74%; 95% CI 0.62-0.96; P=0.018), ancillary staff vs. physicians (43.6% vs. 74.0%; 95% CI 0.48-0.72; P<0.001), ancillary staff vs. nurses (43.6% vs. 70.5%; 95% CI 0.51-0.75; P<0.001) and private vs. academic hospitals (74.2% vs. 66.3%; 95% CI 0.83-0.97; P<0.001). It is worth noticing that in India, the HH compliance of physicians is higher than in nurses. Adherence to HH was significantly increased by implementing the IMHHA. Programs targeted at improving HH are warranted to identify predictors of poor compliance.

Characterization and antimicrobial susceptibility pattern of clinical isolates of Enterococci at a tertiary care hospital in Mumbai, India

Context: Enterococcus is considered an important nosocomial pathogen because of its intrinsic as well as acquired antibiotic resistance. It also has the potential of transferring vancomycin resistance to other organisms such as Listeria monocytogens and Staphylococcus aureus. Aims: The objective of the present study was to determine antibiotic-resistance pattern of Enterococcus with special reference to vancomycin. Settings and Design: A total of 54 clinical isolates of enterococci were collected during the study period of 1 year at a tertiary care center in Mumbai. Material and Methods: Speciation and antibiotic sensitivity testing were done by standard procedures. Minimum inhibitory concentration (MIC) to vancomycin was carried out by agar dilution method. Results: Speciation and antibiotic sensitivity testing were done by standard procedures. The MIC to vancomycin was done by agar dilution method. Conclusions: Vancomycin, Linezolid, and Teicoplanin can be safely used for the treatment of serious enterococcal infections.

Determination of the Efficacy of Isoxyl, A Mycolic Acid Inhibitor in Vitro against M. tuberculosis Strains in Comparison to Other Mycolic Acid Inhibitors

Multi drug resistant (MDR) tuberculosis (TB) has become more prevalent in recent years and second line drugs are not as effective as the standard therapy and are more toxic and expensive. There is an urgent need for new antitubercular drugs. The components of the cell envelope of Mycobacteria have been the subject of intense research for a number of years because of the fact that enzymes involved in their biosynthetic pathways including mycolic acids, offer attractive and selective targets for the developments of novel antimycobacterial agents. The mechanisms of action of various mycolic acid inhibitors like Isoniazide ( INH) and Ethionamide (ETH) have been studied intensively. Recently, mycolic acid inhibitors like Thiolactomycin (TLM), Triclosan (TRC) and Isoxyl (ISO) have been reported to have potent activity against MDR strains of M. tuberculosis. Present study was conducted with the objective of determining the efficacy of ISO in vitro against M. tuberculosis strains in comparison to other mycolic acid inhibitors. Minimum Inhibitory Concentration pattern of clinical isolates of M. tuberculosis to mycolic acid synthesis inhibitors namely TRC, TLM, ISO, INH And ETH were determined by agar dilution method. . Total 10 MDR strains and 10 susceptible strains of Mycobacterum tuberculosis (M. tuberculosis) along with standard strain of M. tuberculosis H37Rv were included in the study. This study shows promising activity of ISO against various strains of M.tuberculosis in comparison to other mycolic acid inhibitors. Hence more study on this compound will be beneficial in drug development process.

Determine Suitability of Isoxyl, A Mycolic Acid Inhibitor for Intermittent Chemotherapy of Tuberculosis

Intermittent chemotherapy is attractive. If drugs can be given less frequently than once a day, fully supervised treatment is much easier. In managing patients with tuberculosis (TB), administration of drugs at intermittent intervals would reduce cost and possibly toxicity of drugs, as well as enhance adherence through greater feasibility of directly observed therapy. There is an urgent need to develop new effective antitubercular compounds, compounds that increase the permeability of the mycobacterial cell wall by inhibiting the synthesis of cell wall components and enhance the activity of conventional drugs as a result of increased penetration of these latter agents to susceptible internal targets. As drug development is a long and expensive process, it becomes predominant to reexamine drugs that were formerly deemed effective against TB and increase the permeability of the Mycobacterial cell wall. One such drug is Isoxyl (ISO). ISO is an old drug, used for the clinical treatment of TB in 1960’s. Hence there was a thought to recheck its efficacy against Mycobacterium tuberculosis strains as it is an old drug which have proven its efficacy. Present study was conducted with the objective, to determine suitability of ISO for intermittent chemotherapy of TB.In vitro Pulsed exposure study of ISO against Test culture and Standard strain of M. tuberculosis H37 Rv after growth of test organisms in log phase was carried out. Viable counts were carried out before addition of drug, immediately after washing and at intervals thereafter.Sensitivity tests were set up on sterile LJM slants. The effect of exposure was estimated by noting the delay before the organisms began to grow. Pulsed exposure study of ISO in infected macrophages was also done. The rate of growth in the cultures after exposure to ISO was similar to the usual growth rate. ISO was not bactericidal during exposure and growth began immediately after the drug was removed by washing. There was significant difference, after applying un-paired t-test ,in the bacterial count observed by exposure in INH 1 mcg/ml (24 hrs exposure) and ISO 10 mcg/ ml (24 hrs exposure) and 10 mcg/ml (96 hrs exposure) concentrations. Same observations made in pulse exposure study of ISO in macrophage cell line. Summarizing, the assessment of suitability for intermittent chemotherapy, it seems likely that ISO would be least satisfactory. Some caution must be expressed about extrapolating the results of in vitro experiments and to the treatment of human TB. There is no adequate substitute for clinical studies of intermittent treatment of pulmonary tuberculosis with ISO.