Rajdeep Saha

Prevalence of Pseudomonas aeruginosa and Acinetobacter spp producing metallo-β-lactamase in a tertiary care hospital

Background: Hospital acquired infection (HAI) due to multidrug resistant pathogens are increasing day by day. Among which MBL producing Pseudomonas aeruginosa and Acinetobacter spp contribute a major portion of HAI. Aims: The objective is to determine the antibiotic susceptibility pattern of P. aeruginosa and Acinetobacter spp. showing imipenem resistance and prevalence of MBL producing strains among them in a tertiary care hospital. Materials and Methods: Over a period of 5 months in a tertiary care hospital, 60 Pseudomonas aeruginosa and 50 Acinetobacter spp. were isolated. These were tested phenotypically for detection of metallo-β-lactamase (MBL) production, by imipenem-ethylenediaminetetraacetic acid (EDTA) combined disc method and by four fold or more reduction of minimum inhibitory concentration (MIC) against imipenem with EDTA. Result and Conclusion: The prevalence of MBL producing Pseudomonas aeruginosa was found to be 41% and Acinetobacter spp. 22%. Antibiotic susceptibility tests revealed multidrug resistance for most antibiotics but 100% sensitivity for colistin. A big proportion of these positive strains were isolated from patients with multiple risk factors like prolonged hospital stay, indwelling urinary catheter, continuous mechanical ventilation, prolonged antimicrobial therapy, intravenous lines. The overall mortality rate among them was as high as 21%.

Ventilator associated pneumonia in a tertiary care hospital in India: Incidence, etiology, risk factors, role of multidrug resistant pathogens

Background: Ventilator associated pneumonia (VAP), a hospital acquired infection (HAI) is seen among critically ill patients on mechanical ventilation (MV) due to various causes, in intensive care units (ICUs). VAP increases morbidity, mortality, as well as the cost of healthcare. Materials and Methods: A prospective study was done over a period of 10 months in a tertiary care hospital in India to determine the incidence, etiological agents, their sensitivity profiles, and risk factors associated with VAP. Combination disc method, ethylenediaminetetraacetic acid (EDTA) disc synergy (EDS) tests, and AmpC disc tests were performed for detection of extended-spectrum beta-lactamases (ESBL), metallo-beta-lactamases (MBL), and AmpC beta-lactamases, respectively. Results: One hundred and forty adult patients, on MV for 48 h and more, were included and 28 (20%) developed VAP. The incidence density rate of VAP was 21.875 per 1,000 ventilator days. Most of the patients had late onset VAP (60.7%) with average number of days for onset around 8 days. Pseudomonas spp. and Acinetobacter spp. were significantly associated with late onset VAP, whereas Enterobacteriaceae, Staphylococcus aureus , Haemophilus influenzae , Streptococcus pneumoniae , Burkholderia cepacia, and Candida species were commonly isolated from early onset VAP. Polymicrobial infections occurred in 14 cases, so overall 43 VAP pathogens were isolated. Thirty (69.7%) of them were multidrug resistant (MDR), among which ESBL contributed 23.25%, MBL 30.23%, AmpC beta-lactamases 9.30%, and to methicillin resistant S. aureus (MRSA) contributed 6.97%. Prior antibiotic therapy ( P P P P P = 0.0012), and impaired consciousness ( P = 0.0191) were significant risk factors for VAP. Conclusions: Proper knowledge of risk factors can help identify high risk groups for VAP, among the critically ill patients on MV. MDR pathogens, with production of ESBL, MBL, AmpC beta-lactamases, and MRSA were commonly associated with VAP. So, judicious use of antibiotic is recommended.

A case report of nonhealing leg ulcer infected with Stenotrophomonas maltophilia in an immunocompetent patient in a Tertiary Care Hospital of Eastern India

Stenotrophomonas maltophilia is an aerobic, motile Gram-negative, nonfermentative bacillus considered as an opportunistic pathogen causing infection typically in individuals with immunosuppression, organ transplantation and malignancies. Contaminated water or medical devices in the hospital environment are the primary causes of infection. Here, we report a case of nonhealing leg ulcer infected with S. maltophilia in an immunocompetent individual.

Rhino-oculo-cerebral aspergillus and mucor co-infections in an immunocompromised patient with type 2 diabetes mellitus

Mucormycosis are pathogenic moulds of the mucorales species usually occurring in immunocompromised patients or in patients with uncontrolled diabetes mellitus. Aspergillosis is the clinical condition caused by Aspergillus species and may cause an invasive disease with high case fatality rate, especially in immunosuppressed patients. A 46-year-old male patient with Type 2 diabetes mellitus with underlying malignancy presented with proptosis of left eye. Combined infections of Mucor and Aspergillus were diagnosed by means of computed tomography (CT) scan and biopsy. Treatment with Amphotericin B and Voriconazole was started, the patient died within 3 months, from multi-organ failure.

Adrenal histoplasmosis with disseminated cutaneous manifestations in an immunocompetent patient: A case report

This report describes a case of adrenal histoplasmosis along with disseminated cutaneous involvement in a 48-year-old immunocompetent male. The patient presented with multiple erythematous nodules on the skin of the scalp, face, back, thigh, abdomen, and soles. Abdominal computed tomography (CT) imaging revealed bilateral adrenomegaly, with hepatosplenomegaly. Histological examination of the biopsy specimen from both the skin lesion and CT-guided fine-needle aspiration cytology (FNAC) aspirates of the adrenal gland showed a granulomatous infiltrate with numerous intracellular Periodic Acid Schiff (PAS)-positive rounded yeast cells within the macrophages. Culturing of these materials, incubated in Sabouraud′s agar, showed growth of Histoplasma capsulatum. Treatment with itraconazole showed an excellent response.

A Case Report of Staphylococcus aureus Induced Cutaneous Botryomycosis in a Patient with Acquired Immune Deficiency Syndrome

Botryomycosis is a rare bacterial infection that can involve the skin and viscera. It is multifocal in development, characterized by granulomatous bacterial infection. The organisms form granules, which are composed of bacterial masses that are adhered to each other. Here, we describe one unusual case of culture proved Staphylococcus aureus induced botryomycosis in patients with the acquired immune deficiency syndrome who was successfully treated.

A case report of white grain eumycetoma caused by Scedosporium apiospermum in a tertiary care hospital of the Eastern India

Scedosporium apiospermum and its asexual state Pseudallecheria boydiiare increasingly recognized as an opportunistic pathogen. Here, we describe a white grain eumycetoma of left foot of a 48-year-old female caused by S. apiospermum. Treatment with oral voriconazole was successful.

Right-sided scrotal ascariasis

We report a case of 35-year-old male patient who presented with painful right side of scrotum and worm pouting out of the scrotum. The patient had undergone surgery for strangulated right inguinal hernia 2 years back. On exploration we found multiple adult Ascaris worms in the scrotum with right-sided hydrocele. All the worms were removed and eversion of sac was done.