Raman Sardana

Candida auris candidaemia in Indian ICUs: analysis of risk factors

Objectives To identify the risk factors associated with Candida auris candidaemia, as this fungus now poses a global threat. Methods We performed a subgroup analysis of a previously reported study of 27 Indian ICUs. The clinical data of candidaemia cases due to C. auris and other Candida species were compared to determine significant risk factors associated with C. auris infection. Results Of the 1400 candidaemia cases reported earlier, 74 (5.3%) from 19 of 27 ICUs were due to C. auris . The duration of ICU stay prior to candidaemia diagnosis was significantly longer in patients with C. auris candidaemia (median 25, IQR 12-45 days) compared with the non- auris group (median 15, IQR 9-28, P  <   0.001). Based on logistic regression modelling, admission to north Indian ICUs [OR 2.1 (1.2-3.8); P  =   0.012], public-sector hospital [OR 2.2 (1.2-3.9); P  =   0.006], underlying respiratory illness [OR 2.1 (1.3-3.6); P  =   0.002], vascular surgery [OR 2.3 (1.00-5.36); P  =   0.048], prior antifungal exposure [OR 2.8 (1.6-4.8); P  <   0.001] and low APACHE II score [OR 0.8 (0.8-0.9); P  =   0.007] were significantly associated with C. auris candidaemia. The majority (45/51, 88.2%) of the isolates were clonal. A considerable number of isolates were resistant to fluconazole ( n  =   43, 58.1%), amphotericin B ( n  =   10, 13.5%) and caspofungin ( n  =   7, 9.5%). Conclusions Although C. auris infection has been observed across India, the number of cases is higher in public-sector hospitals in the north of the country. Longer stay in ICU, underlying respiratory illness, vascular surgery, medical intervention and antifungal exposure are the major risk factors for acquiring C. auris infection even among patients showing lower levels of morbidity.

Yokenella regensburgei infection in India mimicking enteric fever

Yokenella regensburgei is an opportunistic human pathogen of the Enterobacteriaceae family rarely reported to cause human infections. Here, we present a case report of Y. regensburgei bacteraemia from India clinically resembling enteric fever in an apparently immunocompetent paediatric patient.

ESBLs producing Enterobacteriaceae in critical care areas – a clinical and cost analysis from a tertiary health care centre

Objective: ESBLs pose a major threat in clinical therapeutics. In the present study we have tried to do clinical analysis of one hundred ESBLs producing Enterobacteriaceae isolates from various clinical specimens from patients admitted in critical care areas. Methods: ESBLs detection was done by CLSI, DDS and Vitek methods. Clinical analysis of each patient was done by regularly visiting in CCA and reviewing patients status and medical records. Results: All of the 13 patients on foleys catheter grew ESBLs positive isolates and amongst 10 non catheterized patients, 9 grew ESBLs negative isolates. Thirteen out of 14 patients on CVP/arterial line grew ESBLs positive isolates. Out of 24 patients who underwent surgery, 22 grew ESBLs positive isolate. Forty seven out of 68 patients who were on 3rd or 4th generation cephalosporins within last 1 month of giving the sample grew ESBLs positive isolates. Conclusion: We have found a statistically significant (p<0.0.05) relationship in between foleys catheterization and production of ESBLs from urinary isolates. There was no statistically significant association in between CVP/arterial line and blood culture isolates. We did not find difference in mortality rates in between patients infected with ESBLs positive or negative isolates. The mortality in patients was associated with their primary illness or associated co-morbid conditions. We found that the detection of ESBLs is important for the de-escalation of therapy thereby saving net cost of treatment.

Prevalence of nonalcoholic fatty liver disease in normal-weight and overweight preadolescent children in Haryana, India

ObjectiveTo document the prevalence of non-alcoholic fatty liver disease (NAFLD) and metabolic parameters among normalweight and overweight schoolchildren.DesignCross-sectional study.SettingThirteen private schools in urban Faridabad, Haryana.Participants961 school children aged 5-10 years.MethodsUltrasound testing was done, and 215 with fatty liver on ultrasound underwent further clinical, biochemical and virological testing.Outcome measuresPrevalence of fatty liver on ultrasound, and NAFLD and its association with biochemical abnormalities and demographic risk factors.ResultsOn ultrasound, 215 (22.4%) children had fatty liver; 18.9% in normal-weight and 45.6% in overweight category. Presence and severity of fatty liver disease increased with body mass index (BMI) and age. Among the children with NAFLD, elevated SGOT and SGPT was observed in 21.5% and 10.4% children, respectively. Liver enzyme derangement was significantly higher in overweight children (27% vs 19.4% in normal-weight) and severity of fatty liver (28% vs 20% in mild fatty liver cases). Eleven (8.1%) children with NAFLD had metabolic syndrome. Higher BMI (OR 35.9), severe fatty liver disease (OR 1.7) and female sex (OR 1.9) had strong association with metabolic syndrome.Conclusions22.4% of normal-weight and overweight children aged 5-10 years had fatty liver. A high proportion (18.9%) of normal-weight children with fatty liver on ultrasound indicates the silent burden in the population.

Nocardia Farcinica brain abscess in an immunocompetent old patient: A case report and review of literature

By definition, a brain abscess is an intraparenchymal collection of pus. Nocardia shows to have a special tropism for the neural tissue. Solitary abscess represents the most common manifestation in the central nervous system, accounting for 1%–2% of all cerebral abscesses. In this report, we present a case of primary multiple brain abscesses due to Nocardia farcinica in an immune competent patient. Early diagnosis and surgical intervention is significant for the patient.

Recurrent high fistula-in-ano: Think of tuberculosis!

A 41-year-old male presented with purulent discharge and pain in the perianal region. There was no history of fever or weight loss. The patient gave a history of being operated 14 times earlier for the same complaints. Perioperative discharge showed acid-fast bacilli on Ziehl-Neelsen (ZN) stain. No pulmonary focus of tuberculosis (TB) was found. The patient was started on antitubercular treatment and has not reported any pain or discharge from the perianal region for the last 1 year. A high index of suspicion of TB should be kept in mind in perianal lesions, especially recurrent lesions, even when no primary focus is found. Surgery and medical treatment combined may be needed in such cases.

Surgical Site Infection

ABSTRACT The incidence of surgical site infections (SSI) depends upon the patient risk-factors, surgical procedure, and practices observed by the operating team. This review aims at examining existing guidelines upon prevention of SSI. Various recommendations pertaining to pre-operative, operative and postoperative phase were evaluated. Implementation of measures like meticulous surgical scrubbing, and surgical site preparation, appropriate antimicrobial prophylaxis (right antimicrobial, dose, timing, and duration), right operative environment, observing strict antisepsis, and glucose control have majorly contributed towards reducing infections. Surveillance strategies towards SSI are essential as they help in guiding towards appropriate implementation of various measures.

Abdominal Tuberculosis – How Far are Our Diagnostics Illuminating?

Tuberculosis can involve any part of the gastrointestinal tract from mouth to anus, the peritroneum, pancreas and the hepatobiliary system. Gastrointestinal tuberculosis mimics many clinical conditions and only a high degree of suspicion can help in the diagnosis otherwise there are chances of missing it leading to high morbidity and mortality. Various methods of diagnosis are available but which one is the right test for a particular patient needs to be ascertained. Culture remains the gold standard method of diagnosis. Fast track cultures like MGIT/M Bact Alert 3 D can give faster results with in few days to few weeks. Molecular tests are fastest and can be used as a supplementary test. Nested PCR can give results with in few hours.