Current Trends in Nosocomial Associated UTI (NAUTI) in Urology Ward

Background: Nosocomial associated urinary tract infections are common, which not only causes morbidity and mortality but also increases cost of health related expenditure in urology patients. Such infections are more difficult to treat because of presence of risk factors e.g. stone, reduced kidney functions. Limited studies are available which focus on type of organisms involved in NAUTI and their presentation in urology departments. Objective: To determine the proportion of microorganisms involved in Nosocomial associated urinary tract infections (NAUTI) and their presentations in urology ward. Methods: This cross-sectional study was conducted in Dubai Hospital in Dubai UAE, from 2017-2018. All patients, who were admitted in urology department with negative urine cultures, were included in study. Urine cultures were sent at time of discharge and a week after discharge from hospital. Patients were followed up in outdoor at first and second week. Results: Total 475 patients were included in this study in given time period. 315(66.31%) patients were male and 160(33.68%) patients were female. On their first follow up after a week, Urine cultures, which were sent at discharge time reveals,73(15.36%) patient’s urine cultures were positive, out of them 21(28.76%) were Mixed Bacterial Growth (MBG). E.coli was most common organism 20(27.39%) in which 11(15.06%) were ESBL positive, klebsiela 9(12.32%) in which 4(5.47%) were ESBL positive. Other organisms include Psuedomonas 4(5.47%), candida 16(21.91%) and enterococcus 3(4.11%). Frequency of candida was second highest, probably because of use of antibiotics during admission. Conclusion: Prevalence of NAUTI in urology is 19.79% (94/475 patients). Enterobacterale species were main responsible organisms for NAUTI in Urology ward. E.coli was most common organism isolated and klebsiela was second most common. Key words: Nosocomial UTI, ESBL UTI, Urology ward

Bacterial Aetiology of Pharyngotonsillitis in Paediatric Age Group in a Tertiary Care Hospital in Kerala

BACKGROUND Pharyngotonsillitis is defined as a spectrum of conditions ranging from inflammation primarily confined to the tonsils to pharyngitis implying generalized inflammation of the whole of pharynx. Children are more prone to get several episodes of pharyngotonsillitis per year during their school years. Pharyngitis caused by Streptococcus pyogenes can cause two non-suppurative complications, acute rheumatic fever and acute glomerulonephritis which is responsible for significant morbidity and mortality. The present study was conducted to identify the prevalence of bacterial pathogens causing pharyngotonsillitis and to study their antibiotic sensitivity pattern that would indicate the optimum line of treatment. METHOD A total of 200 children at the age group of 2 - 12 years who had clinical features of pharyngotonsillitis according to the inclusion criteria were recruited for this study over a period of one year. With the help of a disposable wooden spatula, pus from the pharyngo tonsillar region was collected and processed. Predominant isolates obtained were identified and antibiotic sensitivity was done. RESULTS Bacteria was isolated from 70 samples. Pharyngotonsillitis was found most prevalent at the age group of 8 – 10 years. Intake of cold food stuffs and passive smoking at home was found to have statistically significant association as risk factor for pharyngotonsillitis. Staphylococcus aureus was the most common organism isolated followed by Streptococcus pyogenes. The other organisms isolated were group G and C streptococci, Streptococcus pneumoniae, Pseudomonas aeruginosa and Klebsiella pneumonia sub species (spp) aerogenes. CONCLUSIONS Staphylococcus aureus was the most common organism isolated, followed by Streptococcus pyogenes. All the isolates of beta haemolytic streptococci were found to be sensitive to penicillin. There was increased incidence of resistance to macrolides among the gram-positive isolates except Streptococcus pneumoniae and it may be due to the wide spread use of macrolides injudiciously. All the bacterial pharyngotonsillitis cases were cured with the antibiotic given according to the sensitivity except one case. KEYWORDS Pharyngotonsillitis, Acute Rheumatic Fever, Acute Glomerulonephritis, Bacterial Pathogens, Antibiogram

Comparative study of biofilm formation in tubotympanic and atticoantral ear disease

<p class="abstract"><strong>Background:</strong> Biofilm is an organized bacterial community that may be homogeneous or heterogeneous. It plays a significant role in the pathogenesis of chronic rhinosinusitis, chronic tonsillitis and chronic suppurative otitis media. Biofilms may explain the recurrence and recalcitrant episodes of otorrhea in chronic otitis media (COM). The objective of this study was to detect biofilm formation in chronic suppurative otitis media and compare the pattern of biofilm formation in tubotympanic and atticoantral ear diseases.</p><p class="abstract"><strong>Methods:</strong> This was a prospective cross sectional study at a tertiary care hospital in Varanasi, Uttar Pradesh, India. Patients included in the study ranged from 10 to 65 years of age from both the sexes and varying socioeconomic status. Samples were collected using sterile precautions in cases of tubotympanic as well as atticoantral COM. The collected samples were directly inoculated onto MacConkey and blood agar media. LisaScan® EM microtitter plate reader was used to identify the presence of biofilm.</p><p class="abstract"><strong>Results:</strong> The most common organism was <em>P. aeruginosa</em> and <em>S. aureus</em> followed by <em>Moraxella catarrhalis</em> whereas in cases with tubotympanic COM, most common organism was <em>S. aureus</em>. We found that, in atticoantral type of COM biofilm formation was significantly more common as compared to that in tubotympanic type of COM.</p><p class="abstract"><strong>Conclusions:</strong> Biofilm formation in COM is even higher when atticoantral disease is present.</p>

Microbiological Profile and Sensitivity Data among the Neonatal Population from a Tertiary Care Hospital in South India

Background: Sepsis is one of the most common causes of mortality and morbidity among neonates. The prevalence of microorganisms varies with regions, and the sensitivity pattern also changes over time. Aim: To study the prevalence of various microorganisms and their sensitivity pattern among the neonatal population in a tertiary care hospital in South India. Methods: This was a retrospective descriptive study. We screened the records of all neonates admitted to the hospital during a period starting from January 1st, 2016, to September 30th, 2018. The details of the patients with any sterile body fluids showing microbial growth were collected. Descriptive analysis was done using IBM SPSS version 20. Results: There were 77 organisms isolated during the study period, with the majority among outborn babies. Seventy-two isolates were from blood, two from CSF and urine, with one from the central line. The most common organism was Klebsiella (22%), followed by Burkholderia cepacia (12%), Staphylococcus aureus (9%), and Streptococcus agalactiae (7%). 9% of the organisms were fungus, with the most common being Kodamaea Ohmeri. Among the antibiotics tested for sensitivity, Meropenem had the maximum sensitivity ratio (84%), followed by Co-trimoxazole (83%) and Vancomycin (82%). Piperacillin tazobactam sensitivity was only 56%, and Ciprofloxacin was sensitive in 65% of cases. Most (6 out of 7) of the fungal isolates were sensitive to fluconazole. Conclusions: Klebsiella remains to be the most common organism causing severe infection in young infants. Worrying rise in the incidence of uncommon organisms (like Kodamaea Ohmeri, GBS, Burkholderia) and carbapenem resistance was noted. It is, therefore, essential to update the antibiotic policy of the neonatal units on a timely basis.

Clinico- bacteriological profile of Community Acquired Pneumonia (CAP) in children aged 3-59 months: A cross sectional study

Background: Worldwide community-acquired pneumonia (CAP) is the major cause of high mortality among under five children in India. After introduction of Pneumococcal and H. influenzae vaccination there is paucity of data regarding etiological profile of pneumonia. Aims and Objective: To evaluate the Clinico- epidemiological profile and etiology of community acquired pneumonia in children. Materials and Methods: We enrolled children aged 3-59 months with CAP (based on WHO criteria of tachypnea with cough or breathing difficulty) over 18 months and recorded presenting symptoms, clinical signs and chest radiography. We performed blood and nasopharyngeal swab (NPS) bacterial culture simultaneously to detect etiological agent of community acquired pneumonia in children. Results: Out of 150 cases of CAP, 90 % of caeses had cough and fever and nearly 80-90% cases had tachypnea and crackles on examination. Radiological findings suggestive of pneumonia was seen in 86% cases . Most common organism isolated was S aureus in both NPS culture (18.7 %) and blood culture (14.7 %). Other common organisms detected in NPS culture were S pneumoniae (6%), E Coli (4.7%), Klebsiella (4.7%), CONS (3.3%), and Pseudomonas (2.7%). In blood culture the common organism detected after S aureus was E coli (5.3%), S pneumoniae (3.3%), Klebsiella (3.3%), CONS( 3.8%), and Pseudomonas (2.5%). Conclusions: We observed that S aureus was the predominant etiological organism isolated in both blood and nasopharyngeal swab bacterial culture in patients suffering from community-acquired pneumonia.

Bacterial etiology and antimicrobial susceptibility pattern of neonatal sepsis at a tertiary care hospital in Nepal

Background: Sepsis is the second major cause of mortality among neonates. Present study was done to identify the common organisms which cause early and late onset neonatal sepsis in neonates admitted in our department and their antibiotic sensitivity patterns.Methods: All neonates weighing more than 1500 gms and born to mothers with pre-existing infection, admitted to neonatal intensive care unit for suspected neonatal sepsis were included in the present study. They underwent blood culture and antibiotic sensitivity profiling.Results: 210 newborns were admitted to the NICU of our department for suspected neonatal sepsis. Longer duration of rupture of membranes was found to be significantly associated with growth of organisms. Amongst the cases with gram positive organisms, most were due to Coagulase-negative staphylococci (CoNS) (n=25), followed by Staphylococcus aureus (n=14), and, Enterococcus (n=4). Gram negative organisms isolated constituted 17 organisms. Amongst the cases with gram negative organisms, mostly were due to Klebsiella (n=10), followed by Pseudomonas (n=5) and E. coli (n=2). The most common organism causing early onset sepsis was CoNS, while Staphylococcus aureus was the most common organism causing late onset sepsis. CoNS was fully sensitive to Vancomycin and Amikacin. Staphylococcus aureus was fully sensitive to Amikacin, α-hemolytic. Streptococcus were sensitive to Amikacin, Vancomycin and Piperacillin and Tazobactum and Enterococcus was sensitive to Amikacin and Vancomycin.Conclusions: Antimicrobial surveillance of neonatal septicaemia is required to know the antibiotic sensitivity pattern and thus to formulate policies on use of antibiotics and to know the changing spectrum of antimicrobial sensitivity patterns.

Analysis of Geriatric Infections and a Guide to Empirical Antibiotic Therapy

BACKGROUND Elderly people have increased susceptibility to infection and are at significantly increased risk of morbidity and mortality due to various common infections. Urinary tract and respiratory tract infections predominate in elderly people. Gram negative pathogens especially E. coli are commonly observed pathogens. In gram positive infections, staphylococcus is usually isolated from skin and soft tissue infections. METHODS Data was collected prospectively between the months of March 2015 and August 2016. Patient demographics and clinical data were recorded from oral questionnaires and hospital records. 219 patients satisfied the inclusion criteria. All patients were subjected to basic investigations with blood and urine cultures at the time of admission. Other cultures like respiratory or pus cultures were collected as and when needed. Specific investigations such as ultrasound abdomen, computed tomography kidneys, ureters and bladder (CT KUB), CT thorax, echocardiography, neuroimaging and procalcitonin were done in certain patients when required. RESULTS Of the 219 patients included in this study, 127 (58 %) were males and 92 (42 %) were females. Mean age of the study population was 72.40. The most common source of bacteraemia was urinary in 33 % and was unknown in 25 %. The most common organism isolated in blood culture was Staphylococcus aureus followed by E. coli. Respiratory infections had unidentified pathogens in 81 % of patients. The most common organism isolated from respiratory secretions was klebsiella followed by acinetobacter and pseudomonas. 11 % of patients developed multi organ dysfunction syndrome of which urinary and respiratory systems were the most common primary sources of infection. CONCLUSIONS A significant incidence of unidentified source of infection was observed. Staphylococcus bacteraemia was a significant observation as E. coli is reported to be common. Urinary tract and respiratory infections were seen to be associated with increased incidence of multiorgan dysfunction. KEYWORDS Elderly, Febrile Illness, Staphylococcus aureus, Escherichia coli, Multiorgan Dysfunction

Effect of neonatal sepsis on platelet counts and their indices

Background: Neonatal septicemia is a clinical syndrome characterized by signs and symptoms of infection with or without accompanying bacteremia in the first month of life. Objective of the study was to know the effect of sepsis on platelet counts and their indices.Methods: The study was carried out over a period of one and half year from December 2015 to July 2017 at Sangmeshwar and Basaveshwar hospital attached to M. R. medical college, Kalaburagi. 100 cases were considered for this study after proper screening for complete blood count (CBC), platelet count and their indices like mean platelet volume, platelet distribution width and C-reactive protein (CRP) and blood culture in neonates admitted in our neonatal intensive care unit (NICU) with proven sepsis.Results: A total of 100 neonates with blood culture positive for bacterial cases were considered for the study. Early onset septicaemia (59%) was more common than late onset septicaemia (41%). Out of 100 cases 57% cases had growth of gram negative organisms, 40% had growth of gram positive organisms and 3% had growth of fungal. Tachypnea (27%), lethargy (20%) and refusal of feeds (8%) were the commonest clinical presentation followed by, fever (6%), convulsions (5%) and jaundice (5%). 60% neonates had thrombocytopenia of varying severity. Staphylococcus aureus was the most common organism associated with thrombocytopenia (43.3%). Mean platelet volume (MPV) was high in 85% of cases and platelet distribution width (PDW) was high in 96% of cases.Conclusions: The present study highlights the association of thrombocytopenia, mean platelet volume and platelet distribution width with causative organism in proven neonatal sepsis. Staphylococcus aureus was the most common organism causing thrombocytopenia in our NICU.

Abstract 14160: Transcatheter Aortic Valve Replacement Associated Infective Endocarditis: Comparison of Early, Intermediate and Late Onset Cases

Introduction: Transcatheter aortic valve replacement associated infective endocarditis (TAVR-IE) is a relatively rare complication of TAVR. Little is known about the characteristics of early, intermediate versus late onset TAVR-IE. Methods: We studied the risk factors, microbiological patterns, diagnostic and treatment strategies in patients with early (<60 days), intermediate (60-365 days) and late onset (>1 year) TAVR-IE. Results: Ten out of 494 definite cases of prosthetic valve IE between 2007 and 2019, were confirmed to have TAVR-IE from the IE registry at our center. The mean age was 78.1 ± 13.7 years, with 50% being female. Most (90%) TAVR procedures were performed via transfemoral route, and one underwent transapical TAVR. Baseline comorbidities were common, with mean BMI 33.1 ± 5.5 kg/m2, diabetes and hypertension in 60% and chronic kidney disease in 50% of cases. Mean STS risk score was 7.8 ± 5.7. Most (60%) TAVR-IE cases had intermediate onset, with Staphylococcus aureus being the most common organism (66.6%). Diagnostic modalities and complications are described in Table 1. Two cases had early onset TAVR-IE, one of which was due to Pseudomonas aeruginosa, and underwent successful surgical treatment. Late onset TAVR-IE was observed in 20% of cases. 18-fluorodeoxyglucose positron emission tomography (18-FDG-PET) aided in diagnosis of TAVR-IE in 20% of cases. Mortality due to IE was observed in 40% of cases. Most of the patients underwent conservative management, and 37.5% survived over a mean follow up of 709 ± 453 days. Two patients underwent surgery, of whom one died day 30 post-operatively from sepsis. Mortality due to IE occurred in 25% of cases in the early and intermediate onset groups, while there was 100% mortality in the late onset group. Conclusions: In a single-center cohort, most TAVR-IE cases had an intermediate onset, with Staphylococcus aureus being the most common organism. Late onset TAVR-IE was associated with higher mortality at follow-up.