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Swami A, Mohanty A, Jamwal A, Turbadkar D, Baveja S, Shastri J, Chitalia V. A comparative analysis of the second and third wave of the Covid-19 pandemic: an experience from a tertiary care hospital in Western India. J Med Microbiol 2023; 72. [PMID: 37171852 DOI: 10.1099/jmm.0.001685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023] Open
Abstract
Introduction. As the world was still recovering from the 2020 pandemic, the devastating impact of Covid-19 driven by the Delta variant shook the world in 2021. As the second wave was declining, there was an unusual surge in Covid-19 positive cases by the end of 2021 which led to global concern about the change in virus characteristics.Hypothesis/gap statement. Whole genome sequencing is critical for understanding a rapidly progressing pandemic.Aim. To provide an insight into the major differences encountered in the changing characteristics between the second and third waves of the pandemic at a tertiary care hospital in India.Methods. A retrospective observational cohort analysis was conducted on Covid-positive patients during the second wave of the Covid-19 pandemic (from March 2021 to April 2021) and the third wave of the Covid-19 pandemic (from December 2021 to January 2022).Results. Out of 303 Covid-19 positive cases, 52 samples were tested by whole genome sequencing during the second wave and 108 during the third wave. A decline of 18.5 % was observed in the case fatality rate from the second wave to the third wave. There was a 5 % decline in the number of patients admitted with ARDS and a 16.3 % decline in the number of patients with co-morbidities.In total, 51.9 percent of cases were due to the Delta variant during the second wave and 95 percent due to the Omicron variant during the third wave. We found that 36.5 % of Covid-positive patients during the second wave had been vaccinated compared to 40 % in the third wave.Conclusion. Whole genome sequencing of clinical samples from a wide range of individuals during a viral epidemic will enable us to develop a more rapid public health response to new variants and identify the required vaccine modifications more quickly.
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Affiliation(s)
- Anjali Swami
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India
| | - Ankita Mohanty
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India
| | - Ashima Jamwal
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India
| | - Dilip Turbadkar
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India
| | - Sujata Baveja
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India
| | - Jayanthi Shastri
- Department of Microbiology, T.N.Medical college and B.Y.L Nair Charitable Hospital and Lab Director, Molecular Lab, Kasturba Hospital for Infectious Diseases, Mumbai, Maharashtra, India
| | - Vidushi Chitalia
- Molecular Lab, Kasturba Hospital for Infectious Diseases, Mumbai, Maharashtra, India
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Bakthavatchalam YD, Elangovan D, Jaganathan SV, Subburaju N, Shankar A, Manokaran Y, J. S, Devi R, Baveja S, Devi S, S. J, Bhattacharya S, S. M. R, Yesudhason B, Shetty V, Mutreja A, Manesh A, Varghese GM, Marwick CA, Parcell BJ, Gilbert IH, Veeraraghavan B. In Vitro Activity of Two Cefepime-Based Novel Combinations, Cefepime/Taniborbactam and Cefepime/Zidebactam, against Carbapenemase-Expressing Enterobacterales Collected in India. Microbiol Spectr 2023; 11:e0492522. [PMID: 36847537 PMCID: PMC10100882 DOI: 10.1128/spectrum.04925-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/31/2023] [Indexed: 03/01/2023] Open
Abstract
In recent times, discovery efforts for novel antibiotics have mostly targeted carbapenemase-producing Gram-negative organisms. Two different combination approaches are pertinent: β-lactam-β-lactamase inhibitor (BL/BLI) or β-lactam-β-lactam enhancer (BL/BLE). Cefepime combined with a BLI, taniborbactam, or with a BLE, zidebactam, has been shown to be promising. In this study, we determined the in vitro activity of both these agents along with comparators against multicentric carbapenemase-producing Enterobacterales (CPE). Nonduplicate CPE isolates of Escherichia coli (n = 270) and Klebsiella pneumoniae (n = 300), collected from nine different tertiary-care hospitals across India during 2019 to 2021, were included in the study. Carbapenemases in these isolates were detected by PCR. E. coli isolates were also screened for the presence of the 4-amino-acid insert in penicillin binding protein 3 (PBP3). MICs were determined by reference broth microdilution. Higher MICs of cefepime/taniborbactam (>8 mg/L) were linked to NDM, both in K. pneumoniae and in E. coli. In particular, such higher MICs were observed in 88 to 90% of E. coli isolates producing NDM and OXA-48-like or NDM alone. On the other hand, OXA-48-like-producing E. coli or K. pneumoniae isolates were nearly 100% susceptible to cefepime/taniborbactam. Regardless of the carbapenemase types and the pathogens, cefepime/zidebactam showed potent activity (>99% inhibited at ≤8 mg/L). It seems that the 4-amino-acid insert in PBP3 (present universally in the study E. coli isolates) along with NDM adversely impact the activity of cefepime/taniborbactam. Thus, the limitations of the BL/BLI approach in tackling the complex interplay of enzymatic and nonenzymatic resistance mechanisms were better revealed in whole-cell studies where the activity observed was a net effect of β-lactamase inhibition, cellular uptake, and target affinity of the combination. IMPORTANCE The study revealed the differential ability of cefepime/taniborbactam and cefepime/zidebactam in tackling carbapenemase-producing Indian clinical isolates that also harbored additional mechanisms of resistance. NDM-expressing E. coli with 4-amino-acid insert in PBP3 are predominately resistant to cefepime/taniborbactam, while the β-lactam enhancer mechanism-based cefepime/zidebactam showed consistent activity against single- or dual-carbapenemase-producing isolates including E. coli with PBP3 inserts.
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Affiliation(s)
| | - Divyaa Elangovan
- Department of Microbiology, Panimalar Medical College Hospital and Research Institute, Chennai, India
| | | | - Nivedhana Subburaju
- Department of Microbiology, Rainbow Children’s Hospital and Perinatal Care, Hyderabad, India
| | - Abirami Shankar
- Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore, India
| | - Yuvasri Manokaran
- Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore, India
| | - Sudarsana J.
- Department of Microbiology, Baby Memorial Hospital, Kozhikode, India
| | - Rema Devi
- Department of Microbiology, Dr. Somervell Memorial CSI Medical College and Hospital, Thiruvananthapuram, India
| | - Sujata Baveja
- Department of Microbiology, Lokmanya Tilak Municipal General Hospital and Medical College (Sion Hospital), Mumbai, India
| | - Sheela Devi
- Department of Microbiology, Pondicherry Institute of Medical Sciences, Kalapet, India
| | - Jayakumar S.
- Department of Microbiology, Saveetha Medical College and Hospital, Chennai, India
| | | | - Rudresh S. M.
- Department of Microbiology, ESI Post Graduate Institute of Medical Science and Research, Bengaluru, India
| | - Bineshlal Yesudhason
- Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore, India
| | - Vignesh Shetty
- Department of Medicine, Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), University of Cambridge, Cambridge, United Kingdom
| | - Ankur Mutreja
- Department of Medicine, Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), University of Cambridge, Cambridge, United Kingdom
| | - Abi Manesh
- Department of Infectious Disease, Christian Medical College and Hospital, Vellore, India
| | - George M. Varghese
- Department of Infectious Disease, Christian Medical College and Hospital, Vellore, India
| | - Charis A. Marwick
- Population Health and Genomics, University of Dundee, Dundee, United Kingdom
| | | | - Ian H. Gilbert
- Division of Biological Chemistry and Drug Discovery, University of Dundee, Dundee, United Kingdom
| | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore, India
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3
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Katyal S, Srivastav S, Katoch O, Rodrigues C, Rupali P, Chakrabarti A, Ray P, Biswal M, Tak V, Nath R, Mukhopadhyay C, Bhattacharya S, Padmaja K, Deotale V, Venkatesh V, Wattal C, Ma T, Nag VL, Ray R, Behera B, Baveja S, Karuna T, Singh SK, Fomda B, Devi SK, Das P, Khandelwal N, Verma P, Thangavelu P, Nazir S, Eshwara VK, Varma M, Mishra TS, Das RR, Malhotra R, Walia K, Guleria R, Mathur P. A self-reported survey on the implementation of infection prevention and control elements in Indian hospitals, part of a HAI surveillance network: Results from 23 hospitals conducting a standardized IPC assessment. Am J Infect Control 2023; 51:29-34. [PMID: 35577058 DOI: 10.1016/j.ajic.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are one of the most common adverse events in patient care that account for substantial morbidity and mortality. We evaluate the existing Infection Prevention and Control (IPC) practices in hospitals participating in the nationally representative HAI Surveillance network. METHODS This cross-sectional survey was conducted in 23 hospitals across 22 states of India from October-2015 to September-2018 in the HAI surveillance network. The World Health Organization (WHO) IPC core components assessment tool for health-care facility level (IPCAT-H) was adapted from IPC assessment tool developed by US Centers for Disease Control and Prevention (US CDC) under the Epidemiology and Laboratory Capacity (ELC) Infection Control Assessment and Response (ICAR) Program. Mann-Whitney U test was used to calculate the significant difference between scores (P < .05). RESULTS Amongst the participating hospitals, 7 were private sectors and 16 were public health care facilities. Infection IPCAT-H average score per multimodal strategy was less than 50% for programmed IPC activities (45.7); implementation of health care workers (HCWs) immunization programme (43.5%); monitoring and evaluation component (38.30%). CONCLUSIONS There is potential for improvement in Human Resources, Surveillance of HAIs as well as Monitoring and Evaluation components.
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Affiliation(s)
- Sonal Katyal
- Department of Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Sharad Srivastav
- Department of Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Omika Katoch
- Department of Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Camilla Rodrigues
- Department of Microbiology, P. D. Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India
| | - Priscilla Rupali
- Departments of Infectious Diseases, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Arunaloke Chakrabarti
- Department of Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Pallab Ray
- Department of Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Manisha Biswal
- Department of Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Vibhor Tak
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Reema Nath
- Department of Microbiology, Assam Medical College, Assam, India
| | | | - Sanjay Bhattacharya
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Kanne Padmaja
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Vijayshri Deotale
- Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Vimala Venkatesh
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Chand Wattal
- Departments of Clinical Microbiology and Immunology, Sir Ganga Ram Hospital, New Delhi, India
| | - Thirunarayan Ma
- Department of Microbiology, Apollo Hospital, Chennai, Tamil Nadu, India
| | - Vijaya Lakshmi Nag
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Raja Ray
- Department of Microbiology, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Bijayini Behera
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sujata Baveja
- Department of Microbiology, Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India
| | - Tadepalli Karuna
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh
| | - Sanjeev K Singh
- Department of Infection Control, Amrita Institute of Medicine Sciences, Amrita University, Kochi, Kerala, India
| | - Bashir Fomda
- Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Sulochana K Devi
- Department of Microbiology, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Padma Das
- Department of Microbiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Neeta Khandelwal
- Department of Microbiology, Government Medical College, Surat, Gujarat, India
| | - Prachi Verma
- Department of Critical Care Medicine, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, India
| | - Premkumar Thangavelu
- Departments of Infectious Diseases, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Shaista Nazir
- Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Vandana K Eshwara
- Department of Microbiology, Kasturba Medical College, Manipal, Karnataka, India
| | - Muralidhar Varma
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Karnataka, India
| | - Tushar S Mishra
- Department of General Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Rashmi R Das
- Department of Paediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Rajesh Malhotra
- Department of Orthopedics, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Kamini Walia
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Purva Mathur
- Department of Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, New Delhi, India.
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Veeraraghavan B, Bakthavatchalam YD, Manesh A, Lal B, Swaminathan S, Ansari A, Subbareddy K, Rangappa P, Choudhuri AH, Nagvekar V, Mehta Y, Appalaraju B, Baveja S, Baliga S, Shenoy S, Bhardwaj R, Kongre V, Dattatraya GS, Verma B, Mukherjee DN, Gupta S, Shanmugam P, Iravane J, Mishra SR, Barman P, Chopra S, Hariharan M, Surpam R, Pratap R, Turbadkar D, Taklikar S. India-discovered levonadifloxacin & alalevonadifloxacin: A review on susceptibility testing methods, CLSI quality control and breakpoints along with a brief account of their emerging therapeutic profile as a novel standard-of-care. Indian J Med Microbiol 2023; 41:71-80. [PMID: 36509611 DOI: 10.1016/j.ijmmb.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/04/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Levonadifloxacin (intravenous) and alalevonadifloxacin (oral prodrug) are novel antibiotics based on benzoquinolizine subclass of fluoroquinolone, licensed for clinical use in India in 2019. The active moiety, levonadifloxacin, is a broad-spectrum antibiotic with a high potency against methicillin-resistant Staphylococcus. aureus, multi-drug resistant pneumococci and anaerobes. OBJECTIVE This review, for the first time, critically analyses the antimicrobial susceptibility testing methods, Clinical Laboratory & Standards Institute (CLSI)-quality control of susceptibility testing and breakpoints of levonadifloxacin. Further, the genesis, discovery and developmental aspects as well as therapeutic profile of levonadifloxacin and alalevonadifloxacin are briefly described. CONTENTS In order to aid the scientific and clinician communities with a single comprehensive overview on all the key aspects of levonadifloxacin and alalevonadifloxacin, the present article covers the reference MIC and disk diffusion methods for levonadifloxacin susceptibility testing that were approved by CLSI and the reference ranges for quality control strains published in the CLSI M100 document. The breakpoints of levonadifloxacin were derived in concordance to US FDA, European Committee on Antibiotic Susceptibility Testing (EUCAST) and CLSI approaches. Further, the article provides a brief account of challenges encountered during the discovery stages of levonadifloxacin and alalevonadifloxacin, activity spectrum and safety benefits accruing from structural novelty-linked mechanism of action. Further, the review also covers in vitro and in vivo activities, registrational clinical studies and patient-friendly features of levonadifloxacin/alalevonadifloxacin. Cumulatively, levonadifloxacin has a potential to offer a long awaited new standard-of-care treatment for the resistant Gram-positive bacterial infections.
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Affiliation(s)
- Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamilnadu, India.
| | | | - Abi Manesh
- Department of Infectious Disease, Christian Medical College, Vellore, Tamil Nadu, India
| | - Binesh Lal
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamilnadu, India
| | | | - Abdul Ansari
- Critical Care Division, Nanavati Max Super Speciality Hospital, Mumbai, Maharashtra, India
| | - K Subbareddy
- Critical care, Apollo Hospitals, Hyderabad, India
| | | | - Anirban Hom Choudhuri
- Critical care, GB Pant Institute of Post Graduate Medical Education & Research, New Delhi, India
| | - Vasant Nagvekar
- Department of Physician/Internal Medicine, Infectious Diseases, Lilavati Hospital, Mumbai, Maharashtra, India
| | - Yatin Mehta
- Department of Medanta Institute of Critical Care and Anesthesiology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Boppe Appalaraju
- Department of Microbiology, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, Tamil Nadu, India
| | - Sujata Baveja
- Department of Microbiology, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Sion, Mumbai, India
| | - Shrikala Baliga
- Department of Microbiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Suchitra Shenoy
- Department of Microbiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Renu Bhardwaj
- Department of Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon Hospitals, Pune, Maharashtra, India
| | - Vaishali Kongre
- Department of Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon Hospitals, Pune, Maharashtra, India
| | | | - Binita Verma
- Department of Microbiology, Shree Jagannath Hospital & Research Centre, Ranchi, Jharkhand, India
| | - D N Mukherjee
- Department of Microbiology, Woodlands Multispeciality Hospital Ltd, Kolkata, West Bengal, India
| | - Shalini Gupta
- Department of Microbiology, Somani Hospital, Jaipur, Rajasthan, India
| | - Priyadarshini Shanmugam
- Department of Microbiology, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chennai, Tamil Nadu, India
| | - Jyoti Iravane
- Department of Microbiology, Government Medical College, Aurangabad, Maharashtra, India
| | - Sudhi Ranjan Mishra
- Department of Microbiology, Aditya Care Hospital, Bhubaneswar, Odisha, India
| | - Purabi Barman
- Department of Microbiology, BLK Super Speciality Hospital, New Delhi, India
| | - Shimpi Chopra
- Department of Microbiology, BLK Super Speciality Hospital, New Delhi, India
| | | | - Rajendra Surpam
- Department of Microbiology, Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Rana Pratap
- Department of Microbiology, Narayan Medical College and Hospital, Jamuhar, Bihar, India
| | - Dilip Turbadkar
- Department of Microbiology, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Sion, Mumbai, India
| | - Shripad Taklikar
- Department of Microbiology, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Sion, Mumbai, India
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Chauhan B, Kumar CA, Baveja S. P037 Study of magnitude and risk factors in patients with candidemia at a tertiary care hospital with speciation and antifungal susceptibility of pathogenic Candida isolates. Med Mycol 2022. [PMCID: PMC9509935 DOI: 10.1093/mmy/myac072.p037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM
Objectives
Nosocomial candidiasis is associated with a mortality rate of over 60% while the attributable mortality rate is 49%. The present study was to determine the magnitude and risk factors in patients with candidemia at a tertiary care hospital with speciation and antifungal susceptibility of pathogenic Candida isolates.
Methods
The present study was a prospective, cross-sectional, observational study, conducted at a tertiary care hospital for a period of 1 year after approval from Institutional ethics committee. It included a total of 150 patients of all age groups, admitted to hospital for ˃48 h and diagnosed as proven Candidemia with isolation of Candida species from at least two blood culture samples or from a clinically significant single blood culture sample. A thorough history and clinical characteristics of each patient was noted. Blood was collected and processed as per standard protocol. Pathogenic Candida species were identified and their antifungal susceptibility testing was performed by disk diffusion method as per the standard method. The antifungal discs used were fluconazole (25 μg), itraconazole (10 μg), voriconazole (1 μg), and amphotericin B (100 units). Results were analyzed statistically using SPSS statistics 20.
Results
Candida species was isolated as the pathogen in 24/150 (16%) of clinically suspected cases of candidemia. Candida species isolated were non-albican Candida (NAC) species, mainly C. glabrata 11/24 (45.83%) followed by C. parapsilosis 8/24 (33.33%), and C. tropicalis 5/24 (20.83%). Candida species was isolated as the pathogen, predominantly in patients of age group 0-10 years [15/24 (62.5%)]. Majority of Candida species were isolated from patients who had prolonged ICU stays. Among 24 patients of proven candidemia, 2 (8.33%) patients were from NICU, 10 (41.6%) from PICU, and 3 (12.5%) from MICU. Other important risk factors observed in the present study were, recent major abdominal surgery, malignancy, and mechanical ventilation, each accounting for 2/24 (8.33%) cases. The resistance pattern of isolates of Candida species to antifungals showed that C. glabrata showed 100% resistance to fluconazole, 63.6% to itraconazole, and 45.4% to voriconazole. C. tropicalis showed 80% resistance to fluconazole, 60% to itraconazole, and 40% to voriconazole. Candida parapsilosis showed 87.5% resistance to fluconazole, 62.5% to itraconazole, and 37.5% to voriconazole. All three isolated pathogenic Candida spp. showed 100% susceptibility to amphotericin B. Mortality observed in present study was 7/24 (29.7%). A total of 5/7 patients were from ICU.
Conclusion
Non-albican Candida (NAC) species, mainly C. glabrata, C. tropicalis and C. parapsilosis were the causative agent of candidemia, seen to predominantly affect 0-10 year age group. Infections caused by Candida species remain a significant problem in ICU. An increase in resistance to azoles is a challenge to its empirical and prophylactic use. This necessitates the usage of antifungals, only on the basis of antifungal susceptibility patterns of the pathogenic isolates.
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Affiliation(s)
| | - Chaya Ashok Kumar
- Lokmanya Tilak Municipal Medical College and General Hospital , Mumbai , India
| | - Sujata Baveja
- Lokmanya Tilak Municipal Medical College and General Hospital , Mumbai , India
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Samaddar A, Tendolkar U, Baveja S. P337 Species distribution and biofilm profile of Candida isolated from clinical specimens at a tertiary care hospital in India. Med Mycol 2022. [PMCID: PMC9515894 DOI: 10.1093/mmy/myac072.p337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Introduction The epidemiology of invasive candidiasis (IC) is dynamically changing, given the increasing population of susceptible hosts, use of indwelling medical devices (IMD), and environmental factors. The presence of an IMD is one of the most important risk factors for persistent infection due to the possibility of biofilm formation. The biofilm cells are significantly less susceptible to antifungal drugs and are able to evade the host immune system, serving as a nidus for reinfections. Objectives Methods A total of 100 Candida isolates from patients with suspected invasive candidiasis were tested for the production of biofilm. Based on clinical history, 62% of the isolates were found to be clinically significant, while 38% represented commensals or colonizers. Species identification was done on the basis of germ tube test, CHROMagar, Dalmau plate technique, and carbohydrate fermentation and assimilation tests, and VITEK 2. Four isolates that failed to be identified by conventional methods were subjected to MALDI-TOF MS. Biofilm production was detected and graded by visual (test tube) and spectrophotometric (microtiter plate) methods. Results Non-albicans Candida (NAC) were the predominant clinically relevant isolates recovered from cases of IC (71%), while C. albicans was most commonly associated with colonization (68.4%). Among the NAC isolates, C. tropicalis was the most common isolate (23%) followed by C. glabrata (11%), C. krusei (8%), C. parapsilosis (6%), C. lusitaniae (2%), C. kefyr (2%), C. rugosa (2%), C. guilliermondii (1%), and C. famata (1%) (Fig. 1). A total of 55% of the Candida isolates produced biofilm. Biofilm positivity in clinically relevant isolates was found to be significantly higher than commensals/colonizers (P <.05). Biofilm positive Candida spp. were most commonly isolated from urine (84.6%) followed by blood (67.8%). Biofilm production by NAC (69%) was found to be significantly higher than C. albicans (31%) (P <.05). Majority of the biofilm positive isolates produced Grade 2 (moderate) biofilm (36.4%). C. tropicalis accounted for maximum biofilm production comprising 20% of Grade 4, 53.8% of Grade 3, and 50% of Grade 2 biofilm (Fig. 2). There was 72.7% concordance between the two methods in grading of biofilm. Spectrophotometric method was found to be more sensitive than a visual method for the detection of biofilm. Conclusion Our study demonstrated a paradigm shift from C. albicans to NAC with the isolation of C. tropicalis from a large number of cases, highlighting the growing importance of this pathogen. The knowledge about local epidemiological trends of Candida spp. is important to guide therapeutic choices. Moreover, clinically relevant Candida spp. were found to possess a greater ability to produce biofilms than commensals or colonizers. These findings are unique as previous studies haven't differentiated between biofilms formed by commensal Candida populations and those related to infections. This study highlights that biofilm production should be considered a relevant biologic variable while treating patients with invasive candidiasis, particularly those who fail to respond to antifungal therapy.
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Affiliation(s)
- Arghadip Samaddar
- National Institute of Mental Health and Neuro Sciences , Bengaluru , India
- Lokmanya Tilak Municipal Medical College & General Hospital , Mumbai , India
| | - Uma Tendolkar
- Lokmanya Tilak Municipal Medical College & General Hospital , Mumbai , India
| | - Sujata Baveja
- Lokmanya Tilak Municipal Medical College & General Hospital , Mumbai , India
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Mathur P, Malpiedi P, Walia K, Srikantiah P, Gupta S, Lohiya A, Chakrabarti A, Ray P, Biswal M, Taneja N, Rupali P, Balaji V, Rodrigues C, Lakshmi Nag V, Tak V, Venkatesh V, Mukhopadhyay C, Deotale V, Padmaja K, Wattal C, Bhattacharya S, Karuna T, Behera B, Singh S, Nath R, Ray R, Baveja S, Fomda BA, Sulochana Devi K, Das P, Khandelwal N, Verma P, Bhattacharyya P, Gaind R, Kapoor L, Gupta N, Sharma A, VanderEnde D, Siromany V, Laserson K, Guleria R, Malhotra R, Katoch O, Katyal S, Khurana S, Kumar S, Agrawal R, Dev Soni K, Sagar S, Wig N, Garg P, Kapil A, Lodha R, Sahu M, Misra M, Lamba M, Jain S, Paul H, Sarojini Michael J, Kumar Bhatia P, Singh K, Gupta N, Khera D, Himanshu D, Verma S, Gupta P, Kumar M, Pervez Khan M, Gupta S, Kalwaje Eshwara V, Varma M, Attal R, Sudhaharan S, Goel N, Saigal S, Khadanga S, Gupta A, Thirunarayan M, Sethuraman N, Roy U, Jyoti Raj H, D'Souza D, Chandy M, Mukherjee S, Kumar Roy M, Goel G, Tripathy S, Misra S, Dey A, Misra T, Ranjan Das R, Bashir G, Nazir S, Ranjana Devi K, Chaoba Singh L, Bhargava A, Gaikwad U, Vaghela G, Sukharamwala T, Ch. Phukan A, Lyngdoh C, Saksena R, Sharma R, Velayudhan A. Health-care-associated bloodstream and urinary tract infections in a network of hospitals in India: a multicentre, hospital-based, prospective surveillance study. Lancet Glob Health 2022; 10:e1317-e1325. [PMID: 35961355 DOI: 10.1016/s2214-109x(22)00274-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 04/28/2022] [Accepted: 06/07/2022] [Indexed: 01/04/2023]
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Katoch O, Katyal S, Srivastav S, Rodrigues C, Rupali P, Chakrabarti A, Ray P, Tak V, Biswal M, Nath R, Mukhopadhyay C, Bhattacharya S, Padmaja K, Deotale V, Venkatesh V, Wattal C, Ma T, Nag VL, Ray R, Behera B, Baveja S, Karuna T, Singh SK, Fomda B, Devi SK, Das P, Khandelwal N, Verma P, Gaind R, Bhattacharyya P, Kumar P, Srivastava A, Iravane J, Majumdar T, Sharma R, Sankara D, Kalwaje Eshwara V, Varma M, Nazir S, Tripathy S, Mishra S, Dey A, Thangavelu P, Kapoor L, Malhotra R, Walia K, Guleria R, Mathur P. Self-reported survey on infection prevention and control structures in healthcare facilities part of a national level healthcare associated infection surveillance network in India, 2019. Am J Infect Control 2022; 50:390-395. [PMID: 34600081 DOI: 10.1016/j.ajic.2021.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Healthcare associated infections (HAIs) are prevalent and difficult to treat worldwide. Most HAIs can be prevented by effective implementation of Infection Prevention and Control (IPC) measures. A survey was conducted to assess the existing IPC practices across a network of Indian Hospitals using the World Health Organization designed self-assessment IPC Assessment Framework (IPCAF) tool. METHODS This was a cross sectional observation study. Thirty-two tertiary care public and private facilities, part of the existing Indian HAI surveillance network was included. Data collected was analyzed by a central team at All India Institute of Medical Sciences, New Delhi, a tertiary care hospital of India. The WHO questionnaire tool was used to understand the capacity and efforts to implement IPC practices across the network. RESULTS The overall median score of IPCAF across the network was 620. Based on the final IPCAF score of the facilities; 13% hospitals had basic IPC practices, 28% hospitals had intermediate and 59% hospitals had advanced IPC practices. The component multimodal strategies had the broadest range of score while the component IPC guidelines had the narrowest one. CONCLUSIONS Quality improvement training for IPC nurses and healthcare professionals are needed to be provided to health facilities.
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Affiliation(s)
- Omika Katoch
- Department of Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Sonal Katyal
- Department of Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Sharad Srivastav
- Department of Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Camilla Rodrigues
- Department of Microbiology, P. D. Hinduja Hospital and Medical Research Center, Mumbai, Maharashtra, India
| | - Priscilla Rupali
- Department of Infectious Diseases, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Arunaloke Chakrabarti
- Department of Microbiology, Graduate Institute of Medical Education and Research, Chandigarh, Punjab, India
| | - Pallab Ray
- Department of Microbiology, Assam Medical College, Assam, India
| | - Vibhor Tak
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Manisha Biswal
- Department of Microbiology, Assam Medical College, Assam, India
| | - Reema Nath
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Sanjay Bhattacharya
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Kanne Padmaja
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Vijayshri Deotale
- Department of Microbiology, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Vimala Venkatesh
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Chand Wattal
- Department of Clinical Microbiology and Immunology, Sir Ganga Ram Hospital, New Delhi, India
| | - Thirunarayan Ma
- Department of Microbiology, Apollo Hospital, Chennai, Tamil Nadu, India
| | - Vijaya Lakshmi Nag
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Raja Ray
- Department of Microbiology, Institute of Post-Graduate Medical Education and Research, Kolkata, West Bengal, India
| | - Bijayini Behera
- Department of Microbiology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sujata Baveja
- Department of Microbiology, Lokmanya Tilak Municipal General Hospital, Mumbai, Maharashtra, India
| | - Tadepalli Karuna
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh
| | - Sanjeev K Singh
- Department of Infection Control, Amrita Institute of Medicine Sciences, Amrita University, Kochi, Kerala, India
| | - Bashir Fomda
- Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | | | - Padma Das
- Department of Microbiology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Neeta Khandelwal
- Department of Microbiology, Government Medical College, Surat, Gujarat, India
| | - Prachi Verma
- Department of Critical Care Medicine, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur
| | - Rajni Gaind
- Department of Microbiology, Safdarjung Hospital and VMMC, Delhi, India
| | - Prithwis Bhattacharyya
- Department of Anaesthesiology and ICU, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India
| | - Puneet Kumar
- Department of Microbiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ashutosh Srivastava
- Department of Microbiology MGM Medical College, Bhopal, Madhya Pradesh, India
| | - Jyoti Iravane
- Department of Microbiology, Govt. Medical College, Aurangabad, Maharashtra, India
| | - Tapan Majumdar
- Department of Microbiology, AGMC & GBP Hospital, Agartala,, Tripura, India
| | - Rajni Sharma
- Department of Microbiology, SMS Medical College, Jaipur, Rajasthan, India
| | - Dhanapaul Sankara
- Department of Microbiology, K.A,V.P. Govt. Medical College, Trichy, Tamil Nadu, India
| | | | - Muralidhar Varma
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Karnataka, India
| | - Shaista Nazir
- Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Swagata Tripathy
- Department of Anesthesia and Critical Care Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Satyajeet Mishra
- Department of Anesthesia, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Anupam Dey
- Department of General Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Premkumar Thangavelu
- Department of Infectious Disease, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Lata Kapoor
- Department of Microbiology, National Institute of Disease Control, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopedics, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Kamini Walia
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, Ansari Nagar, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Purva Mathur
- Department of Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, New Delhi, India.
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Veeraraghavan B, Varghese R, Saigal K, Balasubramanian S, Bai PSP, Lal Y B, Neeravi A, Baskar P, Anandhan K, Kumar CPG, Jayaraman Y, Nag VL, Baveja S, J B, Joshi SA, Iyer R. Activity of novel lactone ketolide nafithromycin against multicentric invasive and non-invasive pneumococcal isolates collected in India. JAC Antimicrob Resist 2021; 3:dlab066. [PMID: 34223128 PMCID: PMC8210042 DOI: 10.1093/jacamr/dlab066] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background India is among the nations reporting substantial healthcare burden linked to pneumococcal infections. Nafithromycin is a novel lactone ketolide antibiotic, which recently entered Phase 3 development in India for the indication of community-acquired bacterial pneumonia (CABP). Objectives To assess the in vitro activity of nafithromycin against serotyped invasive and non-invasive Streptococcus pneumoniae isolates, collected from nine medical centres across India. Methods A total of 534 isolates of S. pneumoniae were collected during 2015–20 and serotyped as per CDC protocol. A subset of erythromycin-non-susceptible S. pneumoniae (n = 200) was screened for the presence of erm(B) and mef(A/E) genes. A subset of MDR isolates (n = 54) were also subjected to MLST. The MICs of antibiotics were determined by the reference agar-dilution method (CLSI). Susceptibilities of the comparators were interpreted as per CLSI criteria. Results Fifty-nine distinct serotypes were identified among the 534 isolates. Among erythromycin-non-susceptible isolates, erm(B) and mef(A/E) genes were found in 49% and 59% strains respectively, while MLST showed clonal diversity. Azithromycin (67.6% non-susceptible) and clindamycin (31.8% non-susceptible) showed limited activity. Penicillin (for non-meningitis) or quinolone non-susceptibility was low (<11% and <6%, respectively). Nafithromycin showed potent activity with MIC50 and MIC90 of 0.015–0.03 and 0.06 mg/L, respectively, regardless of the macrolide resistance mechanisms. Conclusions Indian pneumococcal isolates show poor susceptibilities to macrolides, in concordance with the global trend. Nafithromycin overcomes erm as well as mef-mediated macrolide resistance mechanisms expressed individually or concurrently in S. pneumoniae. This study supports continued clinical development of nafithromycin for pneumococcal infections including CABP.
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Affiliation(s)
| | | | | | - S Balasubramanian
- Kanchi Kamakoti Children's Trust Hospital, Chennai, Tamil Nadu, India
| | | | - Binesh Lal Y
- Christian Medical College, Vellore, Tamil Nadu, India
| | | | | | | | - C P Girish Kumar
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Yuvraj Jayaraman
- ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | | | - Sujata Baveja
- Lokmanya Tilak Municipal Medical College and Hospital, Sion, Mumbai, India
| | - Bhavana J
- Indira Gandhi Institute of Child Health, Bengaluru, India
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Vijay S, Bansal N, Rao BK, Veeraraghavan B, Rodrigues C, Wattal C, Goyal JP, Tadepalli K, Mathur P, Venkateswaran R, Venkatasubramanian R, Khadanga S, Bhattacharya S, Mukherjee S, Baveja S, Sistla S, Panda S, Walia K. Secondary Infections in Hospitalized COVID-19 Patients: Indian Experience. Infect Drug Resist 2021; 14:1893-1903. [PMID: 34079300 PMCID: PMC8164345 DOI: 10.2147/idr.s299774] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/10/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose Critically ill coronavirus disease 2019 (COVID-19) patients need hospitalization which increases their risk of acquiring secondary bacterial and fungal infections. The practice of empiric antimicrobial prescription, due to limited diagnostic capabilities of many hospitals, has the potential to escalate an already worrisome antimicrobial resistance (AMR) situation in India. This study reports the prevalence and profiles of secondary infections (SIs) and clinical outcomes in hospitalized COVID-19 patients in India. Patients and Methods A retrospective study of secondary infections in patients admitted in intensive care units (ICUs) and wards of ten hospitals of the Indian Council of Medical Research (ICMR) AMR surveillance network, between June and August 2020, was undertaken. The demographic data, time of infection after admission, microbiological and antimicrobial resistance data of secondary infections, and clinical outcome data of the admitted COVID-19 patients were collated. Results Out of 17,534 admitted patients, 3.6% of patients developed secondary bacterial or fungal infections. The mortality among patients who developed secondary infections was 56.7% against an overall mortality of 10.6% in total admitted COVID-19 patients. Gram-negative bacteria were isolated from 78% of patients. Klebsiella pneumoniae (29%) was the predominant pathogen, followed by Acinetobacter baumannii (21%). Thirty-five percent of patients reported polymicrobial infections, including fungal infections. High levels of carbapenem resistance was seen in A. baumannii (92.6%) followed by K. pneumoniae (72.8%). Conclusion Predominance of Gram-negative pathogens in COVID-19 patients coupled with high rates of resistance to higher generation antimicrobials is an alarming finding. A high rate of mortality in patients with secondary infections warrants extra caution to improve the infection control practices and practice of antimicrobial stewardship interventions not only to save patient lives but also prevent selection of drug-resistant infections, to which the current situation is very conducive.
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Affiliation(s)
- Sonam Vijay
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Nitin Bansal
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | | | | | - Camilla Rodrigues
- Department of Microbiology, PD Hinduja Hospital, Mumbai, Maharashtra, India
| | - Chand Wattal
- Department of Clinical Microbiology, Sir Ganga Ram Hospital, New Delhi, India
| | - Jagdish Prasad Goyal
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India
| | - Karuna Tadepalli
- Department of Microbiology, All India Institute of Medical Sciences, Bhopal, India
| | - Purva Mathur
- Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Sagar Khadanga
- Department of Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Sanjay Bhattacharya
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Sudipta Mukherjee
- Department of Critical Care Medicine, Tata Medical Center, Kolkata, West Bengal, India
| | - Sujata Baveja
- Department of Microbiology, Lokmanya Tilak Municipal General Hospital, Mumbai, India
| | | | - Samiran Panda
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Kamini Walia
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
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Chaurasia A, Shinde A, Baveja S. Bacteriological Profile and Antimicrobial Susceptibility Pattern of Cerebrospinal Fluid Shunt Infections in Infants and Children. J Pediatr Neurosci 2021; 16:143-148. [PMID: 35018183 PMCID: PMC8706585 DOI: 10.4103/jpn.jpn_216_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/03/2020] [Accepted: 10/20/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Despite the advent of modern neurosurgical techniques, new antibiotics, and modern imaging techniques, infection after ventriculoperitoneal (VP) shunt insertion and/or ventriculostomy is still a serious issue. AIM The aim of this work was to study bacteriological profile and antimicrobial susceptibility pattern of cerebrospinal fluid shunt infections in infants and children. MATERIALS AND METHODS A total of 90 patients under the age of 12 years undergoing cerebrospinal fluid shunt procedures were included. The CSF shunt fluid, external ventricular drain (EVD), shunt tube tip specimens were processed as per standard microbiological techniques. The organisms isolated were subjected to antimicrobial susceptibility using the Kirby-Bauer disk diffusion method. RESULTS Of 20 infected patients 10 (50%) were culture positive. Most common organisms isolated were Acinetobacter baumannii 03 (30%) followed by Enterococcus faecalis 2 (20%). Two isolates of A. baumannii and one isolate of Klebsiella pneumoniae showed carbapenem resistance, which were sensitive to colistin. All Gram-positive isolates were sensitive to vancomycin and linezolid. Reinfection was found only in one (8.33%) patient. In 12 (60%) infected cases with shunt failure, revision of shunt was done. The shunt related mortality in this study was 1.11%. CONCLUSION Most common organisms isolated were A. baumannii followed by E. faecalis. Carbapenem resistance was noted in these isolates which were sensitive to colistin. All Gram-positive isolates were sensitive to vancomycin and linezolid.
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Affiliation(s)
- Ankita Chaurasia
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Alka Shinde
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Sujata Baveja
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
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Gokhale Y, Mehta R, Kulkarni U, Karnik N, Gokhale S, Sundar U, Chavan S, Kor A, Thakur S, Trivedi T, Kumar N, Baveja S, Wadal A, Kolte S, Deolankar A, Pednekar S, Kalekar L, Padiyar R, Londhe C, Darole P, Pol S, Gokhe SB, Padwal N, Pandey D, Yadav D, Joshi A, Badgujar H, Trivedi M, Shah P, Bhavsar P. Tocilizumab improves survival in severe COVID-19 pneumonia with persistent hypoxia: a retrospective cohort study with follow-up from Mumbai, India. BMC Infect Dis 2021; 21:241. [PMID: 33673818 PMCID: PMC7934984 DOI: 10.1186/s12879-021-05912-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cytokine storm triggered by Severe Coronavirus Disease 2019 (COVID-19) is associated with high mortality. With high Interleukin -6 (IL-6) levels reported in COVID-19 related deaths in China, IL-6 is considered to be the key player in COVID-19 cytokine storm. Tocilizumab, a monoclonal antibody against IL-6 receptor, is used on compassionate grounds for treatment of COVID-19 cytokine storm. The aim of this study was to assess effect of tocilizumab on mortality due to COVID-19 cytokine storm. METHOD This retrospective, observational study included patients of severe COVID-19 pneumonia with persistent hypoxia (defined as saturation 94% or less on supplemental Oxygen of 15 L per minute through non-rebreathing mask or PaO2/FiO2 ratio of less than 200) who were admitted to a tertiary care center in Mumbai, India, between 31st March to 5th July 2020. In addition to standard care, single Inj. Tocilizumab 400 mg was given intravenously to 151 consecutive COVID-19 patients with persistent hypoxia, from 13th May to 5th July 2020. These 151 patients were retrospectively analysed and compared with historic controls, ie consecutive COVID-19 patients with persistent hypoxia, defined as stated above (N = 118, from our first COVID-19 admission on 31st March to 12th May 2020 i.e., till tocilizumab was available in hospital). Univariate and multivariate Cox regression analysis was performed for identifying predictors of survival. Statistical analysis was performed using IBM SPSS version 26. RESULTS Out of 269 (151 in tocilizumab group and 118 historic controls) patients studied from 31st March to 5th July 2020, median survival in the tocilizumab group was significantly longer than in the control group; 18 days (95% CI, 11.3 to 24.7) versus 9 days (95% CI, 5.7 to 12.3); log rank p 0.007. On multivariate Cox regression analysis, independent predictors of survival were use of tocilizumab (HR 0.621, 95% CI 0.427-0.903, P 0.013) and higher oxygen saturation. CONCLUSION Tocilizumab may improve survival in severe COVID-19 pneumonia with persistent hypoxia. Randomised controlled trials on use of tocilizumab as rescue therapy in patients of severe COVID-19 pneumonia with hypoxia (PaO2/FiO2 less than 200) due to hyperinflammatory state, are warranted.
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Affiliation(s)
- Yojana Gokhale
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India.
| | - Rakshita Mehta
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Uday Kulkarni
- Christian Medical College, Vellore, Tamil Nadu, India
| | - Nitin Karnik
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Sushant Gokhale
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Uma Sundar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Swati Chavan
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Akshay Kor
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Sonal Thakur
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Trupti Trivedi
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Naveen Kumar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Sujata Baveja
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Aniket Wadal
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Shaonak Kolte
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Aukshan Deolankar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Sangeeta Pednekar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Lalana Kalekar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Rupal Padiyar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Charulata Londhe
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Pramod Darole
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Sujata Pol
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | | | - Namita Padwal
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Dharmendra Pandey
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Dhirendra Yadav
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Anagha Joshi
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Harshal Badgujar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Mayuri Trivedi
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Priyanshu Shah
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
| | - Prerna Bhavsar
- Lokmanya Tilak Municipal Medical College, Sion Mumbai, 400022, India
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Baveja S, Karnik N, Natraj G, Natkar M, Bakshi A, Krishnan A. Rapid volunteer-based SARS-Cov-2 antibody screening among health care workers of a hospital in Mumbai, India. IJMS 2020. [PMCID: PMC8219003 DOI: 10.25259/ijms_234_2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objectives: COVID-19 is highly contagious, and health care workers are at high risk of being infected. We carried out a rapid survey to estimate the proportion of HCWs who are serologically positive for SARS-CoV-2 in the Lokmanya Tilak Municipal General Hospital, Mumbai, India. Material and Methods: After the consent of the hospital authorities, volunteers were asked to report at a special booth set up in the hospital between May 1, 2020, and May 16, 2020. After consent, each worker was administered a questionnaire using a handheld computer which had questions on symptoms in the past 30 days, place of posting (COVID designated area or other), work category (doctor/nurse/others), use of personal protective equipment, smoking, comorbidity, and exposure followed by a test for COVID-19 using the STANDARD Q COVID-19 IgM/ IgG Duo Test of SD Biosensor. We estimated weighted seroprevalence with 95% confidence limits after adjusting for the work category. We calculated the adjusted odds ratio (aOR) using logistic regression with seropositivity as an outcome variable and others as independent variables. Results: The final sample included 501 and 1051 subjects working in the COVID area and non-COVID area, respectively, covering 35% of the total staff of the hospital. Overall, 6.9% (95% CI of 5.7–8.2) of the hospital staff was serologically positive for SARS-Cov-2, similar in the COVID area –5.7 (3.8–8.1) and non-COVID area –7.2 (5.7–9.0). Age more than 50 years (aOR 2.65; 1.45–4.85) and being in others work category 2.84 (1.34–6.02) were identified as significant predictors of being seropositive. Only 10% of the subjects reported COVID-like illness in the past 1 month. Conclusion: The overall modest prevalence of infection among the health care workers, especially non-doctors and nurses, and similarity of prevalence in COVID and non-COVID area staff indicate the possibility of non-hospital source of infection.
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Affiliation(s)
- Sujata Baveja
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and Government Hospital, Mumbai COVID Health Worker Study Group, Mumbai, Maharashtra, India,
| | - Nitin Karnik
- Department of Medicine, Lokmanya Tilak Municipal Medical College and Government Hospital, Mumbai COVID Health Worker Study Group, Mumbai, Maharashtra, India,
| | - Gita Natraj
- Department of Microbiology, Mumbai, Maharashtra, India,
| | - Milind Natkar
- Medicine KEM Hospital and Seth GS Medical College, Mumbai, Maharashtra, India,
| | - Asha Bakshi
- Department of Neurosurgery, Moolchand Hospital, New Delhi, India,
| | - Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India,
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Samaddar A, Tendolkar U, Baveja S. Species distribution and biofilm profile of Candida isolated from clinical specimens at a tertiary care hospital in India. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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15
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Gokhale Y, Patankar A, Holla U, Shilke M, Kalekar L, Karnik ND, Bidichandani K, Baveja S, Joshi A. Dermatomyositis during COVID-19 Pandemic (A Case Series): Is there a Cause Effect Relationship? J Assoc Physicians India 2020; 68:20-24. [PMID: 33187031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Viruses have been shown to modify the clinical picture of several autoimmune diseases, including type 1 diabetes, systemic lupus erythematosus (SLE), rheumatoid arthritis and multiple sclerosis. Viral infections have also been considered as a possible trigger for autoimmune disorders like myositis through myositis specific antibodies. Dermatomyositis is an acquired inflammatory myopathy which is relatively rare with incidence of 9.3 per 1 million persons. Usually we come across 1-2 patients of dermatomyositis per year, amongst 800-1000 new patients in our tertiary care rheumatology services. A surge in the incidence was noted this year during the months of April-August of 2020, the period coinciding with the occurrence of corona virus (COVID-19) pandemic in the city of Mumbai, the total number of cases encountered being five in a span of six months. The following case series includes five such cases with review of available literature on virus-triggered autoimmunity with special reference to SARS-CoV-2 and the challenges of immunosuppression during this pandemic.
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Affiliation(s)
- Yojana Gokhale
- Professor of Medicine, In charge of Rheumatology Services, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra
| | - Aditi Patankar
- Lecturer in Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra
| | - Usha Holla
- Resident in Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra
| | - Mrinal Shilke
- Resident in Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra
| | - Lalana Kalekar
- Associate professor of Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra
| | - Niteen D Karnik
- Professor and Head of Department of Medicine, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra
| | - Kushal Bidichandani
- Lecturer in Radiology, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra
| | - Sujata Baveja
- Head of Department of Microbiology, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra
| | - Anagha Joshi
- Head of Department of Radiology, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra
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Appalaraju B, Baveja S, Baliga S, Shenoy S, Bhardwaj R, Kongre V, Dattatraya GS, Dhole T, Verma B, Mukherjee DN, Gupta S, Shanmugam P, Iravane J, Mishra SR, Barman P, Chopra S, Hariharan M, Surpam R, Pratap R, Joshi P, Khande H, Mane A, Jain R, Bhagwat S. In vitro activity of a novel antibacterial agent, levonadifloxacin, against clinical isolates collected in a prospective, multicentre surveillance study in India during 2016-18. J Antimicrob Chemother 2020; 75:600-608. [PMID: 31840170 DOI: 10.1093/jac/dkz493] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/10/2019] [Accepted: 10/25/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Levonadifloxacin is a novel antibiotic belonging to the benzoquinolizine subclass of fluoroquinolones with potent activity against MRSA and quinolone-resistant Staphylococcus aureus. IV levonadifloxacin and its oral prodrug alalevonadifloxacin have recently been approved in India for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) including diabetic foot infections. OBJECTIVES To investigate the in vitro activity of levonadifloxacin against contemporary clinical isolates collected from multiple tertiary care hospitals across India in the Antimicrobial Susceptibility Profiling of Indian Resistotypes (ASPIRE) surveillance study. METHODS A total of 1376 clinical isolates, consisting of staphylococci (n = 677), streptococci (n = 178), Enterobacterales (n = 320), Pseudomonas aeruginosa (n = 140) and Acinetobacter baumannii (n = 61), collected (2016-18) from 16 tertiary hospitals located across 12 states in India, were included in the study. The MICs of levonadifloxacin and comparator antibiotics were determined using the reference agar dilution method and broth microdilution method. RESULTS Levonadifloxacin exhibited potent activity against MSSA (MIC50/90: 0.5/1 mg/L), MRSA (MIC50/90: 0.5/1 mg/L) and levofloxacin-resistant S. aureus (MIC50/90: 1/1 mg/L) isolates. Similarly, potent activity of levonadifloxacin was also observed against CoNS including MDR isolates (MIC50/90: 1/2 mg/L). Against Streptococcus pneumoniae, levonadifloxacin (MIC50/90: 0.5/0.5 mg/L) showed superior activity compared with levofloxacin (MIC50/90: 1/2 mg/L). Among levofloxacin-susceptible Enterobacterales, 80.6% of isolates were inhibited at ≤2 mg/L levonadifloxacin. CONCLUSIONS Levonadifloxacin displayed potent activity against contemporary MRSA and fluoroquinolone-resistant staphylococcal isolates, thus offering a valuable IV as well as an oral therapeutic option for the treatment of ABSSSIs. Furthermore, levonadifloxacin exhibited a broad-spectrum activity profile as evident from its activity against streptococci and levofloxacin-susceptible Gram-negative isolates.
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Affiliation(s)
- Boppe Appalaraju
- Department of Microbiology, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, Tamil Nadu, India
| | - Sujata Baveja
- Department of Microbiology, Lokmanya Tilak Municipal General Hospital and Lokmanya Tilak Municipal Medical College, Sion, Mumbai, India
| | - Shrikala Baliga
- Department of Microbiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Suchitra Shenoy
- Department of Microbiology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Karnataka, India
| | - Renu Bhardwaj
- Department of Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon Hospitals, Pune, Maharashtra, India
| | - Vaishali Kongre
- Department of Microbiology, Byramjee Jeejeebhoy Government Medical College and Sassoon Hospitals, Pune, Maharashtra, India
| | - Gogi Suresh Dattatraya
- Department of Microbiology, DM Wayanad Institute of Medical Sciences, Wayanad, Kerala, India
| | - Tapan Dhole
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Binita Verma
- Department of Microbiology, Shree Jagannath Hospital & Research Centre, Ranchi Jharkhand, India
| | - D N Mukherjee
- Department of Microbiology, Woodlands Multispeciality Hospital Ltd, Kolkata, West Bengal, India
| | - Shalini Gupta
- Department of Microbiology, Somani Hospital, Jaipur, Rajasthan, India
| | - Priyadarshini Shanmugam
- Department of Microbiology, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Chennai, Tamil Nadu, India
| | - Jyoti Iravane
- Department of Microbiology, Government Medical College, Aurangabad, Maharashtra, India
| | - Sudhi Ranjan Mishra
- Department of Microbiology, Aditya Care Hospital, Bhubaneswar, Odisha, India
| | - Purabi Barman
- Department of Microbiology, BLK Super Speciality Hospital, New Delhi, India
| | - Shimpi Chopra
- Department of Microbiology, BLK Super Speciality Hospital, New Delhi, India
| | | | - Rajendra Surpam
- Department of Microbiology, Government Medical College and Hospital, Nagpur, Maharashtra, India
| | - Rana Pratap
- Department of Microbiology, Narayan Medical College and Hospital, Jamuhar, Bihar, India
| | - Prashant Joshi
- Drug Discovery Research, Wockhardt Research Centre, Aurangabad, Maharashtra, India
| | - Hemant Khande
- Drug Discovery Research, Wockhardt Research Centre, Aurangabad, Maharashtra, India
| | - Ashish Mane
- Medical Affairs, Wockhardt Ltd, Mumbai, Maharashtra, India
| | - Rishi Jain
- Medical Affairs, Wockhardt Ltd, Mumbai, Maharashtra, India
| | - Sachin Bhagwat
- Drug Discovery Research, Wockhardt Research Centre, Aurangabad, Maharashtra, India
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Samaddar A, Tendolkar U, Baveja S. Biofilm profile of Candida isolated from clinical specimens at a Tertiary Care hospital in India. Access Microbiol 2020. [DOI: 10.1099/acmi.fis2019.po0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Arghadip Samaddar
- Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India
| | - Uma Tendolkar
- Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India
| | - Sujata Baveja
- Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India
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18
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Abstract
Context Acute viral hepatitis (AVH) is predominantly caused by hepatitis A virus (HAV) and hepatitis E virus (HEV), the prevalence of which varies in different geographical regions. Aims This study aimed to determine the prevalence of HAV and HEV infections in patients with AVH, the rate of HAV-HEV co-infection and the prevalence of HEV infection among pregnant women with hepatitis. Settings and Design It was a retrospective observational study conducted over 3 years from January 2015 to December 2017, after obtaining clearance from the institutional ethics committee. Subjects and Methods A total of 675 serum samples were collected from patients with a clinical diagnosis of AVH, between January 2015 and December 2017. The study population included outdoor and hospitalised patients between 3 and 70 years of age who presented with signs and symptoms of hepatitis. The presence of IgM anti-HAV and IgM anti-HEV antibodies in serum were assessed by enzyme-linked immunosorbent assay. Statistical Analysis Used Chi-square test. Results The prevalence of HAV, HEV and HAV-HEV co-infection was found to be 6.96%, 9.63% and 2.07%, respectively. Among males, this was 7.3%, 8.8% and 2.6%, respectively and in females 6.7%, 10.2% and 1.7%, respectively. However, these differences in the prevalence rates were of no statistical significance. The prevalence of HEV infection in pregnant women with hepatitis was 9.4%. HAV and HEV infections showed a seasonal trend with predominance during summer and rainy seasons (May to September). Conclusions A higher seroprevalence of HEV as compared to HAV together with a co-infection rate of 2.07% mandates screening for HEV in all suspected cases of acute hepatitis, particularly pregnant women in whom the outcomes of HEV infection are poor. Health and civic authorities should make necessary efforts to counter epidemic or outbreak situations, thus reducing morbidity, mortality and economic burden.
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Affiliation(s)
- Arghadip Samaddar
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Shripad Taklikar
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Pradnya Kale
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Chaya A Kumar
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Sujata Baveja
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
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19
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Turner J, Hanna W, Dudney T, Baveja S, Sneed G, Huang H, Hohenforst-Schmidt W, Zarogoulidis P. P3.CR-23 Multilobar Adenocarcinoma: A Case Report and Review of the Literature of Papillary Eccrine Adenocarcinoma Presenting with Respiratory Failure. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.2002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Bhisikar S, Mondkar J, Manerkar S, Goel S, D'Dsouza D, Baveja S. Improving Quality of Banked Milk: Utility of Dornic Acid Test. Indian J Pediatr 2018; 85:272-275. [PMID: 29139066 DOI: 10.1007/s12098-017-2518-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 09/27/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify, if Dornic acid test done on human milk bank sample is as effective as doing routine culture, both pre and post pasteurization. METHODS The authors analyzed 477 samples, both pre and post pasteurization. Dornic acid measurement was performed by using N/9 NaOH and titrated to get dornicity of the sample. Senstivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) at different Dornic acid levels were calculated. To find diagnostic power of this study, ROC curve was prepared. Dornic acid for paired pre and post pasteurization were noted and analysed for statistical significance. RESULTS A significant growth was seen in 21% (98/477) samples with coagulase negative staphylococci and gram negative organisms being the major contaminants seen prior to pasteurization. In the index study, Dornic acidity ≥4°D had a sensitivity of 98% but very low specificity of just over 10%. However, 8°D had 92% specificity and acceptable sensitivity of 72% in comparison to gold standard microbiological criteria, making it a good test for analyzing the quality of milk before pasteurization. CONCLUSIONS Dornic acid test at 8°D has a very high specificity with acceptable sensitivity in comparison to dornicity at 4°D. It can be used as a simple method to select better quality of milk sample prior to pasteurization.
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Affiliation(s)
- Swapnil Bhisikar
- Department of Neonatology, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal and General Hospital, Room no 123, 1st Floor, College Building, Sion (West), Mumbai, 400022, India.
| | - Jayashree Mondkar
- Department of Neonatology, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal and General Hospital, Room no 123, 1st Floor, College Building, Sion (West), Mumbai, 400022, India
| | - Swati Manerkar
- Department of Neonatology, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal and General Hospital, Room no 123, 1st Floor, College Building, Sion (West), Mumbai, 400022, India
| | - Sorabh Goel
- Department of Neonatology, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal and General Hospital, Room no 123, 1st Floor, College Building, Sion (West), Mumbai, 400022, India
| | - Desma D'Dsouza
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal and General Hospital, Mumbai, India
| | - Sujata Baveja
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and Lokmanya Tilak Municipal and General Hospital, Mumbai, India
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21
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Tendolkar U, van Diepeningen A, Joshi A, Koomen J, Bradoo R, Baveja S, Agrawal S. Rhinosinusitis caused by Saksenaea erythrospora in an immunocompetent patient in India: a first report. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Uma Tendolkar
- Department of Microbiology, Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai 400 022, India
| | - Anne van Diepeningen
- CBS-KNAW Fungal Biodiversity Centre, Institute of the Royal Netherlands Academy of Arts and Sciences (KNAW), Uppsalalaan 8, 3584 CT, Utrecht, The Netherlands
| | - Anagha Joshi
- Department of Ear, Nose & Throat Surgery, Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai, 400 022, India
| | - Jeroen Koomen
- CBS-KNAW Fungal Biodiversity Centre, Institute of the Royal Netherlands Academy of Arts and Sciences (KNAW), Uppsalalaan 8, 3584 CT, Utrecht, The Netherlands
| | - Renuka Bradoo
- Department of Ear, Nose & Throat Surgery, Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai, 400 022, India
| | - Sujata Baveja
- Department of Microbiology, Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai 400 022, India
| | - Shailesh Agrawal
- Department of Ear, Nose & Throat Surgery, Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai, 400 022, India
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22
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Tendolkar U, Shinde A, Baveja S, Dhurat R, Phiske M. Trichosporon inkin and Trichosporon mucoides as unusual causes of white piedra of scalp hair. Indian J Dermatol Venereol Leprol 2015; 80:324-7. [PMID: 25035357 DOI: 10.4103/0378-6323.136896] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
White piedra of scalp hair is considered a rare entity. We report three cases of this disorder all of whom presented with nodules on the hair. Potassium hydroxide preparations of the hair revealed clustered arthrospores and mature, easily detachable nodules. Cultures grew Trichosporon inkin in 2 patients and Trichosporon mucoides in one patient. Both these fungi are unusual causes of white piedra.
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Affiliation(s)
- Uma Tendolkar
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India
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23
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Sinhal N, Menon A, Yadav R, Baveja S, Anand D, Schrale R. The Introduction of Radial Artery Angiography and Interventions in a Regional Tertiary Hospital North Queensland. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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24
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Abstract
A female child admitted to hospital, diagnosed with acute lymphatic leukemia — CALLA positive, developed loose motions. Her stool culture and blood culture grew Pseudomonas aeruginosa. Although the diarrhea subsided after five days, the stool culture repeatedly grewP. aeruginosa for more than one month, in spite of treatment. Even though diarrhea due to Pseudomonas is rare, it can yet be seen in immunocompromised patients and is also associated with neutropenic enterocolitis. Stool specimens of all leukemia patients on chemotherapy and suffering from diarrhea, should be sent routinely for culture, so as to find out the exact cause of the diarrhea. Proper reporting will enable the clinicians to start appropriate antibiotics, thereby, reducing the morbidity and mortality of the leukemia patients.
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Affiliation(s)
- A De
- Department of Microbiology, L.T.M. Medical College, Sion, Mumbai, India
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25
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Abstract
Disseminated cases of histoplasmosis in acquired immune deficiency syndrome (AIDS) are rarely reported from India. Most of these cases report isolation of this fungus from the bone marrow, lymph node aspirate, spleenic aspirate, and biopsies. We report isolation of Histoplasma capsulatum from the blood of an AIDS patient. A 30-year-old male from Utter Pradesh was admitted with fever, loss of appetite, and nausea since two months. Few intracellular and extracellular budding cells were observed on bone marrow examination on the fifth day of admission. Diagnosis was confirmed by blood cultures taken on the 11th day of admission. Amphotericin B was started, but the patient's condition deteriorated and he died.
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Affiliation(s)
- V P Baradkar
- Department of Microbiology, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai 400 020, India.
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26
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Bhaskaran A, Baveja S, Yadav R. Profile of Stress Induced Cardiomyopathy in North Queensland. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Venkatachalam V, Yadav R, Gangasandra A, Farley T, Baveja S, Latouf S. A Study of Outcomes Following Percutaneous Coronary Interventions (PCI) in the Indigenous Population of North Queensland. Heart Lung Circ 2009. [DOI: 10.1016/j.hlc.2009.05.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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28
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Nataraj G, Baveja S, Kuyare S, Poojary A, Mehta P, Kshirsagar N, Gogtay N. Report: Medical students for monitoring biomedical waste segregation practices--why and how? Experience from a medical college. Waste Manag Res 2008; 26:288-290. [PMID: 18649577 DOI: 10.1177/0734242x07081481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The cornerstone for an effective biomedical waste (BMW) management is appropriate waste segregation. Improper waste segregation practices can have an adverse impact on public health and increase the cost of treatment. Deficiencies in waste segregation practices can be corrected by continuous monitoring and education. Manpower for monitoring waste segregation in a large teaching hospital is scanty. We utilized the undergraduate medical students as monitors and studied the impact on waste segregation practices. A prospective observational study was carried out from August 2004 to January 2005. For monitoring waste segregation, the different areas of the hospital were divided amongst the II M.B.B.S students. They were provided with an observation sheet wherein the status of waste segregation and overall hygiene was recorded on a scale of 1-5. The impact of this programme was then analysed over the study period. The results indicated that a statistically significant improvement in waste segregation practices occurred in all areas. Thus, a large hospital with a medical college can identify students or a similar group for monitoring waste segregation or other aspects of biomedical waste management. This will improve their understanding of good practice in BMW management in future.
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Affiliation(s)
- Gita Nataraj
- Department of Microbiology, Seth G.S Medical College and K.E.M Hospital, Mumbai, India.
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29
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Desai D, Nataraj G, Kulkarni S, Bichile L, Mehta P, Baveja S, Rajan R, Raut A, Shenoy A. Utility of the polymerase chain reaction in the diagnosis of tuberculous meningitis. Res Microbiol 2006; 157:967-70. [PMID: 17008064 DOI: 10.1016/j.resmic.2006.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2006] [Revised: 08/09/2006] [Accepted: 08/09/2006] [Indexed: 11/18/2022]
Abstract
Due to inconsistent clinical presentations and the lack of a rapid, sensitive and specific test, tuberculous meningitis (TBM) is particularly difficult to diagnose. The present study was carried out to determine the utility of the polymerase chain reaction (PCR) using INS primers in the diagnosis of TBM and to compare the efficacy of two different DNA extraction protocols. Fifty-seven cerebrospinal fluid (CSF) samples from suspected cases of meningitis -- 30 definitive/possible TBM and 27 non-TBM -- were processed for microscopy, culture and PCR. Results of computer tomographic (CT) scan findings were noted. The results of smear, culture and PCR were compared using culture and/or clinical response to treatment as the gold standard. The sensitivity of microscopy, culture, CT scan and PCR was 3.3%, 26.7%, 60.0% and 66.7%, respectively. PCR following QIAmp DNA extraction had a sensitivity of 66.7% compared to PCR following a DNA extraction protocol based on the use of cetyl trimethyl ammonium bromide (CTAB) (50%). PCR was positive in all culture-positive CSF samples using either extraction method. PCR is a rapid and sensitive technique; above all, it can diagnose tuberculous meningitis at a very early stage.
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Affiliation(s)
- Dhyanesh Desai
- Department of Microbiology, Seth GS Medical College and KEM Hospital, Mumbai, India
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30
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Patil R, Baveja S, Nataraj G, Khopkar U. Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in community-acquired primary pyoderma. Indian J Dermatol Venereol Leprol 2006; 72:126-8. [PMID: 16707818 DOI: 10.4103/0378-6323.25637] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although prevalence of MRSA strains is reported to be increasing, there are no studies of their prevalence in community-acquired primary pyodermas in western India. AIMS This study aimed at determining the prevalence of MRSA infection in community-acquired primary pyodermas. METHODS Open, prospective survey carried out in a tertiary care hospital in Mumbai. MATERIALS AND METHODS Eighty-six patients with primary pyoderma, visiting the dermatology outpatient, were studied clinically and microbiologically. Sensitivity testing was done for vancomycin, sisomycin, gentamicin, framycetin, erythromycin, methicillin, cefazolin, cefuroxime, penicillin G and ciprofloxacin. Phage typing was done for MRSA positive strains. RESULTS The culture positivity rate was 83.7%. Staphylococcus aureus was isolated in all cases except two. Barring one, all strains of Staphylococcus were sensitive to methicillin. CONCLUSIONS Methicillin resistance is uncommon in community-acquired primary pyodermas in Mumbai. Treatment with antibacterials active against MRSA is probably unwarranted for community-acquired primary pyodermas.
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Affiliation(s)
- Rahul Patil
- Department of Dermatology, Seth GS Medical College and KEM Hospital, Mumbai, India.
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31
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Poojary A, Nataraj G, Kanade S, Mehta P, Baveja S. RAPID ANTIBIOTIC SUSCEPTIBILITY TESTING OF MYCOBACTERIUM TUBERCULOSIS: ITS UTILITY IN RESOURCE POOR SETTINGS. Indian J Med Microbiol 2006. [DOI: 10.1016/s0255-0857(21)02287-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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32
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Poojary A, Nataraj G, Kanade S, Mehta P, Baveja S. Rapid antibiotic susceptibility testing ofMycobacterium tuberculosis: Its utility in resource poor settings. Indian J Med Microbiol 2006; 24:268-72. [PMID: 17185845 DOI: 10.4103/0255-0857.29385] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
PURPOSE To compare the rapid colorimetric nitrate reductase based antibiotic susceptibility (CONRAS) test performed on Mycobacterium tuberculosis isolates with the conventional method i.e, the proportion method. METHODS One hundred clinical isolates of M. tuberculosis were tested for susceptibility to isoniazid (INH) and rifampicin (RIF) by the conventional proportion method and CONRAS in Middlebrook 7H9 liquid medium enriched with growth supplements (MB7H9S). RESULTS The performance of the CONRAS test was evaluated using proportion method as the gold standard. The sensitivity (ability to detect true drug resistance) and specificity (ability to detect true drug susceptibility) of the CONRAS test to INH was 93.75 and 98.52% and for RIF it was 96.10 and 100% respectively. The mean time for reporting was 6.3 days and the test showed excellent reproducibility. The kappa (k) value for INH was 0.92 and for RIF was 0.99, indicating excellent agreement between the two methods. CONCLUSIONS CONRAS test is a rapid and reliable method of drug susceptibility for M. tuberculosis.
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Affiliation(s)
- A Poojary
- Department of Microbiology, Seth GS Medical College and KEM Hospital, Mumbai--400012, Maharashtra, India
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Sachdev D, Amladi S, Natraj G, Baveja S, Kharkar V, Mahajan S, Khopkar U. An outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in dermatology indoor patients. Indian J Dermatol Venereol Leprol 2003; 69:377-80. [PMID: 17642945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen. Indiscriminate and increased use of systemic antibiotics has led to the emergence of MRSA. Infected or colonized ward patients are the main reservoir of infection. Once colonized, the risk of subsequent local and systemic infections is high, especially in the elderly, and in debilitated and immunosuppressed patients. METHODS We report an outbreak of MRSA in the dermatology ward of a tertiary care hospital and describe measures taken to control it. RESULTS Ten patients were found to be MRSA positive over a span of three months while screening swabs from wet lesions in indoor patients. On the basis of risk assessment, they were treated with appropriate systemic and topical therapy. One patient died while the remaining nine patients showed a good response to therapy. All the MRSA isolates were found to be sensitive to vancomycin, teicoplanin and linezolid. CONCLUSION This is the first case report of MRSA infection in dermatology indoor patients in India.
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Affiliation(s)
- D Sachdev
- Department of Dermatology, Seth G. S. Medical College & K. E. M. Hospital, Mumbai
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Jaiswal AK, Verma R, Kumar V, Vaishmpayan SS, Baveja S. Tonsure trichotillomania. Indian J Dermatol Venereol Leprol 2000; 66:41-42. [PMID: 20877022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
An unusual case of tonsure trichotillomania is reported for its rarity and clinical interest.
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Affiliation(s)
- A K Jaiswal
- Department of Skin & STD, Base Hospital, Lucknow-226 002, India
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Verma R, Jaiswal AK, Vaishampayan SS, Baveja S. Lichenoid epidermal naevus. Indian J Dermatol Venereol Leprol 1999; 65:232. [PMID: 20921668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A case of lichenoid epidermal naevus with unusual clinical presentation is reported.
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Affiliation(s)
- R Verma
- Department of Skin & STD, Base Hospital, Lucknow, 226 002, India
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Verma R, Jaiswal AK, Vaishampayan SS, Baveja S. Lichenoid epidermal naevus. Indian J Dermatol Venereol Leprol 1998; 64:295-296. [PMID: 20921802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A case of lichenoid epidermal naevus with unusual clinical presentation is reported.
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Affiliation(s)
- R Verma
- Department of Skin & STD Base Hospital, Lucknow, 226 002, India
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Abstract
Zero-order release of oxprenolol hydrochloride was obtained by controlling the swelling and erosion of the matrix. This formulation involves only mixing of drug, hydroxypropylmethylcellulose (HPMC), and sodium carboxymethylcellulose (Na CMC) at the ratio of 1:0.4:1.6, respectively, and compressing the mixture directly into tablets. The in vitro release pattern from this optimized matrix tablet was reproducible. Accelerated stability studies revealed that the optimized formulation remains stable for an approximately 2-year shelf life. This sustained-release (SR) tablet was evaluated in dogs, and for comparison a conventional (CV) formulation was also given at the same dose level. Plasma oxprenolol levels were monitored by a sensitive and specific high-performance liquid chromatographic (HPLC) method. Significant differences in the pharmacokinetic parameters, i.e., lower Cmax, higher values of tmax, MRT, AUC, and plasma concentration at 24 hr, and nearly constant plasma levels over 12 hr, indicated that the SR matrix tablet is superior to the CV rapid-releasing formulation. The in vitro release parameters and in vivo pharmacokinetics correlated well.
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Affiliation(s)
- K P Devi
- Department of Pharmaceutical Sciences, Panjab University, Chandigarh, India
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