Diving deep for the needle in the haystack: An outbreak investigation of Burkholderia cenocepacia bacteremia

In an Indian oncology setting, between August and December 2021, 56 patients, developed Burkholderia cenocepacia bacteremia. An investigation revealed a contaminated batch of the antiemetic drug palonosetron. The outbreak was terminated by withdrawing the culprit batch and the findings were reported promptly to regulatory authorities.

The battle against fungi- lessons in antifungal stewardship from COVID-19 times: a consensus statement on behalf of the International Society of Antimicrobial Chemotherapy, Alliance for the Prudent Use of Antibiotics, European Society of Clinical Microbiology and Infectious Diseases Study Group for Antimicrobial Stewardship, and European Society of Clinical Microbiology and Infectious Diseases Fungal Infection Study Group

The COVID-19 pandemic has undoubtedly highlighted the detrimental effect of secondary pathogens in patients with a primary viral insult. In addition to superinfections with bacterial pathogens, invasive fungal infections were increasingly reported. While the diagnosis of pulmonary fungal infections has always been challenging, it became even more problematic in the setting of COVID-19 especially when it comes to the interpretation of the radiological findings and mycology test results in these patients. Moreover, the long duration of hospitalization in intensive care units coupled with underlying host factors such as multiple comorbidities including preexisting immunosuppression, the use of immunomodulatory agents and pulmonary compromise caused additional vulnerability to fungal infections in this patient population. In addition, the heavy workload during the COVID-19 outbreak, the redeployment of untrained staff, and sometimes the lack of gloves, gown and masks has made it more difficult for many healthcare workers to strictly adhere to infection control preventive measures. Taken together, these factors favored patient to patient spread of fungal infections such as those caused by Candida auris or environment to patient transmission such as nosocomial aspergillosis. Because fungal infections were associated with increased morbidity and mortality, empiric treatment was overly used and abused in COVID-19 infected patients, potentially contributing to increased resistance in fungal pathogens. In this paper, we aim to focus on essential elements of antifungal stewardship in COVID-19 for three fungal infections, namely COVID-19 associated candidemia (CAC), pulmonary aspergillosis (CAPA) and mucormycosis (CAM).

P483 Invasive fungal infection in hematopoietic stem cell transplant recipient from an Indian oncology setting

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM

 

Objectives

Invasive fungal infections (IFI) are one of the major causes of morbidity and mortality in post-hematopoietic stem cell transplant (HSCT) recipients. Data from India are limited. The objective was to analyze the incidence, risk factors, and outcomes associated with IFI in our center.

Methods

Adult patients, who underwent marrow/stem cell transplantation between 2014-2018, in an oncology center in India, were included in this retrospective observational study. The revised consensus definition of IFI by the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) in 2008, was considered to define cases. Incidence, risk factors, and outcomes associated with IFI were analyzed.

Results

Out of the 126 patients who underwent HSCT between 2014-2018, 56 (44.4%) had Allo HSCT, 64 (50.8%) had auto HSCT and 6 (4.8%) had haplo-identical HSCT. A total of 83 (63%) were males and 43 (34%) females, 113 (83.9%) Asians, and 13 (10.3%) Africans. Total 111 (88%) patients received myeloablative conditioning and 24 (19%) received total body irradiation. The hematological conditions were acute myeloid leukemia (AML) n = 23 (18.25%), acute lymphoblastic leukemia (ALL) n = 16 (12.69%), chronic myeloid leukemia (CML) n = 4 (3.17%), Hodgkins lymphoma (HL) n = 17 (13.4%), non-Hodgkins lymphoma (NHL) n = 11 (8.73%), Myeloma n = 35 (27.7%), sickle cell disease n = 13 (10.31%), etc. Most patients received fluconazole 78 (61.9%) followed by micafungin 23 (18.25%), posaconazole 20 (15.87%), voriconazole 4 (3.17%), and liposomal amphoterin B 1 (0.79%) as antifungal prophylaxis. The overall rate of IFI (possible cases included) was auto-HSCT n = 5 (7.81%), and Allo-HSCT n = 5 (8.92%). Among auto-HSCT, the IFI was Proven = 0, Probable n = 1 (1.5%), and Possible n = 4 (6.25%), and among Allo-HSCT Proven = 0, Probable n = 2 (3.57%), and Possible n = 3 (5.35%). These cases had IFI lung based on imaging and serological tests. None of the cases had a lung biopsy. There were no incidents of candidemia. No patients in Haplo-HSCT had IFI. The 1-year survival rate among the IFI cases was 8/10 (80%). As the number of patients with IFI was very low, a meaningful comparison of the risk factors, and the impact of prophylactic regimens were difficult.

Conclusions

The overall rate of IFI in HSCT patients in our setting was low compared to global data.

Prevalence of faecal carriage of Carbapenemase Producing Enterobacteriaceae in healthy Indian subjects from the community

PURPOSE

Faecal carriage of carbapenemase-producing Enterobacterales (CPE) has been extensively investigated in hospitalized patients, but limited data is available on the carriage rate in healthy individuals in India.

METHODS

A total of 1000 stool samples were screened for CPE from healthy individuals in Chennai (n ​= ​50), Hyderabad (n ​= ​184) and Mumbai (n ​= ​766). Diluted stool samples were cultured on chromID CARBA SMART plates. Growing colonies were screened for CPE by RAPIDEC® CARBA NP Test and minimum inhibitory concentration (MIC) of imipenem by E-Test. PCR was performed for confirmation of CPE genes.

RESULTS

Out of the 1000 stool samples tested, 6.1% were positive for CPE. A total of 64 carbapenem resistant isolates (56 ​E.coli, 4 Klebsiella pneumoniae, 3 Enterobacter cloacae and 1 Citrobacter freundii) were recovered from ChromID CARBA SMART biplate. Carbapenemase production was identified in 57/64 isolates by RAPIDEC® CARBA NP test. PCR analysis showed 28 bla_NDM-1 and 33 bla_OXA48. Three remaining isolates (2 ​E.coli, 1 ​K.pneumoniae) were negative for the tested carbapenemase genes. Interestingly, out of these 61 PCR positive isolates, 49.1% displayed imipenem MIC within the susceptibility range on the basis of CLSI interpretative criteria.

CONCLUSIONS

Faecal carriage of CPE among healthy individuals was 6.1%. Comprehensive measures to improve the sanitation scenario and implementation of National AMR action plan are needed to prevent further generation and dissemination of carbapenem resistant Enterobacterales (CRE).

Challenges in Implementing Antimicrobial Stewardship (AMS) in Organ Transplant Centers in India

INTRODUCTION

We, in India, have unique challenges in implementing AMS (Antimicrobial Stewardship) in our institutions, especially the transplant settings. Identifying challenges, addressing them and finding innovative solutions to these is the need of the hour.

CHALLENGES

Several challenges in India exists which hamper implementation of effective AMS like,lack of adequately trained personnel (ID physicians and clinical pharmacists), missing opportunities of AMS during the timeline and lack of India specific outcome measures for AMS programme.

SOLUTIONS

Finding local solutions can make our AMS implementation more effective. Numbers of ID physicians are increasing ((24 in 2011 to > 300 in 2020) and we expect the specialty to grow more and make rapid progress in AMS. We propose that cost savings and overall improvement in clinical outcome to be included in outcomes measures, rather than rates of C. difficle infection. Effective implementations of National Medical Commission (NMC) mandatory AMS training regulation are few such steps which can fill the gaps.

CONCLUSION

AMSP is one of the several components of tackling the AMR related negative consequences in transplant patients. Transplant physicians, surgeons and institutions should understand the bigger picture and strive hard to convince the policymakers to act for the benefit of the transplant recipients and the transplant programs across the country. This article is protected by copyright. All rights reserved.

A Case of Severe Aeromonas Bacteremia with Necrotizing Fasciitis of Lower Limb and Fournier s Gangrene in a Post-Allogenic Unrelated Hematopoietic Stem Cell Transplant Recipient

Bikram DasBackground  Aeromonas is a water-dwelling Gram-negative bacillus primarily associated with gastrointestinal tract diseases. Aeromonas sobria causing gastroenteritis has been reported in India. In immunocompromised host, Aeromonas sobria can also present with severe necrotizing skin and soft tissue infection with a high mortality rate. We report a case of Aeromonas sobria sepsis with skin and soft tissue infection in the background of immunosuppression. Case Presentation  Fifty-year-old male who underwent an unrelated donor peripheral stem cell transplant for relapsed pre-B acute lymphoblastic leukemia in complete clinical remission on graft versus host disease prophylaxis, post-white blood cell engraftment presented with acute onset lethargy, lower limb pain without fever, or any skin changes initially. He rapidly worsened clinically over few days and developed sepsis, multiorgan dysfunction with the appearance of erythema and blister over the lower limb, and Fournier's gangrene of scrotum. He was found to have Aeromonas sobria bacteremia with isolated resistance to carbapenems while sensitive to all other classes of antibiotics. Despite appropriate antibiotic therapy and supportive measures, he succumbed to death for this invasive bacterial disease. Conclusion  Aeromonas should be considered a cause of sepsis in immunosuppressed hosts, especially those with hematological malignancy presenting with necrotizing skin and soft tissue infection. Considering the virulence of this pathogen, despite the very susceptible antibiogram, such patients must be managed aggressively. Early recognition of the disease with a combination of medical and surgical management might help to improve the outcome.

South Asian Declaration-Consensus Guidelines for COVID-19 Vaccination in Cancer Patients

We provide the South Asian Declaration, containing the consensus guidelines for coronavirus disease 2019 (COVID-19) vaccination in cancer patients.

Intestinal carriage of colistin resistant Enterobacteriaceae in hospitalized patients from an Indian center

There is limited data on the gut colonization rate of colistin resistant (Col-R) bacteria in patients and healthy volunteers in India. Aim of this study was to investigate the stool carriage rate of Col-R in hospitalized patients. Stool samples were inoculated in Eosin Methylene Blue agar plates supplemented with colistin. Colistin minimum inhibitory concentrations (MICs) were determined by the broth microdilution method. PCR for the mcr-1 was performed on Col-R Enterobacteriaceae isolates. Mutations in the mgrB gene were analyzed in K. pneumoniae isolates. Mcr-1 positive E. coli was subjected to whole-genome sequencing. Out of 65 stool samples screened, 33 (51%) samples carried Col-R bacteria. Majority (76.7%) of the isolates were sensitive to carbapenem.

Knowledge Assessment of E-Bug Assisted Antimicrobial Resistance Education Module in Class VII School Students of South Indian Coastal Town of Manipal

Antimicrobial resistance (AMR) is a recognized public health threat today globally. Although many active and passive stewardship strategies are advocated to counter AMR clinically, educating school going children on AMR could be a cost-effective measure to minimize AMR development in the future. We implemented NICE’s e-bug as a module to educate class VII school students on AMR determinants. A prospective quasi-experimental study on 327 students from nine different schools of class VII around Manipal town, Udupi district, Karnataka state, India were included in the study. Ten questions on AMR determinants from the e-bug program were used in written pre-test. After an education intervention, a post-test was conducted. Descriptive statistics to estimate epidemiological characteristics, Wilcoxon Signed Ranks and Kruskal–Wallis tests were applied to analyze statistical significance of pre/post-test performance scores and between schools. Students had inadequate knowledge on seven AMR determinants (antimicrobial indication, its course, hand hygiene, fermentation, spread of infection, microbial multiplication and characteristics of microbe) as analyzed from the post-test performance (p < 0.05). Comparison of post-test performance between schools showed significant improvement in scores (p < 0.05) for three questions (definition on antimicrobial, cover while cough/sneezing and microbial characteristics). Although students exhibited sub-optimal knowledge on some AMR determinants, they showed keenness to learn, which was evident by their post-test performance. Our findings and previous similar studies from Europe are suggestive of early pedagogic interventions on AMR through inclusion of such education modules in the regular school curriculum could be a potential tool for AMR prevention.

Retrospective Study of Nephrotoxicity Rate among Adult Patients Receiving Colistin Compared to β-lactam Antibiotics

Purpose

Patients receiving colistin for carbapenem-resistant gram-negative bacteria (CR-GNB) infections generally have multiple risk factors for nephrotoxicity, so it might be possible that colistin may be erroneously blamed for the nephrotoxicity.

Materials and methods

We retrospectively analyzed case records of patients who received colistin and those who received antibiotics other than colistin [carbapenem or β-lactam–β-lactamases inhibitors (βL–βLI)] for gram-negative bacteremia. Those patients with preexisting renal failure and those who received antibiotics for <72 hours were excluded from the study. Nephrotoxicity was assessed using the risk of renal dysfunction, injury to the kidney, failure of kidney function, loss of kidney function, end-stage kidney disease (RIFLE) criteria.

Results

Out of the 222 patients, the colistin arm had 118 and the noncolistin arm had 104 patients. Even though the colistin arm had significantly higher number of sicker patients with neutropenia (40.7% vs 14.4%, p = 0.0001), mechanical ventilation (0.0001), having lines (0.0001), on inotropes (0.003), receiving other nephrotoxic drugs (0.0001), and higher Pitt score (p = 0.0001), there was no significant difference in the nephrotoxicity between the two arms (10.2% vs 9.6%, p = 0.89). Logistical regression showed a higher Pitt bacteremia score (p = 0.03) and a higher Charlson comorbidity index (p = 0.02), but not colistin administration (p = 0.32), were independently associated with nephrotoxicity.

Conclusion

Administration of colistin was not associated with higher rates of nephrotoxicity than carbapenems or βL–βLI agents.

How to cite this article

Ghafur A, Bansal N, Devarajan V, Raja T, Easow J, Raja MA, et al. Retrospective Study of Nephrotoxicity Rate among Adult Patients Receiving Colistin Compared to β-lactam Antibiotics. IJCCM 2019;23(11):518–522.

Spectrum of bacteremia in posthematopoietic stem cell transplant patients from an Indian center

BACKGROUND

Despite the relatively low prevalence of Gram-positive bacteremic infections in Indian oncology patients, glycopeptides are extensively used for empirical management of febrile neutropenia. Our aim was to analyze the spectrum of bacteremia in posthematopoietic stem cell transplant (HSCT) recipients in our center and make a recommendation on glycopeptide use in this patient population.

MATERIALS AND METHODS

Retrospective analysis of bacteremic data from HSCT recipients in a tertiary care oncology and transplant center from South India, between 2011 and 2013.

RESULTS

In 217 patients, 52 bacteremic episodes were identified. The majority of the isolates were Gram-negatives (88.4%) with very few Gram-positives (7.69%).

CONCLUSION

Glycopeptides need not be included in the empirical antibiotic regimen in post-HSCT settings with very low Gram-positive infection rates.

Monotherapy versus combination therapy against carbapenem-resistant Gram-negative bacteria: A retrospective observational study

BACKGROUND

Colistin-based combination therapy (CCT) is extensively used to treat infections due to carbapenem-resistant Gram-negative bacteria (CRGNB). There are no data available from India on the usefulness of combination therapy, especially in the oncology setup. The aim of this study was to analyze the clinical effectiveness of CCT over monotherapy in patients with CRGNB.

MATERIALS AND METHODS

We conducted a retrospective, observational study of patients with CRGNB bloodstream infections in our oncology and bone marrow transplant center.

RESULTS

Over a 3-year study period (2011-2014), we could identify 91 patients satisfying study criteria. There was no statistically significant difference in the 28-day mortality between monotherapy and combination therapy arms (mono n = 26, mortality 10 (38.5%); combination n = 65, mortality 28 (40%); P = 0.886). Neutropenic patients with Enterobacteriaceae bloodstream infections performed better with combination therapy (mono n = 7, mortality 6 (85.7%); combination therapy n = 22, mortality 8 (36.4%); P = 0.035). There was no significant difference in the 28-day mortality between the two treatment arms in other subgroups.

CONCLUSION

Our study did not find CCT superior to colistin monotherapy in patients with CRGNB blood stream infections; except in the subgroup of neutropenic patients with Enterobacteriaceae bloodstream infections, where combination therapy performed better.

Monotherapy versus Combination Therapy against Nonbacteremic Carbapenem-resistant Gram-negative Infections: A Retrospective Observational Study

Background:

Superiority of colistin–carbapenem combination therapy (CCCT) over colistin monotherapy (CMT) against carbapenem-resistant Gram-negative bacterial (CRGNB) infections is not conclusively proven.

Aim:

The aim of the current study was to analyze the effectiveness of both strategies against CRGNB nonbacteremic infections.

Design:

This was a retrospective observational cohort study.

Subjects and Methods:

Case record analysis of patients who had CRGNB nonbacteremic infections identified over a period of 4 years (January 2012–December 2015) was done by medical record review at a tertiary care center in India.

Statistical Analysis:

P < 0.05 was considered as significant. Multivariate analysis was performed using Cox regression.

Results:

Out of 153 patients (pneumonia 115, urinary tract infection 17, complicated skin and soft-tissue infection 18, intra-abdominal infection 1, and meningitis 2), 92 patients received CCCT and 61 received CMT. Univariate analysis revealed higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score, pneumonia as the diagnosis, and Klebsiella as the causative organism to be the risk factors for higher 28-day mortality (P = 0.036, 0.006, 0.016, respectively). Combination therapy had no significant impact on mortality (odds ratio [OR] = 0.91, 95% confidence interval [CI] = 0.327–2.535, P = 0.857). Multivariate analysis revealed that higher APACHE II score and infection due to Klebsiella were found to be independent risk factors for higher mortality (OR = 3.16 and 4.9, 95% CI = 1.34–7.4 and 2.19–11.2, P = 0.008 and 0.0001, respectively).

Conclusions:

In our retrospective single-center series of CRGNB nonbacteremic infections, CCCT was not superior to CMT. Multicenter large observational studies or prospective randomized clinical trials are the need of the hour.

Carbapenem-Resistant Acinetobacter baumannii and Enterobacteriaceae in South and Southeast Asia

Carbapenem-resistant Gram-negative bacteria, in particular the Acinetobacter baumannii-calcoaceticus complex and Enterobacteriaceae, are escalating global public health threats. We review the epidemiology and prevalence of these carbapenem-resistant Gram-negative bacteria among countries in South and Southeast Asia, where the rates of resistance are some of the highest in the world. These countries house more than a third of the world's population, and several are also major medical tourism destinations. There are significant data gaps, and the almost universal lack of comprehensive surveillance programs that include molecular epidemiologic testing has made it difficult to understand the origins and extent of the problem in depth. A complex combination of factors such as inappropriate prescription of antibiotics, overstretched health systems, and international travel (including the phenomenon of medical tourism) probably led to the rapid rise and spread of these bacteria in hospitals in South and Southeast Asia. In India, Pakistan, and Vietnam, carbapenem-resistant Enterobacteriaceae have also been found in the environment and community, likely as a consequence of poor environmental hygiene and sanitation. Considerable political will and effort, including from countries outside these regions, are vital in order to reduce the prevalence of such bacteria in South and Southeast Asia and prevent their global spread.

An Essential Pathology Package for Low- and Middle-Income Countries

Objectives

We review the current status of pathology services in low- and middle-income countries and propose an “essential pathology package” along with estimated costs. The purpose is to provide guidance to policy makers as countries move toward universal health care systems.

Methods

Five key themes were reviewed using existing literature (role of leadership; education, training, and continuing professional development; technology; accreditation, management, and quality standards; and reimbursement systems). A tiered system is described, building on existing proposals. The economic analysis draws on the very limited published studies, combined with expert opinion.

Results

Countries have underinvested in pathology services, with detrimental effects on health care. The equipment needs for a tier 1 laboratory in a primary health facility are modest ($2-$5,000), compared with $150,000 to $200,000 in a district hospital, and higher in a referral hospital (depending on tests undertaken). Access to a national (or regional) specialized laboratory undertaking disease surveillance and registry is important. Recurrent costs of appropriate laboratories in district and referral hospitals are around 6% of the hospital budget in midsized hospitals and likely decline in the largest hospitals. Primary health facilities rely largely on single-use tests.

Conclusions

Pathology is an essential component of good universal health care.

Colistin Nephrotoxicity in Adults: Single Centre Large Series from India

Context:

Limited Indian data are available on the rate of colistin nephrotoxicity and other risk factors contributing to the development of this important side effect.

Aim:

This study aims to generate data on colistin nephrotoxicity from a large cohort of Indian patients.

Design:

Retrospective cohort study.

Materials and Methods:

Case record analysis of patients who received colistin, in an oncology center in India, between January 2011 and December 2015. Nephrotoxicity was assessed using risk, injury, failure, loss, and end-stage (RIFLE) criteria.

Statistical Analysis:

P < 0.05 was considered as statistically significant.

Results:

Out of the 229 patients, 13.1% (30/229) developed abnormal RIFLE. Abnormal RIFLE group (n = 30), in comparison to the normal renal function group (n = 199), had higher number of patients in intensive care unit (ICU) (96% vs. 79%, P = 0.02), higher Acute Physiology and Chronic Health Evaluation (APACHE II) score (23 vs. 19 P = 0.0001), Charlson score (5.9 vs. 4.3, P = 0.001), mechanical ventilation (90% vs. 67%, P = 0.016), 28 days mortality (63% vs. 25%, P = 0.0001), and abnormal baseline creatinine (36% vs. 8%, P = 0.001). Coadministration of vancomycin had higher rates of nephrotoxicity (P = 0.039). There was no significant difference in nephrotoxicity between 6 and 9 MU/day dosing pattern (8.8% vs. 13.8%, P = 0.058).

Conclusion:

Nephrotoxicity rate in our retrospective single center large series of patients receiving colistin was 13.1%. Patients with abnormal baseline creatinine, ICU stay, and higher disease severity are at higher risk of nephrotoxicity while on colistin. A daily dose of 9 million does not significantly increase nephrotoxicity compared to the 6 million. Concomitant administration of vancomycin with colistin increases the risk of nephrotoxicity.

International cooperation to improve access to and sustain effectiveness of antimicrobials

Securing access to effective antimicrobials is one of the greatest challenges today. Until now, efforts to address this issue have been isolated and uncoordinated, with little focus on sustainable and international solutions. Global collective action is necessary to improve access to life-saving antimicrobials, conserving them, and ensuring continued innovation. Access, conservation, and innovation are beneficial when achieved independently, but much more effective and sustainable if implemented in concert within and across countries. WHO alone will not be able to drive these actions. It will require a multisector response (including the health, agriculture, and veterinary sectors), global coordination, and financing mechanisms with sufficient mandates, authority, resources, and power. Fortunately, securing access to effective antimicrobials has finally gained a place on the global political agenda, and we call on policy makers to develop, endorse, and finance new global institutional arrangements that can ensure robust implementation and bold collective action.

Elizabethkingia meningoseptica bacteremia in immunocompromised hosts: The first case series from India

Background:

Although Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) infections in immunocompromised hosts have been recognised, clinical data detailing these infections remain limited, especially from India. Antimicrobial susceptibility data on E. meningoseptica remain very limited, with no established breakpoints by Clinical and Laboratory Standards Institute (CLSI). The organism is usually multidrug resistant to antibiotics usually prescribed for treating Gram-negative bacterial infections, a serious challenge to the patient and the treating clinicians.

Materials and Methods:

The analysis was done in a tertiary care oncology and stem cell transplant center. Susceptibility testing and identification of E. meningoseptica was done using Vitek auto analyzer. Records of immunocompromised patients with E. meningoseptica bacteremia were analysed from January 2009 to March 2012.

Results:

A total of 29 E. meningoseptica bacteremia cases were documented between 2009 and 2012. Eleven patients were immunocompromised. Three were post stem cell transplant and one was post cord blood transplant. The mean age of the patients was 48.4 years. Mean Charlson’s comorbidity index was 5.7. Four had solid organ malignancies, five had hematological malignancies, and two had lymphoreticular malignancy. Eight patients had received chemotherapy. Mean Apache II score was 18. Mean Pitts score for bacteremia was 4.7. Two were neutropenic (one post SCT, one MDS post chemo) with a mean white blood cell (WBC) count of 450/mm³ . Ten had a line at the time of bacteremia. Mean duration of the line prior to bacteremia was 8 days. Eight had line-related bacteremia. Three had pneumonia with secondary bacteremia. All received combination therapy with two or more antibiotics which included cotrimoxazole, rifampicin, piperacillin–tazobactam, tigecycline, or cefepime–tazobactam. All the isolates showed in vitro resistance to ciprofloxacin. Five patients died, but a multivariate analysis was not done to calculate the attributable mortality.

Conclusion:

In our study, central line was the commonest risk factor for E. meningosepticum bacteremia, although a multivariate analysis was not done. There has not been much of a change in the susceptibility pattern of these organisms over 3 years, with good susceptibility to piperacillin–tazobactam and cotrimoxazole. Even though uncommon, E. meningoseptica is an important pathogen, especially in immunocompromised hosts with indwelling devices.

Mucormycosis in patients without cancer: a case series from A tertiary care hospital in South India

BACKGROUND

Mucormycosis (Zygomycosis) is a life-threatening infection. We attempted to analyse clinical features and risk factors of Mucormycosis cases in a tertiary care referral institution in India, in patients without underlying malignancy.

METHODS

We retrospectively analyzed data of patients diagnosed as having Mucormycosis over a 10 year period of 2000-2010. Patients with a histopathology report and/or a Microbiology report of Zygomycetes or Mucor from a biopsy specimen were included in the study.

RESULTS

Out of the 27 cases, rhino-orbital/rhino-cerebral involvement occurred in 12 (44.4%) patients, pulmonary involvement in 3 (11.1%) cases, soft tissue involvement in 11 (40.7%) cases and gastrointestinal involvement in one patient (3.7%). Diabetes mellitus is the main risk factor, followed by renal failure and trauma. Mean ESR value of these patients was 118 mm/1 hour. Mean WBC count was 20 x 10(9)/L, and neutrophil count 82%. The mean absolute neutrophil count (ANC) was 16.8 x 10(9)/L.

CONCLUSION

The interesting finding in our study was the presence of neutrophilic leucocytosis and high ESR in most of the patients. In a predisposed individual, especially in a diabetic, in countries with high environmental fungal burden; presence of high ESR and neutrophilic leucocytosis with a compatible clinical presentation should raise suspicion of Mucormycosis.

'The Chennai Declaration': An Indian perspective on the antimicrobial resistance challenge

'The Chennai Declaration', the consensus document of the meeting 'A Roadmap to Tackle the Challenge of Antimicrobial Resistance', is the first of its kind in Indian medical history on the subject. The Declaration is a compilation of clear-cut and practical recommendations suitable to the Indian scenario. Sincere efforts to implement these recommendations will be an inspiring example to the whole region.

"The Chennai declaration" - Indian doctors' fight against antimicrobial resistance

“The Chennai Declaration” is the result of the first ever joint meeting of medical societies in India addressing antibiotic resistance. The declaration is not a policy by itself, but a call for a national policy. The Declaration has looked into all major aspects of the problem of antimicrobial resistance, has suggested practical solutions, explained in detail the responsibility of each and every stakeholder.