Rise in the Pathogenic Status of Coagulase-Negative Staphylococci Causing Bloodstream Infection

BACKGROUND

Coagulase-negative staphylococci (CoNS) are one of the frequently isolated bacteria from blood cultures. Since they are part of the normal skin flora, they were previously considered contaminants. But now, they can be considered as established pathogens causing bloodstream infection (BSI). This study aims to estimate the prevalence of CoNS in BSI cases.

METHODS

This study was conducted at the Microbiology Department, All India Institute of Medical Sciences (AIIMS), Raipur, India, for eight months (January 2022 to August 2022). Data were collected retrospectively from medical and laboratory records. Paired blood cultures from 5085 clinically suspected sepsis cases were subjected to aerobic culture for five days in the BacT ALERT 3D system. Pathogenicity was established after recovery of CoNS from paired blood cultures of symptomatic patients.

RESULTS

CoNS were isolated from 2.35% of patients, the most common species being Staphylococcus haemolyticus (51.67%). About 90% of isolates were methicillin-resistant. All the isolates were susceptible to linezolid, teicoplanin, and vancomycin, except one isolate of S. haemolyticus which was intermediate to vancomycin. Minimum inhibitory concentration (MIC) 50 and MIC 90 for vancomycin were 1 ug/ml and 2 ug/ml, respectively.  Conclusion: Paired blood cultures are necessary to determine the pathogenicity of CoNS in BSI cases. A high prevalence of methicillin resistance, accompanied by high resistance rates to other non-beta lactam antibiotics, warrants the strict implementation of antimicrobial stewardship practices.

P195 Factors related to outcome of bloodstream infections due to Candida parapsilosis complex: A single center observation study from Central India

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM

 

Objectives

Candida parapsilosis infection has recently emerged as an important antifungal-resistant nosocomial pathogen having the unique ability to grow on inanimate objects and surfaces. Very limited studies from low and middle-income countries are available on the association of risk factors and antifungal susceptibility testing (AFST) of this species. The aim of this study was to analyze the predisposing conditions, outcome, and antifungal susceptibility pattern of candidemia due to C. parapsilsosis complex.

Methods

A single-center retrospective observational study from January 2019 to December 2021 of all cases of candidemia was carried out at an 890-bedded University Hospital in central India. Data regarding demographic characteristics and clinical risk factors were collected from the patient's medical records. Antifungal susceptibility testing was performed; MIC results were interpreted according to CLSI breakpoints (M27-A3). Risk factors and outcome association at the species level were analyzed by using Fisher's exact test. Variables with a P ≤ .05 at the descriptive analysis were analyzed by Cox regression. A P-value of ≤ .05 was considered to represent the statistical significance and all statistical tests were two-tailed.

Results

Of 211 patients diagnosed with Candidemia during the study period, 53 (25.1%) were infected with C. parapsilosis which represented the second most frequently isolated yeast after C. albicans (n = 98; 46.4%). A total of 26 (49%) C. parapsilosis isolates were non-susceptible to fluconazole (NSF), which included resistant (n  =  20) and susceptible dose-dependent (n  =  06) isolates. The median patient age was 63 years.15.3% were neonates. The majority of patients (90%) suffered from multiple comorbidities, diabetes mellitus (43%) being the commonest. A total of 55% of patients underwent surgical intervention within 30 days from the onset of candidemia. Univariate logistic regression revealed that ICU admission [odds ratio (OR) 2.45], central venous catheter use (OR 2.46), renal impairment (OR 1.687) were more common among NSF isolates than fluconazole-susceptible (FS) isolates (all P <.05). The overall crude mortality at 30 days was 36%; higher in patients infected with FNS isolates than FS isolates.

Conclusion

There is an increase in the absolute number of invasive infections by C.parapsilosis observed over the past 2 years. At this moment, the percentage of fluconazole non-susceptible C. parapsilosis is very high and poses a threat to infected patients and has a clinical impact in our hospital. Being able to identify and treat infections caused by this pathogen is important to prevent clinical outbreaks.

Epidemiological Characteristics of the COVID-19 Pandemic During the First and Second Waves in Chhattisgarh, Central India: A Comparative Analysis

Background

There is a scarcity of reports of comparative analysis between the first and second waves of the pandemic from any part of India. This article aims to comprehensively investigate the epidemiology of coronavirus disease 2019 (COVID-19) during the course of the pandemic in the state of Chhattisgarh, central India.

Methodology

A comparative epidemiological analysis of the first and second waves of COVID-19 across Chhattisgarh was conducted on the vital parameters of total tests performed, cases diagnosed, age and gender distribution, case fatality ratio (CFR), and mitigation strategy reported by the state and central government health agencies using the data from Indian Council of Medical Research and National Informatics Centre portals.

Results

The second wave was shorter than the first wave but the absolute number of cases increased by 2.4 times and deaths by 2.7 times. There was a significant increase in cases per million, deaths per million, and test positivity rate. The hospitalization rate and test per case ratio dropped in the second wave from 33 to 20 and from 12.6 to 7.2, respectively. Both infection and deaths were higher among males in both the waves (p < 0.001). CFR increased from 1.2% in the first wave to 1.4% in the second wave (p < 0.001; odds ratio = 1.14 (1.1-1.19)). Increased mortality was seen in all ages except the young (≤20 years) and the old (>60 years).

Conclusions

The significantly high number of cases and deaths during the second wave provides evidence to undertake preparedness measures for mitigating any future waves. Regular surveillance, monitoring, and analysis of epidemiological data are pertinent for continued situational awareness.

Genetic analysis of human papilloma virus 16 E6/E7 variants obtained from cervical cancer cases in Chhattisgarh, a central state of India

Human papilloma virus genotype 16 (HPV-16), a predominant etiological cause of cervical cancer (CC) vary in inflicting oncogenicity according to their geographical distribution and mutational changes. With no published data from central India, the present study aimed to genetically analyze HPV-16 E6/E7 variant obtained from CC women of Chhattisgarh. In twenty one CC patients, PCR amplified E6/E7 genes were decoded by DNA sequencing to study phylogenetic relatedness, mutational changes and their in-silico effect on protein structure. E6 analysis revealed nineteen sequences exhibited intratypic variation. L83V mutation was observed in 76.2% sequences followed by S71C seen in 28.6% sequences. Mutations of E41G, A46G, F47V, R77S, L99V and Q107K were observed in three sequences each. C140 Stop codon mutation has caused early truncation of E6 in three sequences to produce the conformational structural change. In contrast, E7 was relatively more conserved showing D4E (4.7%), G88R (23.8%), I93T (9.5%) and C94S (9.5%) mutations. Other than L83V and S71C, E6 and E7 mutations were reported for the first time from India. E6/E7 nonsynonmous mutations have a spectrum of biological effect in progression of CC. Phylogenetic analysis revealed ten sequence belonged to Asian while eleven to European sublineage to show CC cases in Chhattisgarh are a mix of Asian and European lineage. Asian sequences showing higher frequency of L83V mutations and exclusive presence of S71C and C140 Stop codon mutations may be linked with higher oncogenicity. Various E6/E7 mutational data may prove useful for development of better diagnostic and vaccine for the region of Chhattisgarh.

The dilemma of differentiating between acute hepatitis B and chronic hepatitis B with acute exacerbation: Is quantitative serology the answer?

Background/Aims

Acute exacerbations of chronic hepatitis B (CHB-AEs) are common in endemic areas and are often presumed to be acute hepatitis B (AHB) due to their similarities in clinical and serological pictures, presenting a major diagnostic dilemma. This study aimed to identify laboratory markers for differentiating between the two groups, and to establish the cut-off value for significant markers.

Methods

A retrospective analysis of records was conducted for patients who presented with clinical features of acute hepatitis along with hepatitis B surface antigen (HBsAg) and IgM antibody to hepatitis B core antigen (IgM anti-HBc) positivity from May 2015 to May 2017. A total of 172 patients were enrolled and grouped as AHB (n=89) and CHB-AE (n=83) based on their history of hepatitis B virus infection and duration of HBsAg persistence. Virological and biochemical parameters were analyzed and compared. Cut-off values, sensitivity, and specificity of the variables were calculated.

Results

The median value of signal by cut-off (S/Co) ratio for IgM anti-HBc was significantly higher in AHB group (30.44) compared to CHB-AE group (8.63) with a sensitivity and specificity of 97% and 84%, respectively, at a cut-off of 20.5 (P<0.01). The mean international normalized ratio (INR) was significantly greater in CHB-AE (1.88±1.24) group compared to AHB group (1.62±0.17) with a sensitivity and specificity of 57.9% and 45.1%, respectively, at a cut-off value of 1.27.

Conclusions

A value of 20.5 S/Co of IgM anti-HBc and 1.27 INR could be helpful in differentiating between AHB and CHB-AE. (Clin Mol Hepatol 2020;26:187-195)

Scrub typhus and leptospirosis in rural and urban settings of central India: a preliminary evaluation

Scrub typhus and leptospirosis are bacterial zoonotic diseases reported from different parts of India, whose prevalence in Chhattisgarh is unknown. Our study was carried out to delineate the prevalence of these illnesses there and to assess the clinical profiles of rural and urban patients. A total of 169 patients with acute febrile illnesses (AFI) was enrolled in our study from May to December 2018, of whom 35 (20.7%) tested positive for scrub typhus and only one tested positive for leptospirosis by respective IgM ELISA. Scrub typhus seropositivity was higher in rural patients (25.0%) than in urban (18.1%). Patients in the age group 16-30 years were the most commonly affected. The commonest presenting symptoms were fever with headache (68.57%), extreme weakness (57.14%), myalgia/arthralgia (54.29%) and abdominal pain (51.43%). The preliminary evidence for the presence of scrub typhus in Chhattisgarh necessitates its inclusion in the panel of tests for AFI.

Point -of -care testing (POCT) in molecular diagnostics: Performance evaluation of GeneXpert HCV RNA test in diagnosing and monitoring of HCV infection

BACKGROUND

Molecular testing at the point-of-care may turn out to be game changer for HCV diagnosis and treatment monitoring, through increased sensitivity, reduced turnaround time, and ease of performance. One such assay GeneXpert^® has recently been released.

OBJECTIVES

Comparative analysis between performances of GeneXpert^® and Abbott HCV-RNA was done.

STUDY DESIGN

174 HCV infected patients were recruited and, one time plasma samples from 154 patients and repeated samples from 20 patients, obtained at specific treatment time-points (0, 4, 12 and 24) weeks were serially re-tested on Xpert^®.

RESULTS

Genotype 3 was the commonest, seen in 80 (66%) of the cases, genotype 1 in 34 (28.3%), genotype 4 in 4 (3.3%) and genotypes 2 and 5 in 1 (0.8%) each. Median HCV RNA load was 4.69 log₁₀ (range: 0-6.98log₁₀) IU/ml. Overall a very good correlation was seen between the two assays (R²=0.985), concordance of the results between the assays was seen in 138 samples (89.6%). High and low positive standards were tested ten times on Xpert^® to evaluate the precision and the coefficient of variation was 0.01 for HPC and 0.07 for the LPC. Monitoring of patients on two different regimes of treatment, pegylated interferon plus ribavirin and sofosbuvir plus ribavirin was done by both the systems at baseline, 4, 12 and 24 weeks. Perfect correlation between the assays in the course of therapy at different treatment time- point in genotypes 3 and 1 was seen.

CONCLUSION

The study demonstrates excellent performance of the Xpert^® HCV assay in viral load assessment and in treatment course monitoring consistency.