Antimicrobial Resistance Among Uropathogens: Surveillance Report From South India

Background Urinary Tract Infection (UTI) is one of the most common infections encountered in clinical practice. Evidence supports that empirical treatment guidelines based on local bacterial spectrum and antimicrobial resistance (AMR) surveillance provide the best clinical results and also prevent the emergence of resistant strains. Antimicrobial resistance has been increasing at an alarming rate throughout the world. This warrants continuous reporting and surveillance of the emergence of AMR among the uropathogens across regions and nations. Materials and methods A retrospective cross-sectional study using antibiograms of adult patients with culture-proven UTI during January 2011 and January 2017 was done. Comparative analysis was performed between the two study periods for the prevalence, changing trends of antimicrobial resistance, and usage of antimicrobials for testing. Results The commonest organism cultured during each study period was Escherichia coli (56.6% and 51.6%). The most frequently tested antibiotics were ampicillin (97%, 88%), amikacin (85%, 85%), nitrofurantoin (95%, 95%), cephalexin (84%, 93%), and norfloxacin (83%, 83%). There was a significant increase in resistance proportion noted for imipenem (by 29.8%), meropenem (by 18.3%), ertapenem (by 24.9%), ciprofloxacin (by 26.5%), nitrofurantoin (by 11.2%), amikacin (by 8.7%), and cefotaxime (by 7.4%) in 2017 as compared to 2011. A significant increase in susceptibility was seen for tobramycin (by 32.5%), cefepime (by 14.4%), and polymyxin (by 12.6%) in 2017 when compared to 2011. Conclusion Our analysis has shown that there is an alarmingly increasing trend for AMR among uropathogens in this region as compared to developed countries. Data on changing trends of antimicrobial testing and reporting might help in strengthening antimicrobial surveillance.

Salmonella typhi Splenic Abscess Following Blunt Abdominal Injury: A Case Report

Splenic abscess as a complication of enteric fever due to Salmonella typhi is a rare entity. Here, we are presenting a case of splenic abscess caused by Salmonella typhi with a blunt injury to the abdomen as the predisposing factor. The patient underwent total splenectomy due to failure of conservative management. Splenic abscess is a potential life threatening disease if left untreated. In spite of its rarity, Salmonella typhi has to be considered as a possible pathogen causing the disease.

P053 Invasive Mucormycosis (Zygomycosis) -Pre-Covid Era and Covid Era: a retrospective study at a tertiary care centre, chennai

 

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

Objectives

Methods

This is a retrospective, hospital-based descriptive study. This study included patients admitted during the pre-COVID and COVID era at a tertiary care center, Chennai. The cases were categorized into two: (1) possible mucormycosis cases which included direct microscopy [Potassium hydroxide (KOH) and histopathological examination] positives and (2) confirmed cases which included direct microscopy and culture positives. Direct microscopic examinations like KOH wet mount and histopathological examination (H and E stain and special stains) were performed. Samples were cultured on Sabourauds dextrose agar and identification was done by analyzing the microscopic morphology using lactophenol cotton blue mount. AFST was performed for culture positive isolates with amphotericin B, itraconazole, posaconazole, voriconazole and isavuconazole by microbroth dilution method according to CLSI M38-A2.

Results

During the Pre-COVID era, out of the 365 samples received in the laboratory, 35 were possible mucormycosis cases. Only 17 were confirmed cases, out of which 16 grew Rhizopus oryzae and 1 grew Apophysomyces elegans. During the COVID era, among 886 samples received in the laboratory, 143 were possible mucormycosis cases, and 31 were confirmed cases that grew Rhizopus oryzae (26), Rhizomucor pusillus (2), Mucor sp (2), and Basidiobolus ranarum (1). Though the risk factors were common during the pre-COVID and COVID era, additional risk factors like steroid therapy (19.2%), and COVID infection (28.7%) were seen during the COVID era. Though clinical presentations were common during both pre-COVID and COVID era, additional complications like epistaxis (0.57%), orbital cellulitis (32.7%), and loss of smell (8.04%) were seen during COVID era. The prevalence of complications was more during COVID era compared to pre-COVID era. Treatment received during the pre-COVID era was only amphotericin B, whereas during the COVID era majority of the patients received posaconazole (74.5%) followed by liposomal amphotericin B (25.5%). The antifungal susceptibility test showed the following mean minimum inhibitory concentration (MIC) values: amphotericin B (1.8 μg/ml), itraconazole (3.6 μg/ml), posaconazole (0.31 μg/ml), and voriconazole (1.61 μg/ml) during the pre-COVID era while the mean MIC values during the COVID era had the following variations: amphotericin B (0.97 μg/mL), itraconazole (13.6 μg/ml), Posaconazole (13.4 μg/ml), voriconazole (14.5 μg/ml), and isavuconazole (1.10 μg/ml).

Conclusion

High incidence of Mucormycosis during the COVID-19 era may be related to common risk factors of COVID and mucormycosis. Though most of the risk factors and clinical presentations were similar during the pre-COVID and COVID era, serious complications like loss of vision and the percentage of complications were more during COVID era which may be attributed to the increased invasiveness of Zygomycetes during COVID infection. The high mean MIC value of amphotericin B during pre-COVID era and higher mean MIC value of posaconazole during COVID era may be contributed to the higher usage of these antifungals. Usage of the antifungal agents is the main contributor toward the resistance. Newer azole like isavuconazole which had a low mean MIC in our study, can be considered as a good therapeutic option for the future management of resistant infections. Hence timely management of the patients with an appropriate antifungal agent by performing AFST will help in the reduction of resistance in the future.

Rise of mucormycosis during the COVID-19 pandemic and the challenges faced

Mucormycosis (previously called zygomycosis) is a diverse group of increasingly recognized and frequently fatal mycotic diseases caused by members of the class zygomycetes. Mucormycosis is around 80 times more common in India, compared to other developed countries, with a frequency of 0.14 cases per 1,000 population. The most frequent causative agent of mucormycosis is the following genera from the Order Mucorales Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Cunninghamella, and Saksenaea. The major risk factors for the development of mucormycosis are diabetic ketoacidosis, deferoxamine treatment, cancer, solid organ or bone marrow transplantations, prolonged steroid use, extreme malnutrition, and neutropenia. The common clinical forms of mucormycosis are rhino-orbital-cerebral, pulmonary, cutaneous, and gastrointestinal. During the second wave of COVID-19, there was a rapid increase in mucormycosis with more severity than before. Amphotericin B is currently found to be an effective drug as it is found to have a broad-spectrum activity and posaconazole is used as a salvage therapy. Newer triazole isavuconazole is also found effective against mucormycosis. This study aimed to review various studies on the laboratory diagnosis and treatment of mucormycosis.

Phaeohyphomycosis of the paranasal sinuses caused by Fonsecaea pedrosoi - A case report

Phaeohyphomycosis of  paranasal sinuses is not very frequent. We here report a case of paranasal sinusitis caused by Fonsecaea pedrosoi in a 53 year old diabetic male, with deviated nasal septum. With surgical correction and antifungal treatment with itraconazole, the patient’s condition improved and he was discharged. Fonsecaea exists in the environment as a saprophyte and its infection is usually not lethal. However in immunocompromised individuals, when there is systemic invasion the mortality rate is high. With limited treatment options available for this fungus, early and prompt identification plays a major role not only in treatment, but also prevents further invasion.