Purva Mathur

All India Institute of Medical Sciences, New Dilli, NCT, India

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Publications (77)87.85 Total impact

  • Intensive Care Medicine 09/2015; 41(12). DOI:10.1007/s00134-015-4047-z · 7.21 Impact Factor

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    ABSTRACT: Background: Occupational exposure to sharps and splashes pose a major hazard among health care workers (HCWs); so knowledge and awareness regarding sharps/splashes by blood and potentially infectious body fluids (BBF) is a must. Hence, the study was done to assess the extent of knowledge of the staff and using awareness classes and hands on practice as a model to increase awareness as well as prevention. Materials and Methods: This prospective interventional cohort study, using before – after trial, was conducted in a Level I trauma care centre. All cadres of HCWs were enrolled randomly into 5 different groups of 15 each. This study was conducted in 2 phases – interactive classes and hands on practice (Phase I) and questionnaire assessment and work area observation (phase II). This was repeated twice and the final outcome was analysed. A systematic level of grading was used to assess the improvement. Results: It was observed that Group 1 (doctors) and group 2 (nurses) had the maximum knowledge about such exposures and its prevention compared to the other groups (groups 3, 4 and 5) during the initial assessment (Phase I). The remaining groups showed a major improvement after the 2nd assessment, though their knowledge was poor in the beginning. Groups 1and 2 showed 32% and remaining groups showed a 25% improvement in voluntary reporting after the second assessment (Phase II). Conclusion: Awareness classes and hands on practice are indeed useful in generating knowledge about sharps/ splashes. Certain incentives given at right time can improve it further.
    Journal of Clinical and Diagnostic Research 07/2015; 9(7):DC17-DC21. DOI:10.7860/JCDR/2015/12833.6219 · 0.23 Impact Factor
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    ABSTRACT: Wound is a disruption of normal anatomic structure and function of the skin, and any infection in this constitutes wound infection. Wound infection delays wound healing, and it causes wound breakdown, leading to increased hospital stay, morbidity and mortality. Most of the published data available focus on surgical site infections. In the developing countries, however, wound infection is an important cause of hospital mortality and morbidity. No data are available on the microbial profile of the wounds presenting at our hospital.
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    ABSTRACT: Trauma is one of the leading causes of mortality worldwide with infections as important causes of death in such patients. Bacterial infections cause activation of monocytes with excessive synthesis of pro-inflammatory cytokines. Hence, this prospective study was conducted to assess the activity of monocytes in traumatized sepsis patients using flow cytometry and to assess if they have any prognostic potential. A total of 16 consecutive trauma patients with sepsis and having positive blood culture were enrolled, along with four healthy controls during the period of March 2013 to July 2013. Blood from septic patients were collected on the same day when blood culture was positive and on days 2 and 5 thereafter. Surface staining for monocytes with CD14 and intracellular staining for interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) was done and results were analyzed by flow cytometer. Procalcitonin (PCT) assay was done using MiniVidas. Complete clinical follow-up was done for the patients. Of the 16 patients, four died due to infections by various microorganisms. Isolated abdominal trauma (25%) was the most common injury among the enrolled patients of sepsis. Levels of TNF-α were significantly decreased when stimulated with lipopolysaccharide in the fatal patients as compared to the healthy controls. Patients having sepsis who survived had an increased level of TNF-α during the follow-up periods. This study showed that activity of monocytes to produce TNF-α and IL-6 were reduced in severe sepsis. Early identification of such immune-paralysis can help in earlier intervention to salvage this vulnerable trauma population.
    Journal of laboratory physicians 05/2015; 7(1). DOI:10.4103/0974-2727.154785
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    ABSTRACT: Bloodstream infection (BSI) and bacteremias due to Enterococcus spp. are increasing worldwide with the current need to understand its causes among hospitalized trauma patients. Hence, the study was conducted. A 3-year retrospective laboratory cum clinical based study was performed at a level I trauma center in India. Patients with health care associated enterococcal bacteremia were identified using the hospital database, their episodes of BSI/bacteremia calculated and their clinical records and treatment were noted. A total of 104 nonrepetitive Enterococcus spp. was isolated of which Enterococcus faecium was the most common (52%). High-level resistance to gentamicin high-level aminoglycoside resistance was seen in all the Enterococcus spp. causing bacteremia, whereas a low resistance to vancomycin and teichoplanin was observed. Overall mortality was more in patients infected with vancomycin-resistant Enterococcus (5/11, 46%) compared to those with vancomycin sensitive Enterococcus (9/93, 10%); though no significant association of mortality with Enterococcus spp. bacteremia (P > 0.05) was seen. The rate of bacteremia due to Enterococcus spp. was 25.4 episodes/1,000 admissions (104/4,094) during the study period. Enterococcal bacteremia is much prevalent in trauma care facilities. Here, a microbiologist can act as a sentinel and help in preventing such infections.
    Journal of laboratory physicians 05/2015; DOI:10.4103/0974-2727.151699
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    ABSTRACT: Maxillofacial trauma is an apt example of a difficult airway. The anesthesiologist faces challenges in their management at every step from airway access to maintenance of anesthesia and extubation and postoperative care. A retrospective study was done of 288 patients undergoing surgery for maxillofacial trauma over a period of five years. Demographic data, detailed airway assessment and the method of airway access were noted. Trauma scores, mechanism of injury, duration of hospital stay, requirement of ventilator support were also recorded. Complications encountered during perioperative anaesthetic management were noted. 259 (89.93%) of the patients were male and 188 (62.85%) were in the 21-40 year range. 97.57% of the cases were operated electively. 206 (71.53%) patients were injured in motor vehicular accidents. 175 (60.76%) had other associated injuries. Mean Glasgow coma scale score (GCS), injury severity score (ISS) and revised trauma score (RTS) were 14.18, 14.8 and 12, respectively. Surgery was performed almost nine days following injury. The mean duration of hospitalization was 16 days. ICU admission was required in 22 patients with mean duration of ICU stay being two days. Majority of patients had difficult airway. 240 (83.33%) patients were intubated in the operating room and fibreoptic guided intubation was done in 159 (55.21%) patients. Submental intubation was done in 45 (14.93%) cases. Maxillofacial injuries present a complex challenge to the anaesthesiologist. The fibreoptic bronchoscope is the main weapon available in our arsenal. The submental technique scores over the time-honored tracheostomy. Communication between the anaesthesiologist and the surgeon must be given paramount importance.
    04/2015; DOI:10.4103/0259-1162.150142
  • Purva Mathur ·
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    ABSTRACT: HealthCare Associated Infections (HCAIs) are increasingly considered to be preventable adverse events, which require prioritized global attention. In the face of increasing antimicrobial resistance, prevention remains the best method to curb these infections. Surveillance of HCAIs and antimicrobial resistance using standard methods is becoming a model for prevention. Surveillance identifies the rates of HCAIs, the areas for intervention and improvement, as well as the impact of those preventive interventions. Objectivized definitions, algorithmic diagnosis and electronic databases have made surveillance systems more user-friendly and effective over time. The scope of surveillance is ever-widening with increasing need for post-discharge surveillance, day-care and home-based treatment and the technology revolution. This review provides an overview of the global health care associated infection surveillance systems and recent innovations therein.
    04/2015; DOI:10.1016/j.jpsic.2015.02.002
  • Purva Mathur ·

    03/2015; DOI:10.1016/j.jpsic.2015.02.001

  • Journal of laboratory physicians 02/2015;
  • S. Sagar · P. Mathur · A. Sharma ·
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    ABSTRACT: Object-oriented programming is not enough influential to handle the changing requirements. Component-based software development is a paradigm, which develops software systems that are integrated with the existing software component as plug-ins, which can be reused again and again. Hence, reusability of a component is more important than other quality factors of a software system. Selection of the most reusable software component is one of the critical activity for developing a quality system. Reusability has few types of sub-quality factors, which have considerable impact on reusability either directly or indirectly. In this paper Fuzzy-Analytic Hierarchy Process (Fuzzy-AHP) model is proposed for component selection using reusability as an important quality factor of a software component. Proposed model selects components with concurrent consideration of multiple criteria and ranks the components according to their reusability values. An empirical analysis has also been carried out on six industrial components, which are used for cleaning the system or improving system performance. A code is developed in Java for the proposed model, which successfully assigns the rank to each component based on overall performance index value. The result shows that the proposed approach is suitable for identifying the best software component in efficient and simple manner.
    International journal of innovative computing, information & control: IJICIC 01/2015; 11(3):1045-1058. · 1.66 Impact Factor

  • 01/2015; DOI:10.4103/1793-5482.165785
  • Priyam Batra · Purva Mathur · M.C. Misra ·

    Journal of Infection 12/2014; 70(6). DOI:10.1016/j.jinf.2014.12.004 · 4.44 Impact Factor
  • Nonika Rajkumari · Purva Mathur · Mahesh Chandra Misra ·
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    ABSTRACT: Background: Soft tissue and wound infections due to Enterococcus spp. are increasing worldwide with current need to understand the epidemiology of the Enterococcal infections of wounds and its prevalent antibiotic resistance pattern among hospitalized patients more so in trauma patients. Aim: Hence, we have looked into the distribution of Enterococcus spp. responsible for causing wound and soft tissue infections among trauma patients, its antibiotic resistance pattern and how it affects the length of hospital stay and mortality. Methodology: A laboratory cum clinical based study was performed over a period of 3 years at a level I trauma centre in New Delhi, India. Patients with Enterococcal wound and soft tissue infections were identified using the hospital data base, their incidence of soft tissue/ wound infections calculated, drug resistance pattern and their possible risk factors as well as outcomes analysed. Results: A total of 86 non-repetitive Enterococcus spp. was isolated of which E. faecium was maximally isolated 48 (56%). High level of resistance was seen to gentamicin HLAR in all the species of enterococcus causing infections whereas a low level resistance to vancomycin and teichoplanin was observed among the isolates. Longer hospital stay, repeated surgical procedure, prior antibiotic therapy and ICU stay were observed to associate with increased morbidity (p < 0.05) and hence, more chances of infections with VRE among the trauma patients. The overall rate of wound and soft tissue infections with Enterococcus sp. was 8.6 per 1,000 admissions during the study period. Conclusion: Enterococcal wound infection is much prevalent in trauma care facilities especially in the ICUs. Here, a microbiologist can act as a sentinel, help in empirical therapeutic decisions and also in preventing such infections.
    Journal of global infectious diseases 11/2014; 6(4):189-93. DOI:10.4103/0974-777X.145253
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    ABSTRACT: Introduction: As most trauma patients require long term hospital stay and long term antibiotic therapy, the risk of fungal infections in such patients are steadily increasing. Early diagnosis and rapid treatment is life saving in such critically ill trauma patients. Aims: To see the distribution of various species of Candida among trauma patients and compare the accuracy, rapid identification and cost effectiveness between VITEK 2, CHROMagar and conventional methods Settings and design: Retrospective laboratory-based surveillance study performed over a period of 52 months (January, 2009 – April, 2013) at a level I trauma centre in New Delhi, India. Methods and material: All microbiological samples positive for Candida were processed for microbial identification using standard methods. Identification of Candida was done using chromogenic medium and by automated VITEK 2 Compact system and later confirmed using the conventional method. Time to identification in both was noted and accuracy compared with conventional method. Statistical analysis used: Performed using the SPSS software for Windows (SPSS Inc. Chicago, IL, version 15.0). P values calculated using χ2 test for categorical variables. A p < 0.05 was considered significant. Results: Out of 445 yeasts isolates, C. tropicalis (217, 49%) was the species which was maximally isolated. VITEK 2 was able to correctly identify 354 (79.5%) isolates but could not identify 48 (10.7%) isolates and wrongly identified or showed low discrimination in 43 (9.6%) isolates but CHROM agar correctly identified 381 (85.6%) isolates with 64 (14.4%) misidentification. Highest rate of misidentification was seen in C. tropicalis and C. glabrata (13, 27.1% each) by VITEK 2 and among C. albicans (9, 14%) by CHROMagar. Conclusions: Though CHROMagar gives identification at a lower cost compared to VITEK 2 Wand are more accurate, which is useful in low resource countries, its main drawback is the long duration taken for complete identification.
    Indian Journal of Medical Microbiology 10/2014; 32(4):391-397. DOI:10.4103/0255-0857.142243 · 0.88 Impact Factor
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    ABSTRACT: Drug resistance to Pseudomonas sp. has spread to such a level irrespective of the type of patients, that its pattern of distribution and antibiotic resistance needs to be studied in detail, especially in trauma patients and hence the study. A 6 year study was carried out among trauma patients to see the trend and type of resistance prevalent in the apex hospital for trauma care in India among nonduplicate isolates where multidrug-resistance (MDR), cross-resistance and pan-drug resistance in Pseudomonas sp. were analyzed. Of the total 2,269 isolates obtained, the species, which was maximally isolated was Pseudomonas aeruginosa (2,224, 98%). The highest level of resistance was seen in tetracycline (2,166, 95.5%, P < 0.001) and chloramphenicol (2,160, 95.2%, P < 0.001) and least in meropenem (1,739, 76.7%, P < 0.003). Of the total, 1,692 (74.6%) isolates were MDR in which P. aeruginosa (75%) were maximum. MDR Pseudomonas is slowing increasing since the beginning of the study period. Of 1,797 imipenem-resistant P. aeruginosa isolated during the study period, 1,763 (98%) showed resistance to ciprofloxacin or levofloxacin, suggesting that cross-resistance may have developed for imipenem due to prior use of fluoroquinolones. Antibiotic resistance in Pseudomonas sp. is fast becoming a problem in trauma patients, especially in those who requires prolong hospital stay, which calls for proper antimicrobial stewardship.
    Journal of global infectious diseases 10/2014; 6(4):182-5. DOI:10.4103/0974-777X.145250
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    ABSTRACT: Introduction: Mupirocin is an effective antibiotic for elimination of methicillin-resistant Staphylococcus aureus (MRSA) from nasal colonization and has been used to control outbreaks. Current reports show an increasing trend of resistance to this antibiotic. Objective: This study was conducted to analyze the resistance pattern of MRSA to mupirocin among the patients admitted following trauma to an apex trauma care center of India and to compare the efficacy between two methods of antimicrobial sensitivity testing. Materials and Methods: A total of 150 isolates of MRSA from various clinical samples of trauma patients over a period of 2 years were included in this study. These strains were confirmed for MRSA using VITEK ® 2 Compact and the Clinical Laboratory Standard Institute disc diffusion methods. The mupirocin susceptibility of the strains was tested by using E-test and 5 μg mupirocin disc in parallel each time, and the results were compared. Results: Clear zones of inhibition were observed in both tests. Though, good correlation was observed between the disc diffusion and E-tests in >98%, E-test showed a tendency to show lower minimum inhibitory concentration (MIC) in the remaining. These finding did not affect the final interpretation or outcomes. Of the total 150 strains, 138 (92%) showed sensitivity with the zone size in the range of 30-45 mm by 5 μg disc; rest (8%) showed sensitivity with the zone in the range of 18-30 mm by 5 μg disc, but 143 (95%) showed MIC ≤ 0.094 μg/ml and 8 (5%) gave MIC ≤ 0.75 μg/ml but ≥0.094 μg/ml by E-test. However, when both tests were compared, 5 (3.3%) showed zone size between 14 and 25 mm with ≤0.75 but >0.25 μg/ml MIC; 7 (5%) falling between 25 and 30 mm zone with MIC of ≤0.25 but >0.094 μg/ml and 138 (92%) showed zone >30 mm with MIC ≤0.094 but >0.064 μg/ml. Conclusions: All the MRSA isolates in our study were sensitive to mupirocin which is an encouraging finding. Though good screening for sensitivity can be done with 5 μg mupirocin disc, E-test provides a much clear and accurate results in clinical set-up. Hence, disc test can be used in resource poor countries and supplemented with E-test when needed.
    Journal of laboratory physicians 09/2014; 6(2):91-95. DOI:10.4103/0974-2727.141505
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    ABSTRACT: Objectives Health care workers (HCWs) face constant risk of exposure to cuts and splashes as occupational hazard. Hence, a prospective observational study was conducted to observe the exposure of HCWs to various sharp injuries and splashes during health care and to work up a baseline injury rate among HCWs for future comparison in trauma care set ups. Methods A 2 years and 5 months study was conducted among the voluntarily reported exposed HCWs of the APEX trauma centre. Such reported cases were actively followed for 6 months after testing for viral markers and counselled. The outcomes of such exposed HCWs and rate of seroconversion was noted. To form a future reference point, the injury rate in trauma care HCWs based on certain defined parameters along with the rate of under reporting were also analysed in this study. Results In our study, doctors were found to have the highest exposures (129, 36.2%), followed by nurses (52, 14.6%) and hospital waste disposal staff (27, 7.6%). Of the source patients, highest number of them were HBV positive (11, 3.1%), followed by HIV positive patients (8, 2.2%). No seroconversion was seen in any of the exposed HCWs. Injuries by sharps (303, 85.1%) outnumber those due to the splashes (53, 14.9%) which were much higher in those working in pressing situations. Underreporting was common, being maximally prevalent in hospital waste disposal staff (182, 51.1%). Conclusions High rates of exposure to sharp injuries and splashes among HCWs call for proper safety protocols. Proper methods to prevent it, encouraging voluntary reporting and an active surveillance team are the need of the hour.
    Injury 09/2014; 45(9). DOI:10.1016/j.injury.2014.03.001 · 2.14 Impact Factor
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    ABSTRACT: Purpose: Candida spp. is a common cause of bloodstream infections. Candidemia is a potentially fatal infection that needs urgent intervention to salvage the patients. Trauma patients are relatively young individuals with very few comorbidities, and the epidemiology of candidemia is relatively unknown in this vulnerable and growing population. In this study, we report the epidemiology of candidemia in a tertiary care Trauma Center of India. Materials and Methods: The study was conducted from January 2009 to July 2012. All patients from whose blood samples a Candida spp. was recovered were included in this study. A detailed history and follow up of the patients was done. The isolates of Candida were identified to the species level. The speciation was done by conventional methods, including morphology on Corn Meal Agar, color development on Triphenyl Tetrazolium Chloride Agar and CHROMagar, and germ tube tests. The VITEK 2 YST ID colorometric card, a fully automated identification system was also used. Antifungal susceptibility was performed using the VITEK 2 system. Results: A total of 212 isolates of the Candida species were recovered from blood samples of 157 patients over the study period. Candida tropicalis, 82 (39%), was the most common, followed by C. parapsilosis, 43 (20%), C. albicans, 29 (14%), C. glabrata, 24 (11%), C. rugosa, 20 (9%), C. hemulonii,; 6 (3%), C. guilliermondii, 4 (2%), C. famata, 3 (1.5%), and C. lusitaniae 1 (0.5%). Out of all the candidemia patients, 68 (43%) had a fatal outcome. Fluconazole and Amphotericin B resistance was seen in seven (3.3%) and seven (3.3%) of the isolates, respectively. Conclusion: Candidemia is a significant cause of mortality in trauma patients in our center, with C. tropicalis and C. parapsilosis being the predominant pathogens. Resistance to antifungal drugs is a matter of concern. Better hospital infection control practices and good antibiotic stewardship policies could possibly help in reducing the morbidity and mortality associated with candidemia.
    Journal of laboratory physicians 07/2014; 6(2):96-101. DOI:10.4103/0974-2727.141506
  • Sonal Asthana · Purva Mathur · Vibhor Tak ·
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    ABSTRACT: The greatest threat to antimicrobial treatment of infections caused by Gram-negative bacteria is the production of carbapenemases. Metallo-beta-lactamases and plasmid-mediated serine carbepenemases like Klebsiella pneumonia carbapenemase are threatening the utility of almost all currently available beta-lactams including carbapenems. Detection of organisms producing carbapenemases can be difficult, because their presence does not always produce a resistant phenotype on conventional disc diffusion or automated susceptibility testing methods. These enzymes are often associated with laboratory reports of false susceptibility to carbapenems which can be potentially fatal. Moreover, most laboratories do not attempt to detect carbapenemases. This may be due to the lack of availability of guidelines and procedures or lack of knowledge and expertise. Because routine susceptibility tests may be unreliable, special tests are required to detect the resistance mechanisms involved. This document describes the standard methodology for detection of various types of carbapenemases, which can be put to use by laboratories working on antimicrobial resistance in Gram-negative bacteria.
    Journal of laboratory physicians 07/2014; 6(2):69-75. DOI:10.4103/0974-2727.141497