Purva Mathur

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

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Publications (71)84.59 Total impact

  • 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.
  • Purva Mathur
    03/2015; DOI:10.1016/j.jpsic.2015.02.001
  • Journal of laboratory physicians 02/2015;
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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 01/2015; 7(1). DOI:10.4103/0974-2727.154785
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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.
    01/2015; DOI:10.4103/0259-1162.150142
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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 01/2015; DOI:10.4103/0974-2727.151699
  • Priyam Batra, Purva Mathur, M.C. Misra
    Journal of Infection 12/2014; 70(6). DOI:10.1016/j.jinf.2014.12.004 · 4.02 Impact Factor
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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 · 1.04 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 · 2.46 Impact Factor
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    ABSTRACT: 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.
    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
  • European Journal of Trauma and Emergency Surgery 05/2014; 41(1). DOI:10.1007/s00068-014-0407-6 · 0.38 Impact Factor
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    ABSTRACT: Purpose b-hemolytic streptococci (bHS) causes a diverse array of human infections. The molecular epidemiology of b-hemolytic streptococcal infections in trauma patients has not been studied. This study reports the molecular and clinical epidemiology of b-hemolytic streptococcal infections at a level 1 trauma centre of India. Methods A total of 117 isolates of bHS were recovered from clinical samples of trauma patients. The isolates were identified to species level and subjected to antimicrobial susceptibility testing. Polymerase chain reaction (PCR) assay was done to detect exotoxin virulence genes. The M protein gene (emm gene) types of GAS strains were ascertained by sequencing. Results Group A Streptococcus (GAS) was the most common isolate (64 %), followed by group G Streptococcus (23 %). A large proportion of GAS produced speB (99 %), smeZ (91 %), speF (95 %) and speG (87 %). smeZ was produced by 22 % of GGS. A total of 25 different emm types/subtypes were seen in GAS, with emm 11 being the most common. Resistance to tetracycline (69 %) and erythromycin (33 %) was commonly seen in GAS. Conclusions b-hemolytic streptococcal infections in Indian trauma patients are caused by GAS and non-GAS strains alike. A high diversity of emm types was seen in GAS isolates, with high macrolide and tetracycline resistance. SpeA was less commonly seen in Indian GAS isolates. There was no association between disease severity and exotoxin gene production. Keywords b-hemolytic streptococci, Group A Streptococcus, Spe emm types, Antimicrobial resistance, Trauma patients
    European Journal of Trauma and Emergency Surgery 04/2014; 40(2):175-181. · 0.38 Impact Factor
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    ABSTRACT: β-hemolytic streptococci (βHS) causes a diverse array of human infections. The molecular epidemiology of β-hemolytic streptococcal infections in trauma patients has not been studied. This study reports the molecular and clinical epidemiology of β-hemolytic streptococcal infections at a level 1 trauma centre of India. Methods A total of 117 isolates of βHS were recovered from clinical samples of trauma patients. The isolates were identified to species level and subjected to antimicrobial susceptibility testing. Polymerase chain reaction (PCR) assay was done to detect exotoxin virulence genes. The M protein gene (emm gene) types of GAS strains were ascertained by sequencing. Results Group A Streptococcus (GAS) was the most common isolate (64 %), followed by group G Streptococcus (23 %). A large proportion of GAS produced speB (99 %), smeZ (91 %), speF (95 %) and speG (87 %). smeZ was produced by 22 % of GGS. A total of 25 different emm types/subtypes were seen in GAS, with emm 11 being the most common. Resistance to tetracycline (69 %) and erythromycin (33 %) was commonly seen in GAS. Conclusions β-hemolytic streptococcal infections in Indian trauma patients are caused by GAS and non-GAS strains alike. A high diversity of emm types was seen in GAS isolates, with high macrolide and tetracycline resistance. SpeA was less commonly seen in Indian GAS isolates. There was no association between disease severity and exotoxin gene production.
    European Journal of Trauma and Emergency Surgery 04/2014; 40(2):175-181. DOI:10.1007/s00068-013-0326-y · 0.38 Impact Factor
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    ABSTRACT: Background Central line associated blood stream infections (CLA-BSIs) are a leading cause of health care associated infections. There is paucity of data on the actual magnitude of CLA-BSIs in most hospitals of developing countries due to lack of surveillance. This study reports the impact of an intensive surveillance, training and feedback on the rates of CLA-BSIs at an Indian trauma center. Methods The study was conducted at a level 1 trauma center from June 2010 to January 2013. The clinical details of all patients and microbiology culture reports who were admitted for more than 48 h were recorded in a pre-designed pro forma. These details were further entered in an automated software based upon CDC NHSN's definitions of device associated infections. The CLA-BSI rates in a previous pilot study in 2010 were found to be very high. Intensive surveillance, education and training drive was initiated along with better hand hygiene and device care as a part of hospital infection control measures. Results During the study period, a total of 2969 patients were followed up for CLA-BSIs. These patients amounted to a total of 27,394 ICU days and 15,443 CVC days. A total of 93 episodes of CLA-BSI occurred during the study, amounting to a CLA-BSI rate of 6.02/1000 CVC days. Staphylococcus aureus (27; 27.5%) was the most common isolate. A total of 101 episodes of secondary BSIs were also observed during the study. Of these, 70 (69%) were secondary to VAP, 18 (18%) were secondary to wound infections and 13 (13%) were secondary to UTI. Of the 92 patients who accounted for the 93 episodes of CLA-BSIs, a total of 20 (21.7%) had a fatal outcome. Conclusions Thus, with the help of the intensive surveillance, using this software, we have been able to monitor the impact of training, surveillance and interventions on the rates of CLA-BSI, which have reduced from 27.6 to 6/1000 CVC days within a span of 2 years at our institute. Although these measures require a dedicated team effort, they are easy and cost effective to implement and can reduce all device associated infections across all types of health care facilities.
    04/2014; DOI:10.1016/j.jpsic.2013.12.001
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    ABSTRACT: Beta-hemolytic streptococci (βHS) cause a diverse array of human infections. Despite the high number of cases of streptococcal carriers and diseases, studies discerning the molecular epidemiology of βHS in India are limited. This study reports the molecular and clinical epidemiology of beta-hemolytic streptococcal infections from two geographically distinct regions of India. A total of 186 isolates of βHS from north and south India were included. The isolates were identified to species level and subjected to antimicrobial susceptibility testing. Polymerase chain reaction (PCR) was done to detect exotoxin genes, and emm types of group A streptococci (GAS) strains were ascertained by sequencing. GAS was the most common isolate (71.5%), followed by group G streptococci (GGS) (21%). A large proportion of GAS produced speB (97%), smeZ (89%), speF (91%), and speG (84%). SmeZ was produced by 21% and 50% of GGS and GGS, respectively. A total of 45 different emm types/subtypes were seen in GAS, with emm 11 being the most common. Resistance to tetracycline (73%) and erythromycin (34.5%) was commonly seen in GAS. A high diversity of emm types was seen in Indian GAS isolates with high macrolide and tetracycline resistance. SpeA was less commonly seen in Indian GAS isolates. There was no association between disease severity and exotoxin gene production.
    The Journal of Infection in Developing Countries 03/2014; 8(3):297-303. DOI:10.3855/jidc.3216 · 1.27 Impact Factor
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    ABSTRACT: There is an alarming rate of morbidity and mortality observed in the trauma victims who suffer spinal cord injuries (SCI). Such patients are admitted immediately and stay for longer periods of time and thus are at risk of acquiring nosocomial infections. The aim of this study is to analyze the primary cause of mortality in SCI patients. Retrospective study. We conducted a retrospective 4 year analysis of the postmortem data of 341 patients who died after sustaining SCI at a tertiary care apex trauma center of India. Epidemiological data of patients including the type of trauma, duration of hospital stay, cause of death and microbiological data were recorded. On autopsy, out of 341 patients, the main cause of death in the SCI patients was ascertained to be infection/septicemia in 180 (52.7%) patients, the rest 161 (47.2%) died due to severe primary injury. Respiratory tract infections (36.4%) were predominant followed by urinary tract infections (32.2%), blood stream infections (22.2%), wound infections (7.1%) and meningitis reported in only 5 (2.1%) cases. Acinetobacter sp (40%) was the predominant organism isolated, followed by Pseudomonas sp (16.3%), Klebsiella sp (15.1%), Candida sp (7.8%), Escherichia coli (6.9%), Staphylococcus aureus (6.9%), Proteus sp (3.3%), Enterobacter sp and Burkholderia sp (two cases each) and Stenotrophomonas sp (one case). A high level of multidrug resistance was observed. Hospital acquired infections (HAI) are leading cause of loss of young lives in trauma patients; hence efforts should be made to prevent HAIs.
    Journal of laboratory physicians 03/2014; 6(1):36-9. DOI:10.4103/0974-2727.129089

Publication Stats

364 Citations
84.59 Total Impact Points

Institutions

  • 2002–2014
    • All India Institute of Medical Sciences
      • • Department of Laboratory Medicine
      • • Department of Microbiology
      • • Division of Clinical Microbiology
      New Dilli, NCT, India
  • 2010
    • AIIMS Bhopal All India Institute of Medical Sciences
      Bhopal, Madhya Pradesh, India