[Show abstract][Hide abstract] ABSTRACT: Purpose
To compare short- and extended-regimen post-operative antibiotic prophylaxis after open reduction internal fixation (ORIF) of single uncomplicated mandibular fractures.
Subjects and methods
A prospective, single centre, randomized, double-blinded, placebo-controlled study was carried out where 39 patients with single uncomplicated mandibular fractures were treated by an intra-oral approach. They were divided into two groups: group 1 (20 patients) and group 2 (19 patients). Each group received injection amoxicillin + clavulanic acid (30 mg/kg/day) pre-operatively, intra-operatively and for 24 h post-operatively. Group 1 then received placebo and group 2 received oral amoxicillin + clavulanic acid (30 mg/kg/day) in two divided doses for the next 4 days. The patients were evaluated on the 3rd and 7th post-operative day for signs of clinical infection and suture site aspirates were collected for culture. Microbial load was evaluated against the presence or absence of clinical infection in both the groups.
Two patients (10%) in group 1 and three patients (15.7%) in group 2 had clinical signs of infection. No statistically significant difference (p = 0.58) was seen in the incidence of infection in both the groups. Microbial load was positive in seven patients (35%) and six patients (30%) in group 1; four patients (21%) and three patients (15.8%) in group 2 on the 3rd and 7th post-operative day respectively. No statistical significance was seen with the presence of microbial load and clinical signs of infection in both groups.
After ORIF of single uncomplicated mandibular fractures, infection rates are the same with either short- or extended-antibiotic regimen.
[Show abstract][Hide abstract] ABSTRACT: Background
Ongoing educational programs targeting health care professionals have shown positive outcomes by reducing the morbidity and mortality associated with health care–associated infections (HAIs). We undertook this study to measure the impact of such a program in a pediatric critical care unit of a developing country.
This prospective study was conducted in 2 time periods of 6 months each, with an educational intervention for resident doctors and nurses in between. The rates of ventilator-associated pneumonia (VAP) during the preintervention and postintervention periods were estimated by active surveillance.
The incidence density of VAP was reduced by 28% (20.2 vs 14.6 per 1,000 ventilator-days; P = .21, Z test) despite a significant increase in the ventilator utilization ratio during the postintervention period (0.64 vs 0.88; P < .0001, Pearson’s χ² test). There was a statistically significant reduction in mortality among patients who received mechanical ventilation for ≥48 hours in the postintervention period (49.3% vs 31.4%; P = .029, Pearson’s χ² test).
Educational programs have a positive impact on reducing the morbidity and mortality associated with HAIs. Incidence rates based on device-days should be compared by keeping the variations in device utilization ratio in mind.
No preview · Article · Feb 2014 · American journal of infection control
[Show abstract][Hide abstract] ABSTRACT: Background & objectives:
Healthcare associated infections (HAIs) are responsible for morbidity and mortality among immunocompromised and critically ill patients. We undertook this study to estimate the burden of HAIs in the paediatric cancer patients in a tertiary care hospital in north India.
This prospective, observational study, based on active surveillance for a period of 11 months was undertaken in a 4-bedded isolated, cubicle for paediatric cancer patients. Patients who stayed in the cubicle for ≥48 h, were followed prospectively for the development of HAIs.
Of the 138 patients, 13 developed 14 episodes of HAIs during the study period. Patient-days calculated were 1273 days. Crude infection rate (CIR) and incidence density (ID) of all HAIs were 9.4/100 patients and 11/1000 patient-days, respectively. Of the 14 episodes of HAIs, seven (50%) were of blood stream infections (HA-BSI), five (36%) of pneumonia (HAP) and two (14%) urinary tract infections (HA-UTI). The CIRs of HA-BSI, HAP and HA-UTI were 5.1, 3.6 and 1.4/100 patients, respectively. The corresponding IDs were 5.5, 3.9 and 1.6/1000 patient-days, respectively. Mean length of stay was significantly higher in patients who developed an HAI [13.8 (range 7-30), median (Interquartile range) 12 (11-14)] vs 7.5 days [range 2-28, median (interquartile range) 7 (5-9); P<0.0001]. Also mortality was significantly higher in patients who developed an HAI [23% (3/13) vs 3% (4/125), P<0.05].
Interpretation & conclusions:
The incidence of HAIs in the paediatric cancer patients in the study was 11/1000 patient days, of which HA-BSIs were the commonest. HAIs were associated with an increase in morbidity and mortality amongst this high risk patient population.
No preview · Article · Dec 2013 · The Indian Journal of Medical Research
[Show abstract][Hide abstract] ABSTRACT: To describe the clinico-bacteriological profile, and early outcomes of infants diagnosed with Group B streptococcus (GBS) meningitis.
This was a retrospective review of infants (aged 1 mo to 2 y) diagnosed with GBS meningitis in a tertiary care hospital in New Delhi from October 2010 through January 2012. The clinico-bacteriological data and early outcomes of infants with suspected bacterial meningitis and a positive CSF latex agglutination test for GBS were studied. The CSF samples were subjected to PCR for broad spectrum 16s ribosomal DNA and the GBS species specific gene, the scpB.
Twenty seven patients (13 boys, and 14 girls) were diagnosed with GBS meningitis during the study period. Broad spectrum 16s ribosomal DNA PCR was performed on 18 of the 27 CSF samples. Sixteen were positive. All these 16 were also positive for the species specific scpB gene. The median duration of hospital stay was 7 d (range 1-72 d). Nine patients died. One patient each developed ventriculitis, optic atrophy and hydrocephalus. Overall, 12 patients had a complete recovery at discharge.
GBS must be considered in the etiology of bacterial meningitis in Indian infants.
No preview · Article · Jul 2013 · The Indian Journal of Pediatrics
[Show abstract][Hide abstract] ABSTRACT: Background & objectives:
Haemophilus influenzae is an important cause of mortality and morbidity among young children in developing countries. Increasing incidence of antibiotic resistance especially production of extended spectrum beta lactamase (ESBL) has made treatment and management of H. influenzae infection more difficult. Nasopharyngeal H. influenzae isolates are excellent surrogate for determination of antibiotic resistance prevalent among invasive H. influenzae isolates. In this study, we characterized nasopharyngeal H. influenzae isolates obtained from healthy school going children in Delhi.
Nasopharyngeal H. influenzae isolates were collected from healthy school going children and subjected to serotyping, fimbrial typing and antibiogram profiling. ESBL production was recorded using phenotypic as well as molecular methods. Multi locus sequence typing (MLST) of 13 representative nasopharyngeal H. influenzae isolates was performed as per guidelines.
A significant proportion (26 of 80, 32.5%) of nasopharyngeal isolates of H. influenzae were identified as serotype b. Fimbrial gene (hifA) was detected in 23 (28.75%) isolates. Resistance against commonly prescribed antibiotics (Amp, Tet, Chloro, Septran, Cephalexin) were observed to be high among the nasopharyngeal commensal H. influenzae. Extended spectrum beta lactamase (ESBL) production was observed in a five (6.25%) isolates by both double disk diffusion and molecular typing. MLST identified several novel alleles as well as novel sequence types.
Interpretation & conclusions:
Our findings showed high resistance against common antibiotics and detection of ESBL in nasopharyngeal H. influenzae isolates collected from normal healthy school going children in Delhi. Detection of H. influenzae type b capsular gene and the presence of fimbrial gene (hif A) suggest virulence potential of these isolates. Discovery of novel alleles and presence of new sequence types (STs) among nasopharyngeal H. influenzae isolates may suggest wider genetic diversity.
No preview · Article · Nov 2012 · The Indian Journal of Medical Research
[Show abstract][Hide abstract] ABSTRACT: In addition to adequate drainage, successful management of complicated pleural effusions and empyema also requires prompt and aggressive treatment with appropriate antibiotics, for which knowledge of the causative organisms involved is essential. In this study (January 2001 to December 2004), the bacteriological profile of patients with pleural effusion/empyema admitted to our hospital was analysed. A total of 2906 pleural fluid samples were received, of which 459 (15.8%) samples were culture positive. The number of Gram-negative and Gram-positive organisms isolated was 412 (86.4%) and 65 (13.6%), respectively. The most frequent Gram-negative organisms were Acinetobacter spp. (27.7%), Pseudomonas aeruginosa (23.9%) and Klebsiella spp. (12.6%). Staphylococcus aureus (9.6%) was the most frequent Gram-positive organism. Most of the pathogens showed resistance to multiple antibiotic agents.
[Show abstract][Hide abstract] ABSTRACT: Two hundred Staphylococcus aureus strains collected from an Indian hospital were tested for mupirocin susceptibility using disc diffusion method and E-test. High-level and low-level mupirocin resistance was detected in 10 (5%) and 2 (1%) S. aureus strains, respectively. Pulsed-field gel electrophoresis analysis of the high-level mupirocin-resistant methicillin-resistant S. aureus isolates revealed the presence of 2 clones with the majority of strains belonging to 1 clone, suggesting clonal dissemination.
No preview · Article · Jun 2007 · Diagnostic Microbiology and Infectious Disease
[Show abstract][Hide abstract] ABSTRACT: Extended-spectrum beta-lactamases (ESBLs) are rapidly evolving group of beta-lactamase enzymes produced by the Gram negative bacteria. These enzymes have been derived from TEM and SHV genes by mutations and have been well described in Klebsiella pneumoniae. Information on molecular types of ESBL positive Klebsiella sp. is lacking from India. We therefore undertook this study to look for the TEM and SHV genes in ESBL positive Klebsiella sp. isolated from the patients admitted to a tertiary care hospital in north India.
A total of 204 multidrug-resistant isolates of Klebsiellae obtained from clinical samples; blood (n=108), urine (n=15), pus (n=2) and sputum (n=79) were obtained and screened for resistance to 3rd generation cephalosporins (3GC). The ESBL status was determined by double disk diffusion test (DDDT) and further by ESBL E-test. Multiplex PCR specific for TEM and SHV genes was performed to distinguish four different genotypes: TEM-positive, SHV-positive, TEM- and SHV-positive and non-TEM non-SHV ESBL types.
Eighty six per cent (175 of 204) of the isolates were found to be resistant to at least one of the 3GCs, of which 97.1 per cent (170) of Klebsiella sp. isolates were confirmed to be positive for ESBL. Of these 170 isolates, 95 were randomly selected for PCR of TEM and SHV genes. Isolates having both TEM and SHV genes were common (67.3%) whereas only 20 per cent isolates possessed TEM gene and 8.4 per cent SHV gene alone.
Our findings showed that the majority of the ESBL positive clinical isolates of Klebsiella sp. carried both TEM and SHV genes followed by TEM alone. Such studies need to be done in various geographical regions of the country to know about the prevalent genotypes for better management of infection.
Full-text · Article · Feb 2007 · The Indian Journal of Medical Research
[Show abstract][Hide abstract] ABSTRACT: This prospective study was carried out to look for the frequency of isolation of Citrobacter species from clinical specimens and study their antimicrobial susceptibility pattern.
Patients from whom Citrobacter species were isolated during routine diagnostic testing from January to December 2004 were included in the study. Isolates were identified by standard biochemical tests. Antimicrobial susceptibility testing was performed by disk diffusion method as per National Committee of Clinical Laboratory Standards (NCCLS) guidelines.
Citrobacter species were isolated from a total of 205 patients. Infection was nosocomially acquired in 94.6% patients. One hundred eighty one (88.3%) patients had significant underlying illnesses. Culture yielded Citrobacter koseri in 185 (90.2%) and Citrobacter freundii in 20 (9.8%) patients. The distribution of isolates was as follows: urine (46.2%), respiratory tract (16.3%), blood (15.8%), pus (12.1%) and sterile body fluids (9.3%). Drug resistance was observed to be more in C. koseri as compared to C. freundii.
Citrobacter infections are often nosocomially acquired, seen in patients with significant underlying diseases and isolates are commonly drug-resistant. Adoption of hospital infection control practices and a good antibiotic policy may prevent their spread.
No preview · Article · Feb 2007 · The Journal of infection
[Show abstract][Hide abstract] ABSTRACT: Infective Endocarditis (IE) is an emerging infection of the twenty-first century. This chronic Infection is mainly caused by bacteria, although fungi can also be associated with it. It is Important to know the profile of bacteria causing IE in a given region so as to suggest the empirical therapy for this serious illness. Blood culture isolates of clinically diagnosed or suspected cases of IE admitted to various wards of the All India Institute of Medical Sciences were analyzed retrospectively from January 2000 to June 2004. Standard techniques were used for the isolation and identification of the bacteria. Our study has demonstrated the predominance of Gram-negative bacilli, especially, Acinetobacter species and Pseudomonas aeruginosa, which are notorious for antimicrobial resistance, as the aetiological agents of IE. Amongst Gram-positive cocci, Enterococci exhibiting HLAR comprised the predominant species. Methicillin resistance among staphylococcal strains in this Tertiary care hospital is adding to the therapeutic challenge in the management of this serious illness. Although antimicrobial treatment should not be delayed in such cases, we cannot undermine the importance of isolation and identification of the etiological agents and the determination of the antimicrobial susceptibility for the management of these life-threatening conditions as well as for the formulation of guidelines for empirical therapy of these cases.
No preview · Article · Jan 2007 · The Journal of communicable diseases
[Show abstract][Hide abstract] ABSTRACT: Carbapenems are beta-lactam antibiotics, presently considered as most potent agents for treating multi-drug resistant Gram-negative bacilli infections. In India carbapenems available for use are meropenem and imipenem, introduced recently. Resistance to these has been reported in a few bacteria especially Pseudomonas spp. We therefore retrospectively evaluated the antibiotic susceptibility pattern to these agents amongst various clinical isolates in a tertiary care hospital in north India.
In this study Gram-negative bacterial pathogens isolated from clinical samples were tested for extended spectrum beta lactamase (ESBL) production. All ESBL positive bacteria were tested for meropenem and imipenem activity pattern using NCCLS guidelines. A total of 2626 consecutively isolated Gram-negative bacteria, which tested positive for ESBL production by the double disk diffusion method, were included.
The different bacteria isolated were Pseudomonas spp. 759, Acinetobacter spp. 676, Escherichia coli 569, Klebsiella spp. 343, Enterobacter spp. 150, Citrobacter spp. 57 and Proteus spp. 72. Overall resistance to meropenem was more (22.16%) than imipenem (17.32%). Maximum resistance was seen in Pseudomonas spp. M(R) 37.6 per cent, I(R) 30 per cent. In isolates from intensive care units (ICU) resistance to carbapenems was significantly higher than non-ICU patients.
Resistance to meropenem and imipenem was seen in various clinical isolates of Gram-negative ESBL-positive bacteria. There is a need to alarm our clinicians for judicious use of antibiotics.
Full-text · Article · Aug 2006 · The Indian Journal of Medical Research
[Show abstract][Hide abstract] ABSTRACT: Currently, the use of beta-lactamase inhibitors in combination with beta-lactam antibiotics represents an effective measure to combat a specific resistance mechanism of beta-lactamase producing organisms. Knowledge about the susceptibility profile of bacteria to different combination agents available is essential to guide appropriate treatment of severe infections in hospitalized patients. The present study compares the in vitro activity of three commercially available beta-lactam/beta-lactamase inhibitor combinations (piperacillin/tazobactam, cefoperazone/sulbactam, ticarcillin/clavulanic acid) against beta-lactamase producing gram negative bacteria in a tertiary care hospital in north India.
A total of 9004 consecutively isolated extended spectrum beta-lactamase (ESBL) producing gram negative bacteria isolated from various clinical samples from patients admitted to the All India Institute of Medical Sciences, New Delhi, from September 2003 to August 2004 were included in the study. These isolates were screened for ESBL production by the inhibitor based test recommended by the National Committee for Clinical Laboratory Standards (NCCLS). Antibiotic susceptibility testing was carried out by disc diffusion method as per NCCLS guidelines.
Of the 9004 isolates tested, 3232 (35.89%) were sensitive and 568 (6.31%) were resistant to all three combination agents, and rest 5204 (57.80%) were resistant to at least one of the combinations. Susceptibility to piperacillin/tazobactam, cefoperazone/sulbactam, and ticarcillin/clavulanic acid was 81.37, 76.06 and 45.48 per cent respectively. Piperacillin/tazobactam exhibited significantly (P<0.05) greater antimicrobial activity against Pseudomonas spp., Escherichia coli and Klebsiella spp. compared to cefoperazone/sulbactam.
Overall piperacillin/tazobactam was observed to be the best combination agent followed by cefoperazone/sulbactam in our setting. This difference in activities of these combination agents needs to be evaluated further by ascertaining their efficacy in clinical studies.
Full-text · Article · Nov 2005 · The Indian Journal of Medical Research
[Show abstract][Hide abstract] ABSTRACT: The present prospective study was carried out to determine the species distribution and antimicrobial susceptibilities of enterococci isolated from clinical samples in a tertiary care hospital of North India. Enterococcus species isolated from blood, urine, pus, sterile fluids and the hospital environment from October 2003 to January 2004 were identified by standard biochemical tests. Antimicrobial susceptibility testing was performed by the disk diffusion method as per NCCLS guidelines. Out of a total of 105 Enterococcus species recovered during the study period, E. faecium (42.90%) and E. faecalis (40.00%) constituted the predominant isolates. Enterococcus faecium was the commonest blood culture isolate while E. faecalis predominated pus and urine samples. Other species isolated were E. mundtii, E dispar, E. durans, E. avium, E. raffinosus and E. gallinarum. High-level aminoglycoside resistance was detected in 73.3% of isolates. Resistance to vancomycin, teicoplanin and linezolid was not detected. Prevalence of a wide variety of Enterococcus species in clinical samples together with their variable antimicrobial susceptibility patterns emphasizes the need for routinely carrying out detailed speciation and in vitro susceptibility testing of enterococcal isolates in the clinical bacteriology laboratory.
Full-text · Article · Aug 2005 · The Southeast Asian journal of tropical medicine and public health
[Show abstract][Hide abstract] ABSTRACT: Infection with Pseudomonas aeruginosa is a major cause of morbidity and mortality in patients with cystic fibrosis (CF). With chronicity of infection, the organism acquires a mucoid phenotype and grows as microcolonies in a biofilm in the respiratory passages of the host. This acts as a protective niche and helps the organism to evade the host immune response. In the biofilm the organism has a high resistance to antibiotics, leading to problems in eradication, and poses a therapeutic challenge. We studied the antimicrobial susceptibility of P. aeruginosa ATCC 27853 in a biofilm and as free-living forms against ciprofloxacin and gentamicin, the commonly used antibiotics in patients with CF.
Biofilm formation of P. aeruginosa ATCC 27853 was characterized by in vitro biofilm formation assay. The biofilm was detected by light microscopy and quantitated by measuring the absorbance at 575 nm and by viable bacterial counts. After the maximal biofilm was established, the effect of various concentrations of ciprofloxacin (1, 2 and 4 microg/ml) and gentamicin (4, 8, 16, 32 and 64 microg/ml) was observed and the minimal biofilm eradication concentration (MBEC) determined. The minimal bactericidal concentration (MBC) of both the antibiotics was determined against the free-living forms of the organism. The MBEC of the two antibiotics was further compared with the MBC.
On microscopic examination, the maximal biofilm of P. aeruginosa was established on a coverslip at 12 hours, the maximum absorbance was at 575 nm and viable counts were observed at 12 hours, which corresponded to the maximal biofilm production. The organisms in the biofilm showed a 4-fold greater resistance against ciprofloxacin and gentamicin as compared to the free-living forms.
In biofilm, P. aeruginosa shows greater resistance against antibiotics. This renders these antibiotics ineffective, leading to chronic and persistent infections.
Full-text · Article · Jul 2005 · The National medical journal of India