Sweta Shah

Abstract

A 73 years old male patient, was admitted with fever, cough and generalised weakness since two to three days. He was diagnosed to have metastatic adenocarcinoma of lung 3 months back and was on chemotherapy. His blood culture grew The patient succumbed to the disease and various other comorbidities that had led to multi-organ failure. Incidence of bacteraemia due to nocardia and the associated common species in India is not known yet. It is imperative to widen the scope of the laboratory and to use diverse laboratory tools for accurate and rapid diagnosis of rare and unconventional pathogens.   Keywords: Nocardiosis, Nocardia otitidiscaviarum, Lung Adenocarcinoma

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Abstract

Bloodstream infections (BSIs) remain a leading cause of morbidity and mortality especially in intensive care units across the world and timely appropriate antimicrobial therapy is a corner stone in its treatment Aim: (i) To compare the time difference to diagnose BSIs between FABCID2 and identification and sensitivity by automated systems (ii) To analyse the clinical utility of the FABCID2 panel in positive blood samples among ICU patients. Materials and Methods: This was a prospective study done from July 2020 to August 2020 where consecutive thirty positive blood culture received from ICUs were processed for gram stain, culture and antimicrobial susceptibility along with performing PCR with BioFire FilmArray Blood Culture Identification2 (FABCID2) Panel. Time line of positive blood culture from receipt to report generation at multiple points were captured along with impact of results in terms of changing antimicrobial therapy of the patients and outcome. Results: A total of 38 microorganisms were identified from 30 patients. In 70% (21/30) of patients, the result of FABCID2 and growth in culture matched completely, in 23% (7/30) they matched partially and in 6% they did not match. The match between genotypic markers in the assay and phenotypic susceptibility was 100%. FABCID 2 results prompted clinicians to change the antimicrobials prescribed to 33% of total patients (escalation was done in 23.3% of patients and de-escalation was done in 10%. Conclusion: Clinical utility of the FABCID2 Panel in Identification of microorganisms and resistance markers from Positive Blood Culture Bottles is significant which should be used in conjunction with conventional methods to impact patient outcome and antimicrobial stewardship program.   Keywords: FilmArray, BCID 2, Blood stream infections, Blood culture

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Abstract

A 44 years old, immunocompetent, male patient was admitted to the hospital with fever and left hemiparesis. Patient had undergone decompressive craniotomy with partial clot evacuation at another institute for right Prieto-occipital intracranial haemorrhage (ICH) and subarachnoid haemorrhage (SAH) four weeks back. CT scan on the day of admission showed peripherally enhancing brain abscess in right parietal lobe with surrounding oedema which was at the surgical site. Pus evacuated from abscess grew Bacillus cereus. The patient was treated with intravenous vancomycin for two weeks with a favourable outcome. Non-gastrointestinal infections due to B.cereus are emerging.   Keywords: Bacillus cereus, Immunocompetent, Brain abscess, Craniotomy

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