Archana Rao K

Abstract

Introduction: Catheter-associated urinary tract infections (CAUTI), remains the commonest hospital-acquired infection (HAI). This emphasizes the need to implement and monitor effective infection control programs to reduce the risk of CAUTI. Objectives: Aim of the present study was to determine the etiology with antibiotic susceptibility and also to calculate CAUTI rate. Materials and Methods: The Patients admitted in intensive care unit (ICU), Rajarajeshwari Medical College and Hospital who were on urinary catheter insertion for >48 hours from 1 August, 2019 to 30 September, 2019 were included in the study. Under aseptic conditions urine samples were collected from clinically suspected cases of CAUTI, the samples were processed in the department of Microbiology, as per standard protocols. Uropathogens were isolated, identified and subjected to antibiotic sensitivity test. CAUTI rate was calculated and results were noted. Results: Among 460 patients on catheter in ICU, 28(6%) patients developed clinical signs or symptoms of UTI. Of 28 urine samples cultured, 4(14%) yielded growth of single organis [Escherichia coli (3), Klebsiella (1)] and 24(86%) showed no evidence of growth. 2300 catheter days were obtained of 460 patients on indwelling catheter in ICU. Thus CAUTI rate was 1.74 per 1000 catheter days over a 2 month period. Discussion and Conclusion: CAUTI remained a great burden to patient safety and a challenge to the infection control team. Implementation of proper care bundles and continuous education to health care workers plays a key role in reducing the CAUTI rates, thereby decreasing the morbidity and hospital stay to the patients. Keywords: CAUTI, Devise associated, Hospital acquired, UTI, CAUTI rate.

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Abstract

Introduction: Ventilator-associated pneumonia (VAP) is a serious health care-associated infection. It prolongs hospital stay and drives up hospital costs reporting high morbidity and mortality. VAP is defined as pneumonia that occurs 48h or more after endotracheal intubation or tracheostomy, caused by infectious agents not present or incubating at the time mechanical ventilation.VAP requires rapid diagnosis and initiation of the appropriate antibiotics. Materials and Methods: The present study was done in the department of Microbiology, Rajarajeswari Medical college, Bangalore. All the clinically suspected cases of VAP from intensive care units over a period of one year were included in the study. Endotracheal aspirate (ETA) and bronchoalveolar lavage (BAL) samples were collected from all patients and processed . Identification was carried out according to standard biochemical tests. Sensitivity pattern was determined using Kirby-bauer disc diffusion according to CLSI guidelines. Results: Out of 160 patients, who were on mechanical ventilation, 7 patients fulfilled the clinical and microbiological criteria. Incidence of VAP in our study is 4.4 and incidence density is 10.5 for 1000 ventilator days.57% of bacterial isolates were found to be Acinetobacter spp. followed by Pseudomonas aeruginosa 29% and Klebsiella pneumoniae 14%. Among 7 cases, 3(43%) were Early onset, 4(57%) were late onset VAP.  Discussion and Conclusion: Even in the era of advanced medical care VAP remains a major challenge. The risk of developing VAP can be reduced by VAP prevention care bundles. Timely diagnosis is a major step to initiate appropriate antibiotics for better outcomes. Both patients and units are at risk of developing multidrug–resistant organisms and therefore appropriate antibiotic stewardship is essential. Better knowledge of local patterns of pathogens causing VAP can help facilitate treatment choice, in turn reducing the ventilator days and hospital stay. Keywords: Determination of baseline “Widal titre” amongst apparently healthy individuals at tertiary health care center

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Abstract

Introduction: Infections due to Gram-positive bacteria are on a rise, of which those due to Enterococcus spp. form a major part. The shifting pattern of infections caused by Enterococci from novel urinary tract infections to soft tissue and wound infections are increasingly reported. Objective: The aim of the present study is to isolate, speciate Enterococci, determine the antibiotic resistance pattern and to detect vancomycin resistance by E- test. Materials and Methods: All wound swabs, pus samples sent for bacterial culture, irrespective of the diagnosis of the patients which were received to the department of microbiology for a period of one year were included in the study. The samples were processed for isolation, identification and speciation of Enterococci. Antimicrobial susceptibility testing was done by Kirby-Bauer disk diffusion method. Vancomycin resistance was determined by E-test. Results: A total of 3000 pus samples were received over a period of one year. Out of which 43 isolates were detected as Enterococcus species. Among 43 isolates, 26 were E.faecalis, 17 were E.faecium. In present study, ampicillin resistance was seen in 88% followed by resistance to erythromycin (86%) and clindamycin (72%). High level gentamycin resistance was seen in 28% cases. Vancomycin resistance was not detected in any of the samples. Conclusion: The shifting spectrum of infections due to Enterococcus is gaining inquisitiveness among health care workers especially in the trauma care units. Thus there is a prerequisite to isolate speciate and determine the resistance that helps in holistic health care. Keywords: Enterococci, Soft tissue infection, Antibiotic resistance, Vancomycin resistance, E test.

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