2019. Effect of carbapenem resistance on outcomes of bloodstream infection caused by Enterobacteriaceae in lowincome and middle-income countries (PANORAMA): a multinational prospective cohort study. Lancet Infectious Diseases 19 (6) , pp.

Our results indicate that adherence to recommended IC practices is suboptimal. Opportunities for improvement of IC practices exist in several areas, including hospital-wide IC programs and surveillance, antibiotic stewardship, written and posted guidelines and policies across a range of topics, surgical instrument sterilization procedures, and improved hand hygiene.

Background & objectives:Vancomycin-resistant enterococci (VRE) have become one of the most challenging nosocomial pathogens with the rapid spread of the multi-drug resistant strain with limited therapeutic options. It is a matter of concern due to its ability to transfer vancomycin resistant gene to other organisms. The present study was undertaken to determine the emergence of vancomycin-resistant enterococci and the vanA gene among the isolates in a tertiary care hospital of North-East India.Methods:A total of 67 consecutive enterococcal isolates from different clinical samples were collected and identified by using the standard methods. Antibiogram was done by disk diffusion method and VRE was screened by the disk diffusion and vancomycin supplement agar dilution method. The minimum inhibitory concentration (MIC) value for vancomycin was determined by E-test. The VRE isolates were analyzed by PCR for vanA gene.Results:A total of 54 (81%) Enterococcus faecalis and 13 (19%) E. faecium were detected among the clinical isolates and 16 (24%) were VRE. The VRE isolates were multidrug resistant and linezolid resistance was also found to be in three. MIC range to vancomycin was 16-32 µg/ml among the VRE. The vanA gene was found in nine of 16 VRE isolates.Interpretation & conclusions:Emergence of VRE and presence of vanA in a tertiary care hospital setting in North-East India indicate toward a need for implementing infection control policies and active surveillance.

Of the total, 46 isolates were E. faecalis and 54 E. faecium, of which 70% (32 E. faecalis and 38 E. faecium) were HLGRE and 7% (1 E. faecalis and 6 E. faecium) were VRE. Haemolysin and gelatinase production, haemagglutination and biofilm formation was seen in 29%, 17%, 39% 34%, respectively. Virulence factors were more in E. faecalis (P > 0.05). asa1 and gelE were the most prevalent virulence genes [ Figure 1]. None harboured all the virulent genes and 10 isolates did not show any virulence factors. Majority of the strong biofilm producers possessed either asa1 or gelE gene. On statistical analysis, decreasing expression and possession of virulence genes was seen with increasing drug resistance (P < 0.05). Acquisition of vancomycin resistance resulted in this decrease (P < 0.05).We found that just as increase in one aspect of survival fitness reduces the other, as seen in community and hospital acquired Methicillin-resistant Staphylococcus aureus (MRSA), [5] acquisition of plasmids for drug resistance might have led to loss of virulence due to fitness cost benefits relating to VRE. Figure 1: CLI induction testing of S. aureus by disk diffusion. E: ERY disk (15 µg); CD: CLI disk (2 µg). MS Phenotype (a), Constitutive MLSB Phenotype (b), S phenotype (c) b a c [Downloaded free from http://www.ijmm.org on Saturday, June 13, 2015, IP: 61.16.135.116]

Aims and Objectives:To determine sputum conversion rate at monthly intervals of 1st, 2nd and 3rd month in new smear positive cases (cat-1) under treatment under RNTCP.Material and Methods:The study was conducted at DOTS Center, Gauhati Medical College and Hospital; Guwahati between July 2005 to June 2006.The study is a prospective study and consists of 100 cases of new smear positive pulmonary tuberculosis cases (category 1) irrespective of age and sex.Results and Observations:The age & sex distribution of 100 patients showed that majority of the patients (74%) belonged to 2nd, 3rd and 4th decades & 75% were males and 25% were female with male to female ratio 3:1 respectively. The chest x-ray of 100 Smear Positive patients shows that only 60 (60%) patients had x-ray evidence of pulmonary Koch. In the present study, sputum conversion i.e. from smear positive to smear negative at the end of the 1st month is 71%, at the end of 2nd month is 84% and at the end of 3rd month is 92%.Summary & Conclusion:In conclusion, the overall sputum conversion rate under Directly Observed Treatment, Short Course (DOTS) chemotherapy in 100 sputum smear positive Pulmonary Tuberculosis in DOTS centre, Gauhati Medical College & Hospital was 92%.The chest x-ray evidence of pulmonary Koch in 100 patients is 60%.The sputum conversion at the end of 1st month is 71%, at the end of 2nd month it is 84% and at the end of 3rd month the same is 92%. In the present study, the infectivity decreases from the baseline with significant P value for sputum conversion of 3+, 2+ and 1+ sputum positivity. Directly Observed Treatment is an effective intervention for improving adherence to tuberculosis treatment programme in a resource-poor country. A significant decrease in conversion rate was observed with the initial high grade smear positive cases.More Prospective studies on larger number of patients are necessary to sub-stantiate our findings in this study.