Purpose: To present varied clinical presentations, surveillance reports, and final visual outcomes of a rare outbreak of cluster endophthalmitis caused by gram-negative, opportunistic bacilli, Burkholderia cepacia complex (Bcc). Methods: Details of five patients who developed postoperative cluster endophthalmitis were collected. For each patient, an undiluted vitreous sample was collected during vitreous tap. Bacterial culture from the vitreous sample in each case had grown Bcc. Surveillance investigations for root cause analysis (RCA) were performed in the operating room (OR), admission, and day-care wards to localize the source. Results: Four patients had undergone phacoemulsification surgery, and one patient had undergone penetrating keratoplasty. Each patient received an initial dose of empiric intravitreal ceftazidime and vancomycin. The organism isolated in each case was sensitive to ceftazidime, cotrimoxazole, and meropenem and resistant to other antibiotics. Core vitrectomy was done after 48–60 hours in four patients along with intravitreal imipenem injection. One patient did not provide consent for core vitrectomy and subsequently developed phthisis bulbi. Three patients had subsequent recurrences. Two patients had a final BCVA of 20/60, two had BCVA better than 20/200, while one patient had no perception of light. None of the surveillance samples from the OR complex could isolate Burkholderia . Conclusion: Extensive OR surveillance should be done to identify the potential source of infection. However, the source may not be identifiable in few instances like in our case. Longer follow-up is recommended in cases of Bcc endophthalmitis due to the persistent nature of the infection.

Introduction: Vancomycin-resistant enterococci (VRE) are emerging as an important multidrug-resistant pathogen causing nosocomial infections, predominantly bacteremia and urinary tract infections. VRE bacteremia has caused a significant increase in the duration of the hospital stay and mortality and had caused high public health threat due to limited treatment options. Materials and methods: Between October 2017 and September 2020, all consecutive patients with culture-proven bloodstream infection with Enterococcus species, isolated for the first time, were included in the study. A total of 427 Enterococcus species were identified, and antimicrobial susceptibility tests were performed and interpreted using Clinical and Laboratory Standard Institute guidelines. Results: Of the total 427 Enterococcus species isolated, 63 (45.6%) were VRE. Among them, 51/63 (81%) were Enterococcus faecium ( E. faecium ) and 5/63 (8%) were Enterococcus faecalis . There was an increased trend of VRE rate in the bloodstream infections of 6.12% (2018), 13.2% (2019), and 19.2% (2020). The majority of the VRE patients [43/63 (68%)] were admitted to the intensive care units (ICUs). Vancomycin A (VanA) is the most common phenotype isolated from 51/63(81%) patients. Conclusion: This increasing trend of VRE bacteremia is a red alert to the clinicians and the infection control practitioners, so that strict antibiotic policies and proper adherence to the infection control practices can be initiated to reduce the VRE rate. How to cite this article: Sivaradjy M, Gunalan A, Priyadarshi K, Madigubba H, Rajshekar D, Sastry AS. Increasing Trend of Vancomycin-resistant Enterococci Bacteremia in a Tertiary Care Hospital of South India: A Three-year Prospective Study. Indian J Crit Care Med 2021;25(8):881–885.

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Introduction: The blood culture (BC) contamination was a significant problem in our hospital, especially in the emergency department (ED). The study, therefore, was undertaken to improve the BC collection in the ED. Methods: The study was conducted for 1 year divided into two phases of 6 months each: Preintervention phase and intervention phase (regular and phlebotomist groups). The interventions comprised implementing standard protocol for BC collection and conducting educational sessions. In preintervention and regular groups, the BCs were collected by interns and technicians, while dedicated phlebotomist did so in the phlebotomist group. Data were analyzed and interpreted for the contamination rate as well as compliance in adequate filling of the requisition form. Statistical Package for the Social Sciences (SPSS) version 22. A value of P < 0.005 was considered statistically significant, and P < 0.01 was considered statistically significant. Results: In the preintervention group, 13.7% of specimens were reported as contaminated which was reduced to 4.2% and 3.2% in the regular and phlebotomist group, respectively, after intervention. Compliance of health-care workers to various elements of BC collection protocol was also found to be significantly improved in the intervention phase compared to the preintervention phase ( P < 0.001). Conclusions: Implementation of this multimodal intervention resulted in a drastic reduction in BC contamination and improvement in compliance to BC collection protocol and filling of various parameters in the BC requisition form, thus improving the overall effectiveness of BC testing. It was also noted that the contamination rate was further reduced by implementing dedicated phlebotomist.

A B S T R A C T BACKGROUNDDespite several efforts, tuberculosis (TB) continues to be a global concern. For proper management of TB, more sensitive and specific biomarkers for early and accurate diagnosis of TB are still required. Blood based host markers are more appealing as an alternate to sputum-based diagnostics. Thus, in the present study, we evaluated the potential of Serum Complement Component 1 Q Subcomponent C (C1qC) as a marker for tuberculosis. METHODSSerum samples from 84 subjects which included 39 smear positive pulmonary TB patients and 45 controls (Latent TB n=15, Healthy n= 15 and patients with respiratory diseases other than TB n= 15) were collected and Enzyme Linked Immunosorbent Assay was performed to estimate the serum C1qC levels. RESULTSThe mean (±SD) serum C1qC levels in TB, Healthy, Latent TB and patients with respiratory diseases other than TB was found to be 21.80 (±4.39), 13.64 (±1.32), 15.18(±1.29) and 17.31(±1.87) pg/ml respectively. The AUC of serum C1qC to discriminate TB patients from controls was found to be 0.924 (95% CI, 0.869-0.978). At an optimal cut-off value of 16.99 pg/ml, the sensitivity and specificity of serum C1qC to discriminate TB from controls was found to be 84.62% (95% CI, 69.47%-94.14%) and 84.44% (95% CI, 70.54%-93.51%) respectively with a likelihood ratio of 5.44. CONCLUSIONSThe levels of serum C1qC in TB patients was found to be significantly higher than controls. C1qC seems to be a promising marker for the diagnosis and therapeutic monitoring of TB, though further elaborate studies in larger cohorts are required to establish the role for C1qC in the diagnosis and therapeutic monitoring of TB.