Background and Aims:Health-care-associated infection is a key factor determining the clinical outcome among patients admitted in critical care areas. The objective of the study was to ascertain the epidemiology and risk factors of health-care-associated infections in Intensive Care Units (ICUs) in a tertiary care hospital.Methods:This prospective, observational clinical study included patients admitted in ICU over a period of one and a half years. Routine surveillance of various health-care-associated infections such as catheter-associated urinary tract infections (CAUTI), central-line-associated blood stream infections (CLABSI), and ventilator-associated pneumonias (VAP) was done by the Department of Microbiology through specific Infection Surveillance Proforma.Results:Out of 679 patients, 166 suffered 198 episodes of device-associated infections. The infections included CAUTI, CLABSI, and VAP. The number of urinary tract infection (UTI) episodes was found to be 73 (10.75%) among the ICU patients who had indwelling urinary catheter. In addition, for 1 year CAUTI was calculated as 9.08/1000 catheter days. The number of episodes of blood stream infection was 86 (13.50%) among ICU patients having central line catheters. Also, CLABSI was found to be 13.86/1000 central line days. A total of 39 episodes (6.15%) of VAP was found in ICU patients over 18 months and VAP present for 6.04/1000 ventilator days.Conclusions:The organisms most commonly associated with health-care-associated infections were Pseudomonas aeruginosa and Acinetobacter species. The risk factors identified as being significantly associated with device associated infections in our ICU were diabetes, COPD and ICU stay for ≥8 days (P < 0.05).

Clindamycin is kept as a reserve drug and is usually advocated in severe MRSA infections depending upon the antimicrobial susceptibility results. We have reported a higher incidence of iMLS(B) from both community (66.67%) as well as hospital (33.33%) setup. Therefore clinical microbiology laboratory should report inducible clindamycin resistance routinely.

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Background:Urinary tract infection due to Escherichia coli is one of the common problem in clinical practice. Various drug resistance mechanisms are making the bacteria resistant to higher group of drugs making the treatment options very limited. This study was undertaken to detect ESBLs and AmpC production in uropathogenic Escherichia coli isolates and to determine their antimicrobial susceptibility pattern with special reference to fosfomycin.Materials and Methods:A total number of 150 E. coli isolates were studied. ESBL detection was done by double disc synergy and CLSI method. AmpC screening was done using cefoxitin disc and confirmation was done using cefoxitin/cefoxitin-boronic acid discs. In AmpC positive isolates, ESBLs was detected by modifying CLSI method using boronic acid. Antimicrobial susceptibility pattern was determined following CLSI guidelines. Fosfomycin susceptibility was determined by disc diffusion and E-test methods.Results:ESBLs production was seen in 52.6% of isolates and AmpC production was seen in 8% of isolates. All AmpC producers were also found to be ESBLs positive. ESBLs positive isolates were found to be more drug resistant than ESBLs negative isolates. All the strains were found to be fosfomycin sensitive.Conclusions:ESBLs and AmpC producing isolates are becoming prevalent in E. coli isolates from community setting also. Amongst the oral drugs, no in-vitro resistance has been seen for fosfomycin making it a newer choice of drug (although not new) in future. An integrated approach to contain antimicrobial resistance should be actually the goal of present times.

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Here we report a case of a 55-year-old Indian male presenting with multiple subcutaneous cysts, which developed from painful nodules at the dorsal right wrist joint. Subsequently a painful nodule appeared on the left knee joint. Cytological examination of the knee swelling revealed a suppurative inflammatory lesion consisting of neutrophils, lymphocytes, multinucleated giant cells and few fungal elements, without involvement of the overlying skin. Exophiala spinifera was cultured (CBS 125607) and its identity was confirmed by sequencing of the internal transcribed spacer (ITS rDNA). The cysts were excised surgically, without need of additional antifungal therapy. There was no relapse during one-year follow-up and the patient was cured successfully. In vitro antifungal susceptibility testing showed that posaconazole (0.063 μg/ml) and itraconazole (0.125 μg/ml) had the highest and caspofungin (4 μg/ml) and anidulafungin (2 μg/ml) the lowest activity against this isolate. However, their clinical effectiveness in the treatment of E. spinifera infections remains to be evaluated. In this case report, we have also compiled cases of human E. spinifera mycoses which have been reported so far.

We report the first case of fatal brain infection in an Indian farmer caused by Thielavia subthermophila, a dematiaceous thermophilic fungus in the order Sordariales, and present a review of previous infections from this order. The patient failed amphotericin B therapy combined with surgical excision despite the drug's low MICs in vitro. CASE REPORTA 39-year-old male presented in the Emergency Department of Government Medical College Hospital (GMCH), Chandigarh, India, with complaints of multiple episodes of generalized tonic-clonic seizures for the previous 10 days. He experienced, in addition to the seizures, uncontrolled movements of his limbs and rolling of his eyes, incontinence of urine, and production of foam from his mouth. There was a history of fever for 2 days, associated with an attack of seizures. He was a resident of Ambala (Haryana State, northern India) and a farmer by occupation, with a low socioeconomic status. He was first admitted to a local hospital in Ambala and was subsequently transported to the GMCH. In the past, he never had headaches or any other significant complaints. There was no history of any trauma, roadside accidents, near-drowning, or similar predisposing factors.On examination, the patient was having an altered sensorium and was disoriented, with a Glasgow coma score of E2V2M4. On the basis of generalized tonic-clonic seizures, a presumptive diagnosis of meningioma was made. His chest X ray and electrocardiogram (ECG) were normal. A lumbar puncture was done, and cerebrospinal fluid (CSF) was sent for cytological, biochemical, and microbiological examination. Gram staining, Ziehl-Neelsen (ZN) staining, and fungal smears of CSF were negative, and there was no growth of either bacteria or fungi. The cytological and biochemical examination of CSF was noncontributory. The other laboratory investigations revealed that his hemogram, white blood cells, serum electrolytes, liver function, and glucose concentration were within normal ranges.A magnetic resonance image (MRI) of his brain showed a large, supratentorial, intracranial, right-frontotemporal, spaceoccupying lesion (7.0 by 7.5 by 8.6 cm) and also small components devoid of frank edema alongside the frontal part of the falx cerebri, suggestive of meningioma in the right sphenoidal wing (Fig. 1A and B). Therefore, right-frontotemporal craniotomy was done for excision of the intracranial mass, which intraoperatively showed a white, cheesy, and gelatinous substance, suggestive of infective pathology rather than of meningioma. The excised intracranial mass was sent for histopathological and microbiological examination. Direct microscopy revealed neither Mycobacterium nor other bacteria with ZiehlNeelsen (ZN) staining or Gram staining, respectively, but KOH preparations showed septate, branched fungal hyphae ( Fig. 2A). Histopathological examination with periodic acidSchiff (PAS) staining showed fungal granulomas in the brain parenchyma centered around blood vessels. Granulomas were made up of epithelioid cells with giant cells and c...

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