The study highlighted a high burden of candidemia in Indian ICUs, early onset after ICU admission, higher risk despite less severe physiology score at admission and a vast spectrum of agents causing the disease with predominance of C. tropicalis.

Elizabethkingia meningoseptica, a ubiquitous gram-negative aerobic bacillus, is an emerging hospital acquired pathogen in patients on dialysis. It has been isolated in the hospital environment in water supplies, disinfectants, and medical devices. We present here an analysis of eight healthcare-acquired infections with this organism in adults. To the best of our our knowledge, this is the first report of infections with this organism in patients on hemodialysis.Materials and Methods:Over a 6-month period, eight patients were infected with E. meningoseptica in our hospital. These patients had bacteremia and lower respiratory tract infection. All these patients were on on mechanical ventilation and undergoing bedside hemodialysis in the intensive care unit (ICU). Environmental surveillance was done to detect the possible source.Results:These patients had a common denominator of bedside hemodialysis, and use of broad-spectrum antibiotics. E. meningoseptica was isolated from the water and sink of the ICU.Conclusion:E. meningoseptica is emerging as a nosocomial pathogen among patients on hemodialysis. Its unusual resistance pattern coupled with inherent resistance to colistin makes this organism difficult to treat unless susceptibility patterns are available. Isolation of this organism in handwash sink and water is a significant finding as they have been reported to survive in chlorinated water. Disinfecting the sinks and using filtered water for hand washing in critical areas may help in preventing infections with this organism.

Background: The epidemiology, clinical profile and outcome of paediatric candidemia vary considerably by age, healthcare settings and prevalent Candida species. Despite these differences, few comprehensive studies are undertaken. This nationwide study addresses this knowledge gap. Methods: 487 children who contracted ICU-acquired candidemia at 23 Indian tertiary care centres were assessed for 398 variables spanning demography, clinical characteristics, microbiology, treatment and outcome. Results: Both neonates (5.0 days; range = 3.0-9.5) and non-neonatal children (7.0 days; range = 3.0-13.0) developed candidemia early after ICU admission. Majority of neonates were premature (63.7%) with low birthweight (57.1%). Perinatal asphyxia (7.3%), pneumonia (8.2%), congenital heart disease (8.4%) and invasive procedures were common comorbidities, and antibiotic use (94.1%) was widespread. C tropicalis (24.7%) and C albicans (20.7%) dominated both age groups. Antifungal treatment (66.5%) and removal of central catheters (44.8%) lagged behind. Overall resistance was low; however, emergence of resistant C krusei and C auris needs attention. The 30-day crude mortality was 27.8% (neonates) and 29.4% (non-neonates). Logistic regression identified admission to public sector ICUs (OR = 5.64), mechanical ventilation (OR = 2.82), corticosteroid therapy (OR = 8.89) and antifungal therapy (OR = 0.22) as independent predictors of 30-day crude mortality in neonates. Similarly, admission to public sector ICUs (OR = 3.62), mechanical ventilation (OR = 3.13), exposure to carbapenems (OR = 2.18) and azole antifungal therapy (OR = 0.48) were independent predictors for non-neonates. Conclusions: Our findings reveal a distinct epidemiology, including early infection with a different spectrum of Candida species, calling for appropriate intervention strategies to reduce candidemia morbidity and mortality. Independent factors identified in our regression models can help tackle these challenges.

Background:The global spread of antimicrobial resistance has acquired greater significance in the public health perspective. Drug resistance has posed a threat for the management of various hospital-acquired infections (HAI). For bacteria producing extended spectrum ß lactamase, carbapenems are the drug of choice. However, treatment failures are still a cause of concern due to carbapenemase producers.Aim:Various phenotypic and genotypic methods are available for the detection of carbapenemase producers. Studies thus far have mostly concentrated on comparing various methods for detection of carbapenemase producers. We used low-cost and the easily performed modified Hodge test (MHT) for detecting the carbapenemase producers in Enterobacteriaceae members isolated from various clinical specimens.Material and Methods:The study included 1072 clinical isolates of Enterobacteriaceae collected in India between April 2008 and February 2010. MHT was performed on all the isolates in accordance with CDC and CLSI guidelines.Results:The carbapenemase activity was detected in 35.9% (385/1072) of the isolates. Klebsiella spp. 28.7% (80/278), Citrobacter spp. 20.4% (25/122), 11.3% (38/334) in E. coli, 20.3% (45/221) in Enterobacter spp., and 16.2% (9/117) in Proteus spp. revealed variable resistance activities against carbapenems.Conclusion:Enterobacteriaceae members are among the most common and easily transferable bacterial species responsible for severe HAI. This study revealed a high percentage of Enterobacteriaceae clinical isolates producing carbapenemases in India. Detection of such bacteria, formulating hospital antibiogram, and monitoring the usage of antimicrobial drugs is recommended.

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Background. Tetanus is a life-threatening disease in developing countries and is accompanied by a high mortality rate. Although China is the world’s largest developing country, there have been few clinical studies on tetanus in China. The purpose of this study was to investigate the epidemiology, incidence, and management of tetanus in Fujian Province and to understand the current treatment and prognosis of tetanus patients. Methods. This was a retrospective, multicenter observational study of patients who presented with a clinical diagnosis of tetanus at 5 general hospitals in Fujian from January 2008 to December 2018. Data were analyzed using a computer software system. Results. A total of 95 patients were recruited, including 6 newborns. The average age of the adult tetanus patients was 55.53±15.39 years old. None of the patients knew their previous history of tetanus immunization. The rate of having received human tetanus immunoglobulin (HTIG) was 9.47%. A total of 73 (76.84%) patients were cured, 17 (17.89%) patients had an unknown prognosis, and 5 (5.26%) patients died. Age, severity of illness, and complications all increased the total duration of hospitalization. Compared with endotracheal intubation, tracheotomy increased the length of stay in the ICU (Intensive Care Unit) but did not affect the total hospital length of stay for mechanical ventilation. Conclusions. With the promotion of nationwide immunization against tetanus and the development of critical care medicine, morbidity and mortality rates of tetanus in Fujian are low. It is important to increase awareness among local physicians and staff in charge of tetanus immunization programs and with regard to neonatal tetanus and drug-induced tetanus. The prevention and treatment of tetanus in developing countries should arouse widespread concern in society.

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