IntroductionAmong the several newer beta lactam+beta lactase inhibitors (BL/BLI), ceftazidime-avibactam is the only drug showing activity against OXA-48-like producers. Hence, it is being increasingly used in India to treat infections caused by carbapenem-resistant Enterobacteriaceae (CRE), especially as a colistin-sparing agent. We have used ceftazidime-avibactam in patients suspected and confirmed to have CRE infections in our center, and present a retrospective analysis of our experience. MethodsWe conducted a single-center, retrospective study involving all patients who were treated with ceftazidimeavibactam for suspected and proven CRE infections during a one-year period at our 500-bedded hospital. Our primary objective for this study was taken as all-cause mortality. The secondary objectives were to determine the clinical cure, defined as the end of the treatment regimen with a resolution of primary infection and resistance to ceftazidime-avibactam in patients who underwent the Epsilometer test (E-test). ResultsA total of 103 patients who received ceftazidime-avibactam were identified. The all-cause mortality was 27% while a clinical cure was achieved in 73%. Fifty-two patients received empirical therapy and 51 patients received ceftazidime-avibactam for confirmed CRE infection. Forty-eight patients had an E-test done, out of which 79% of patients had CREs sensitive to ceftazidime-avibactam, and 21% of patients had ceftazidimeavibactam resistant CREs. A higher Sequential Organ Failure Assessment (SOFA) score, Charlson comorbidity index (CCI) score, intensive care unit (ICU) admission, inotrope requirement, and lower days of therapy (DOT) with ceftazidime-avibactam were found to be associated with increased mortality. ConclusionColistin has been considered to be the last-line agent in CRE infections, but there are concerns about its adverse effects and the emergence of resistance. Given our relatively low mortality of 27% in CRE infections treated with ceftazidime-avibactam, coupled with the high susceptibility of the tested isolates, there may be a role for the empirical use of this drug in infections caused by CRE, especially in a setting where colistin may not be ideal.

Background: Malnutrition can be divided into two broad groups, undernutrition and overweight or obesity. Malnutrition in early childhood and adolescence can lead to a large number of complications in later life. This study is intended to nd out the prevalence of underweight, overweight and obesity among school going children aged 13-17 years in a southern district in Kerala and to assess the factors associated with malnutrition among the study population. Methods: A cross sectional study was carried out among 340 school going children in the age group of 13-17 years in Thiruvananthapuram district, Kerala during October to November 2019. The children were interviewed using a semi-structured questionnaire including sociodemographic details, questions on dietary habits, pattern of physical activity, self-awareness and family history. Anthropometric measurements such as height and weight of the students were taken and BMI was calculated. Data was entered in Microsoft Excel and analysed by SPSS software version 21. Results And Conclusion: 53.8% of the study participants were underweight, 5.9% were overweight and 2.1% belonged to the obese category. The factors such as grade of the student (p value:0.004), mother's occupation (p value:0.001), practice of skipping breakfast (p value:0.008), physical inactivity (p value:0.033), use of online food delivery facilities (p value:0.022), lack of awareness on self-health (p value:0.018), family history of obesity (p value:<0.001) and family history of non-communicable diseases (p value:0.002) were found to have a statistically signicant association with malnutrition. Therefore, it is important to take initiatives to tackle the problem of malnutrition among adolescents to bring up a healthy future generation.

BackgroundWith rising trends of multi-drug organism infections and the limited availability of new antimicrobials, management of such cases has become a hassle for the clinician. Ceftazidime-Avibactam (CEF-AVI) is evolving as an effective alternative to polymyxins in the management of Carbapenem-Resistant Organisms (CRO) infections. The Food and Drug Administration (FDA) has approved CEF-AVI in a restricted group of clinical syndromes where the drug could have potential use. ObjectiveThe goal of this study was to evaluate the clinical outcome in terms of 14-day all-cause mortality and clinical cure at seven days in patients on CEF-AVI. MethodologyA retrospective study was conducted on patients who received CEF-AVI in a period of one year in our hospital. Patients were included in the study if they have received CEF-AVI for more than one day of therapy (DOT) and samples from relevant sites have been sent for culture and sensitivity. Variables and outcomes were collected from the hospital information system and medical records. ResultsA total of 78 patients were included, 52 (66.7%) were started empirically on CEF-AVI while 26 (33.3%) were on targeted therapy. Out of the 78 patients, 43 patients had positive cultures among which 32 patients had Carbapenem-Resistant Enterobacteriaceae (CRE)/Carbapenem-Resistant Pseudomonas aeruginosa (CRPA) infection. The most common clinical syndrome in which the drug was used was occult sepsis (27/78; 34.6%) followed by primary bacteremia (20/78; 25.6%) and neutropenic sepsis (11/78; 14.1%). The clinical efficacy which was primarily assessed in terms of clinical cure was met for 55 (70.5%) patients. The 14-day mortality for the studies group was found to be 18 (23%). ConclusionThe analysis of results shows encouraging clinical cure rates and 14-day mortality rates in a subset of severe infections which has limited treatment options.

BackgroundAntibiotic consumption data are scarce in the subcontinent. Defined Daily Doses (Doses) and Days of Therapy (DOT)-based metrics both have inherent disadvantages limiting their application in resource-limited settings primarily in terms of resource hours.. Point Prevalence Study (PPS) offers an offer an initial feasible step for describing antimicrobial use and identifying targets to reduce inappropriate use. Aim of the present study was to use PPS to identify quantitative and qualitative aspects of antimicrobial consumption.MethodsA cross-sectional hospital-based PPS was conducted in 4 tertiary care hospitals—Aster Medcity (Kochi, Kerala), Aster MIMS (Calicut, Kerala), Aster Ramesh (Guntur, Andhra Pradesh), and Aster CMI (Bengaluru, Karnataka)—based on a standardized format derived from the GLOBAL-PPS initiative and WHO resources.ResultsThe total number of patients surveyed was 944.42.7% patients had a standing antibiotic order, out of which 19.80%patients were receiving reserve antimicrobials (WHO classification). 76.23% of prescriptions were used empirically, 16.08% were used as prophylaxis meanwhile 7.67% had a culture-based indication. The overall DOT (per 1000 patient-days) for all antimicrobials in the 4 centers were 86.54, 64.19, 93.71 and 85.93 respectively with a cumulative mean DOT of 82.59. Reserve antimicrobials DOT were 26.28, 14.83, 28.08 and 19.61, respectively, with a mean of 22.2. The most common class of antimicrobial prescribed was β lactam -β lactamase inhibitors (BL/BLI) 27.3% while Carbapenems (8.16%) was the most common amongst reserve antimicrobials. Out of all the prescriptions only 7.67% had indications documented. Documented errors of dosing were seen in 8 patients. Adherence to monitoring for ADE was done in 92.57%.ConclusionThe study reveals antibiotic use in almost 40% of patients under survey with a DOT of 82.59 per 1000 patient-days. Improving empirical use of antimicrobials, BL/BLI focused intervention and improved documentation has been identified as potential areas for intervention based on this study.The study also highlights the scope of PPS as an effective tool in resource-limited setting to define and refine antimicrobial use and contribute toward antimicrobial stewardship as well as other activities aimed reducing antimicrobial resistance across a range of settings. Disclosures All authors: No reported disclosures.

IntroductionThe COVID-19 pandemic has caused nearly 46 million cases globally with nearly 1.2 million deaths. 1 It has been hypothesised that the principal mode of transmission of the causative SARS-CoV-2 virus involves exposure to respiratory droplets during close contacts with infected individuals. 2 However, SARS-CoV-2 is also thought to have airborne or aerosolised transmission under special circumstances, such as being in enclosed spaces, spaces having inadequate ventilation including the use of centralised air conditioning, and, of particular importance in healthcare facilities, aerosolgenerating procedures. 2,3 This characteristic of the virus coupled with a signifi cant proportion of asymptomatic carriers may contribute to its capability of transmission. 2 Hospitals and other healthcare facilities tend to have a combination of these factors present that can facilitate transmission of COVID-19 despite adequate infection control practices. There have been multiple reports of nosocomial transmission of COVID-19 even though the rates remain quite low. 4,5 The use of wards with multiple patients sharing a common air space, common air conditioning, common washrooms that may generate aerosols, as well as the potential of contact between hospital staff with patients during routine clinical care potentially increases the risk of nosocomial COVID-19. We report a cohort of 15 patients with possible nosocomial COVID-19 over a period of 48 days from a tertiary care centre in South India. We reviewed all the patients who were diagnosed to have COVID-19 3 days Background Nosocomial outbreaks of COVID-19 have been reported sporadically since the beginning of the COVID-19 pandemic. We sought to study the transmission dynamics in a nosocomial COVID-19 outbreak in our centre.Methods This was a retrospective cohort study in a 500 bedded tertiary care hospital in South India. Inpatients who were suspected to have likely or de nite hospitalacquired COVID-19 and hospital staff members who were found to be COVID-19 positive during the same time frame were studied and the likely transmission dynamics described.Results During the study period, 173 patients were diagnosed to have COVID-19, out of which, 15 (8.6%) patients who ful lled the criteria for likely or de nitely hospital-acquired COVID-19 infection were identi ed from six different wards. During the same period, 121 hospital staff members were diagnosed with COVID-19. Out of these, 18 (14.9%) hospital staff members were identi ed who could have been the potential source of infection for these 15 patients based on the overlap of location of the staff and the patients, and their infectivity windows. Direct contact and fomite transmission were likely the predominant driver of transmission in our study as there was use of universal face masks and face shields. ConclusionDespite the admission of a large number of COVID-19 patients and a relatively large proportion of hospital staff members who tested positive for the disease, the proportion of nosocomial COVID-19 in our centre ...