Objective: To study the prevalence, causative organisms, and antimicrobial sensitivity pattern of Urinary Tract Infection (UTI)at a tertiary care center in Central India. The study was undertaken from September 2021 to May 2022 at t Methods: he Department of Nephrology, SAIMS, Indore. Clean catch midstream urine samples were collected from patients suspected of UTI from patients on OPD basis and inpatients from various departments. The urine samples were processed for Culture and Antibiotic Susceptibility testing after Culture in Mac Conkey/Blood Agar for 24 hours. The interpretation of the bacterial isolates was carried out by VITEK2 automated system. A total of 3241 samples (Females= 1705 Results : and Males=1536) were processed for urine culture and sensitivity. 1022 samples (Females=522, Males=500) were positive for bacterial infection (31.53% positivity rate). Positive isolates were further divided into Outdoor (OPD=315) and Indoor patients (IPD=707) (Wards=480, ICU=227). E. coli was the most common organism in all groups. However, in ICU most common organism was Pseudomonas. Enterococcus was the most common gram-positive organism. ESBL-producing bacteria among Gram-negative bacteria was 67.4%. Carbapenemase-producing bacteria among Gram-negative bacteria were 60.8%. Among Gram-negative oral drugs sensitivity pattern was: Nitrofurantoin (66.1%), Cotrimoxazole (51.65%), Fosfomycin (48.5%), Amoxycillin+Clavulanic acid (41.15%), Ciprooxacin (38.25%), Cexime (20.5%). Pseudomonas was resistant to most oral drugs. Among Intravenous drugs, the sensitivity pattern was: Colistin (89.2%), Amikacin (64.7%), Gentamycin(55.1%), Piperacillin + Tazobactum (44.8%), Tigecycline (43.9%), Meropenam (35.1%), Cefepime (30.1%), Ciprooxacin (24.71%), Cefoperazone+Sulbactum (20.61%). The sensitivity of Klebsiella was lower than E.coli for most of the drugs. Sensitivity for Fluoroquinolones and Cephalosporins is very low. Among Gram-positive oral medications, the sensitivity pattern was: Linezolid (67.8%) and Nitrofurantoin (65.9%). Among Intravenous drug sensitivity pattern was: Teicoplanin (69.27%), Vancomycin (68.5%), Tigecycline (66.15%), and Linezolid(62.05%). The sensitivity of Enterococcus was higher than Staphylococcus for all drugs. The sensitivity of drugs was higher in OPD patients, followed by wards and least in ICU patients indicating multidrug-resistant strains in ICU are more common. Empirical Conclusion: Antibiotics based on regional antibiotic sensitivity patterns should be started and changed as per Culture reports afterwards. It is need of hour to conduct research on the bacteria's culture and sensitivity patterns considering bacterial resistance and multidrug-resistant strains.
Aim:All prior studies have demonstrated that acute renal damage in People who have the coronavirus disease of2019 (COVID-19) are often diagnosed and have a dismal prognosis. Acute renal injury in COVID-19 patients hasnot been well reported in developing countries like India. Examining the clinical traits, biochemistry, and prognosisof acute kidney injury (AKI) in COVID-19 patients is the aim of this article. Methods:The Department of Nephrology at the Sri Aurobindo Medical College and Graduate Institute (M.P.) inIndore, India, conducted this study from April 1, 2020, to January 31, 2021. We examined 130 COVID-19 casesof AKI recorded by SAMC and PGI in Indore. Included 18 year-old and older COVID-19 patients verified by real-time reverse polymerase chain reaction (RT-PCR). The term “sepsis” was employed in its conventional sense. TheKidney Disease Improving Global Outcomes (KDIGO) guidelines of AKI were adhered to. Patients under the age of18 undergoing renal replacement therapy for CKD in stages I to IV and ESRD were not eligible. Results:A total of 12,438 COVID patients were admitted to our hospital during this period. The incidence ofAKI was 1.04% (130). The mean age was 51.2 years. The male-to-female ratio was 1.4:1 (76:54). Commonestsymptoms were fever in 71.5% (93) of patients, headache in 62% (81) of patients, and cough in 51.5% (67) ofpatients, followed by breathlessness in 37.5% (49) patients. The typical creatinine values at the time of admissionwere 3.57 mg/dl. AKI stage 1 was seen in 30% (39) cases, stage 2 in 45.5% (59) cases, and stage 3 in 24.5%(32) cases. The most common etiology was sepsis in 65% (84) and drugs in 14% (18). T2DM was the mostcommon comorbidity in 42% (55) of patients, HTN in 41.5% (54) of patients, Coronary Artery Disease (CAD) in9.2% (12) of patients, and malignancy in 5% (7) of patients. Oxygen by nasal mask/nasal prongs was requiredin 59% (77) of patients, BIPAP in 16% (21) of patients, and ventilatory support in 12.5% (16) of patients. Theaverage hospitalization was 12.3 days. Dialysis was required in 16% (21) of patients. Notably, 87% (113) of patientsrecovered completely, and 13% (17) of patients expired. The majority of patients had elevated inflammatorymarkers. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were elevated in 81% (105) of patients,and ferritin was raised in 71% (92) of patients. Conclusion:Hospitalized COVID-19 patients commonly get AKI, which is associated with a poor prognosis andhigh mortality. In COVID-19 patients, increased inflammatory markers, type 2 diabetes, sepsis, older age, and malesex were the main risk factors for developing acute renal injury.
There is minimal information on coronavirus disease 2019 (COVID-19) in developing countries regarding renal transplant recipients (RTRs). This paper aimed to study the clinical profile, immunosuppressive regimen, treatment, and outcomes in an RTR with COVID-19. This retrospec-tive study was conducted in the nephrology department of Sri Aurobindo Medical College & Postgraduate Institute, Indore (MP), India, from April 1, 2020 to December 15, 2020. We studied 15 patients, of which 13 were treated at our hospital and two were treated in OPD. The median age of transplant recipients was 45 (Interquartile range [IQR]: 26–62) years, the majority being males, and recipients presented at a median of 4 (IQR: 0.3–11) years after transplant. The most common comorbidities included hypertension in 14 (94%) and diabetes 3 (20%) patients. The presenting symptoms at presentation were cough (80%), headache (52%), fever (46%), and breathlessness (26%). Clinical severity as per comput-erized tomography (CT) severity score ranged from mild (20%), moderate (53%), and severe (27%). Strategies to modify immunosuppressants included discontinuation of antimetabolites without changes in calcineurin inhibitors and steroids (100%). Antiviral therapy (Favipiravir and Remdesivir) was associated with better outcomes and reduced hospital stay. Risk factors for mortality included ABO-incompatibility, severity of disease, high Coronavirus Disease 2019 (COVID-19) Reporting and Data System (CO-RADS) score, allograft dysfunction before COVID-19 infection, acute kidney injury, elevated inflammatory markers, and intensive care unit/ventilator requirement. Overall patient mortality was 13.2%. Risk factor for mortality in COVID-19 positive with RTR appears to be ABO-incompatible transplant, having a previous history of rejection, and patient requiring ventilatory support.
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