Ventilator associated pneumonia in a tertiary care hospital in India: Incidence, etiology, risk factors, role of multidrug resistant pathogensOriginal Article INTRODUCTIONVentilator associated pneumonia (VAP) is pneumonia that occurs 48 h or more after endotracheal intubation and mechanical ventilation (MV) that was not intubating at the time of admission, also including pneumonia developing after extubation.[1] Pneumonia is the second most common intensive care unit (ICU) acquired infection and 86% of nosocomial pneumonias are VAP.[1] Around 10-20% of patients on MV for longer than 48 h, develops VAP. [2,3] Early onset VAP, which occurs during the fi rst 4 days of MV is usually less severe, associated with a better prognosis and more likely caused by antibiotic sensitive bacteria. Late onset VAP, which develops 5 or more days after initiation of MV, is caused by multidrug resistant (MDR) pathogens and associated with increased mortality and morbidity.[4] The common pathogens causing VAP include aerobic gram negative rods such as Pseudomonas aeruginosa, Acinetobacter species, Klebsiella pneumoniae, and Escherichia coli. [1,5,6] VAP due to methicillin resistant Staphylococcus aureus (MRSA) has been rapidly emerging. [5,6] Treatment of VAP is usually supportive, along with administration of proper antibiotic. The selection of proper antimicrobial agents, active against the VAP pathogens is an important determinant for reducing morbidity and Background: Ventilator associated pneumonia (VAP), a hospital acquired infection (HAI) is seen among critically ill patients on mechanical ventilation (MV) due to various causes, in intensive care units (ICUs). VAP increases morbidity, mortality, as well as the cost of healthcare. Materials and Methods: A prospective study was done over a period of 10 months in a tertiary care hospital in India to determine the incidence, etiological agents, their sensitivity profi les, and risk factors associated with VAP. Combination disc method, ethylenediaminetetraacetic acid (EDTA) disc synergy (EDS) tests, and AmpC disc tests were performed for detection of extendedspectrum beta-lactamases (ESBL), metallo-beta-lactamases (MBL), and AmpC beta-lactamases, respectively. Results: One hundred and forty adult patients, on MV for 48 h and more, were included and 28 (20%) developed VAP. The incidence density rate of VAP was 21.875 per 1,000 ventilator days. Most of the patients had late onset VAP (60.7%) with average number of days for onset around 8 days. Pseudomonas spp. and Acinetobacter spp. were signifi cantly associated with late onset VAP, whereas Enterobacteriaceae, Staphylococcus aureus, Haemophilus infl uenzae, Streptococcus pneumoniae, Burkholderia cepacia, and Candida species were commonly isolated from early onset VAP. Polymicrobial infections occurred in 14 cases, so overall 43 VAP pathogens were isolated. Thirty (69.7%) of them were multidrug resistant (MDR), among which ESBL contributed 23.25%, MBL 30.23%, AmpC beta-lactamases 9.30%, and to methicillin resistant S. aureus (MRSA) c...

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Zolpidem is a non-benzodiazepine sedative hypnotic that binds to the benzodiazepine binding site on the gammaaminobutyric acid type A (GABA-A) receptors. It is the most commonly prescribed sleep medication which has been shown to be effective for treating insomnia on a short-term basis with fewer side effects than traditional benzodiazepines, which are feared for their abuse and dependence potential. Many studies have reported efficacy and safety of zolpidem in treatment of insomnia keeping in mind about its low abuse, and dependence capability. We present a case of zolpidem dependence in a 36-year-old male to emphasize that zolpidem also should be judiciously prescribed under supervision so that it does not develop tolerance, abuse and dependence.

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Background: Substance use disorders have become a widespread public health problem, especially in the northeastern states, and limited studies have been undertaken to reflect the picture of the same. Aims: The aim of the study was to study the sociodemographic and clinical profile of drug treatment seekers attending a State Psychiatric Hospital and De-addiction Center of Northeastern India. Materials and Methods: It was a cross-sectional hospital-based study conducted from October 2018 to August 2019. Two hundred and ten consecutive treatment-seeking patients, fulfilling inclusion and exclusion criteria and diagnosed with the International Classification of Diseases version 10 for substance dependence, were included in the study. Results: Most common abused drug was opioids (42.9%), followed by alcohol (14.3%), whereas 29.0% were people who inject drugs. Peer pressure in 55.2% and curiosity in 32.9% were reported to be the most common causes for initiating substances. Hepatitis C was the most common (52.4%) comorbidity related to intravenous drug users. Conclusions: Results of the current study will definitely encourage further large-scale community-level studies to assess the prevalence of substance abuse in the state as well as in drug policymaking.

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