Opportunities to Enhance Diagnostic Testing and Antimicrobial Stewardship: A Qualitative Multinational Survey of Healthcare Professionals.

Introduction: Antimicrobial resistance (AMR) is a global public health challenge. Global efforts to decrease AMR through antimicrobial stewardship (AMS) initiatives include education and optimising the use of diagnostic technologies and antibiotics. Despite this, economic and societal challenges hinder AMS efforts.

Randomized control trial on impact of clinical pharmacist led interventions on antibiotic stewardship program in children 0 to 18 years age in a tertiary care hospital in southern India.

A prospective randomized controlled interventional study was conducted at a quaternary care multispecialty hospital in South India with the primary objective of identifying opportunities to improve antibiotic prescribing patterns in neonates, children, and adolescents. The hospital has a robust clinical pharmacist program wherein antibiotic prescriptions were checked for appropriateness of antibiotic dose, route, formulation, duration of therapy, and IV to oral switch. These characteristics of antibiotic use were therefore similar in the 75 children in the control and 75 in the intervention group.

Comparison of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) as marker of adverse prognosis in patients with infective endocarditis.

Infective Endocarditis (IE) remains a life-threatening condition and early risk stratification helps us to predict mortality and the need for aggressive treatment. We compared NLR, PLR, and SII, on admission to predict in-hospital mortality. Consecutive IE patients, who met inclusion criteria were analysed.

Coinfection of Streptococcus agalactiae and Tuberculous Osteomyelitis of Tibia Mimicking Brodie's Abscess in an Immunocompetent Adult: A Case Report.

Introduction: Coinfection of tuberculous osteomyelitis with Streptococcus agalactiae has not been reported in an immunocompetent adult so far. The slow progress of tuberculous osteomyelitis, due to lack of significant elevations in the laboratory values and changes in the radiographic appearance, often leads to confusion with brodie's abscess. These two clinical conditions often lead to delay in diagnosis and progressive bone destruction.

Use of Ceftazidime-Avibactam in the Treatment of Clinical Syndromes With Limited Treatment Options: A Retrospective Study.

Background With 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.

Mucormycosis of Neck a Rare Presentation.

Mucormycosis is a dreaded clinical entity caused by filamentous fungi of the order Mucorales mainly affecting immunocompromised individuals. Usually seen involving paranasal sinuses, orbit, lungs and gastrointestinal system, it is extremely rare in other areas. Herein we report a rare presentation of Mucormycosis affecting the ear and neck where early detection, timely intervention, multidisciplinary involvement and judicious use of local antibiotics apart from the mainstay treatment regimen like surgical debridement and intravenous Amphotericin B has saved the patient and given him a reasonably good quality of life devoid of morbidity.

A unique case of fever with skin lesions.

The incidence of Nocardiosis was c.1-2 per 100,000 population worldwide in the early 2000s. Co-infection with Nocardia and MOTT (mycobacterium other than tuberculosis) is even more uncommon and has been described only in the setting of pulmonary manifestations in an immunocompromised (HIV) patient.

Analysis of an outbreak of nosocomial COVID-19 at a tertiary care centre in South India.

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.

Pneumococcal Bacteremia and Cryptococcal Meningitis Dual Infection in a Patient With Multiple Myeloma.

Infections remain one of the major complications in patients with multiple myeloma, having a significant impact on morbidity and mortality. The increased risk of infection in these patients are a result of various factors contributing to the impairment of immune system caused by the disease and the chemotherapy regimens given during the treatment phases. Here we report a rare case of pneumococcal bacteraemia and cryptococcal meningitis dual infection in a patient with underlying multiple myeloma who had a favourable clinical outcome.

Pubic symphysis tuberculosis: A diagnostic dilemma.

Symphysis pubis tuberculosis (TB) is extremely rare in the reported literature. The diagnosis of pelvic TB is confounded by close differentials such as osteomyelitis as well as the low yield of TB bacilli in microbiological sampling in the initial stages of the disease. Pelvic TB should be suspected early on in areas with high TB burden, and prompt treatment with antitubercular treatment may help prevent disability associated with the disease.

Clinical Outcomes in Carbapenem-Resistant Enterobacteriaceae Infections Treated With Ceftazidime-Avibactam: A Single-Center Observational Study.

Introduction Among 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.

A road-map for addressing antimicrobial resistance in low- and middle-income countries: lessons learnt from the public private participation and co-designed antimicrobial stewardship programme in the State of Kerala, India.

Background: The global concern over antimicrobial resistance (AMR) is gathering pace. Low- and middle-income countries (LMICs) are at the epicentre of this growing public health threat and governmental and healthcare organizations are at different stages of implementing action plans to tackle AMR. The South Indian state of Kerala was one of the first in India to implement strategies and prioritize activities to address this public health threat.

A quality improvement project on adherence to antibiotic policy in acute admissions from a tertiary care hospital in south India.

The indiscriminate use of antibiotics in clinical practice may be an independent risk factor for the development of antimicrobial resistance. To combat this, our hospital implemented a hospital antibiotic policy which outlines the appropriate antibiotic to be used in an acute admission, based on a continuously updated local antibiogram. However, we felt that compliance with the policy was poor and hence carried out a quality improvement project (QIP) to assess and increase compliance.

A Case of Diphtheria and Infectious Mononucleosis Co-Infection in a Partially Vaccinated Boy.

We report the case of an eight-year-old partially immunized boy who presented with presumed bacterial tonsillitis. He was initially prescribed amoxicillin-clavulanic acid which resulted in the development of an erythematous maculopapular over the face which spread to the trunk and extremities including palms and soles and resolved over the next three days. He was diagnosed to have diphtheria and infectious mononucleosis (IMN) co-infection.

Aspergillus fumigatus meningitis in an immunocompetent young woman.

Aspergillus meningitis is a rare clinical entity that is much more frequently observed among immunocompetent patients. Here we present the case of a 28 year old immunocompetent lady with Aspergillus fumigatus meningitis possibly following spinal anaesthesia for her caesarean section. The diagnosis of Aspergillus meningitis is very difficult and challenging.

Contact tracing: a lesson from the Nipah virus in the time of COVID-19.

Without a vaccine or proven therapeutic options in COVID-19, the World Health Organization (WHO) recommends a combination of measures: rapid diagnosis and immediate isolation of cases; rigorous contact tracing; and precautionary self-isolation of close contacts to curb the spread of COVID-19. During a Nipah outbreak in Kerala, India in 2019, it was confined to a single case. The authors were involved in the in-hospital contact tracing.

Six-year study on peripheral venous catheter-associated BSI rates in 262 ICUs in eight countries of South-East Asia: International Nosocomial Infection Control Consortium findings.

Background: Short-term peripheral venous catheter-associated bloodstream infection rates have not been systematically studied in Asian countries, and data on peripheral venous catheter-associated bloodstream infections incidence by number of short-term peripheral venous catheter days are not available.

Methods: Prospective, surveillance study on peripheral venous catheter-associated bloodstream infections conducted from 1 September 2013 to 31 May 2019 in 262 intensive care units, members of the International Nosocomial Infection Control Consortium, from 78 hospitals in 32 cities of 8 countries in the South-East Asia Region: China, India, Malaysia, Mongolia, Nepal, Philippines, Thailand, and Vietnam. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System.

Six-year multicenter study on short-term peripheral venous catheters-related bloodstream infection rates in 204 intensive care units of 57 hospitals in 19 cities of India: International Nosocomial Infection Control Consortium (INICC) findings.

Background: Short-term peripheral venous catheters-related bloodstream infections (PVCR-BSIs) rates have not been systematically studied in developing countries, and data on their incidence by number of device-days are not available.

Methods: Prospective, surveillance study on PVCR-BSI conducted from September 1, 2013 to May 31, 2019 in 204 intensive care units (ICUs), members of the International Nosocomial Infection Control Consortium (INICC), from 57 hospitals in 19 cities of India. We applied US INICC definition criteria and reported methods using the INICC Surveillance Online System.