Search

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objectives Fungal spores are ubiquitously present in the environment. Appropriate temperature and humidity can lead to fungal growth. It is of concern in a hospital environment. Diabetic and immunosuppressed persons are more vulnerable to such infections. The fairly humid and slightly warm climate of Mumbai is ideal for fungal growth. According to an article released in March 2021, the total fungal count in Mumbai was 16.2 CFUs. Here is a brief gist of how fungal spores were controlled within a tertiary hospital in Mumbai, India which is located near sea by simple but effective methods. Methods Air sampling of the Operation Theatre (OT), Central Sterile Supply Department (CSSD), Bone marrow transplant (BMT) areas is done on weekly basis in the hospital and for areas such as ICU (Intensive Care Unit), Oncology (ONCO) Ward, Cardiac Catheterization (Cath) lab and Digital subtraction angiography (DSA) lab monthly air sampling is done to check for bacterial and fungal load. Two types of air samplers are used: Heico air sampler from HiMedia and Dyanamicro air sampler. OT, BMT, CSSD have HEPA (high efficiency particulate air) filters installed for filtration of air. The other areas like ICU, ONCO ward, Cath lab, and DSA lab do not have HEPA filters. Results In the last 4 years there were two instances where fungal growth was observed once in BMT and once in ICU. In ICU Aspergillus niger growth was observed and in BMT there was a growth of multiple Aspergillus spp. It took nearly 3-4 months for the eradication of the fungus in BMT and 2 months to clear the fungus from ICU. Due to strict engineering control, we were able to restrict the spread within hospital. In BMT unit the growth was observed during rainy season when because of heavy rain there was seepage in one wall of the unit and also there was a leakage of sink in the ante-room area. When these repairs were done the fungal growth was not observed afterward. In ICU thorough cleaning of the Air Handling Unit (AHU) filter leads to resolution of the issue. Both these episodes were uneventful as no patient had any infection due to these. Factors that helped in controlling the fungal spores spread are: Conclusion Even though the hospital is situated near sea and the outside air has high humidity and high microbial load, effective engineering measures and close monitoring of the areas can help in controlling the spread of fungus within the hospital. Routine periodic checks of the air for fungal spores can also help prevent nosocomial infections.

Ocular manifestations of COVID-19 are still being studied. Posterior segment involvement in viral entities is either direct viral involvement or a delayed immune response to the antigen. A 22-year-old woman presented with history of perceiving absolute inferior scotoma in the right eye for 4 days and history of fever and sore throat 10 days ago. Fundus examination revealed disc edema and vessel tortuosity. Humphreys Field Analyzer confirmed inferior field defect and Optical Coherence Tomography showed superior, nasal and inferior retinal nerve fiber layer thickening in the right eye. Patient was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription polymerase chain reaction (RT-PCR) testing. Patient received three doses of injection methylprednisolone over 3 days. There was subjective resolution of scotoma reported 3 weeks posttreatment. We bring forward the first reported case of parainfectious optic neuritis associated with COVID-19.

Empiric antimicrobial therapy in hospitalized patients is guided by an institution’s cumulative antibiogram, which may not be adequate in giving information on decision-making for optimal treatment in different patient populations. Adding patient risk factors can make it more useful for clinicians in guiding empiric therapy and for antimicrobial stewardship. Cumulative data were obtained for blood culture and urine isolates from the laboratory information system of a tertiary care hospital for 6 months (January to June 2019). Further stratification of organism types and resistance rates on the basis of patient risk factors (Patient Types 1, 2, and 3) was performed and analyzed. Salmonella spp. was seen in community-acquired ward patients (Types 1 and 2). Streptococcus pneumoniae was seen in Type 1 patients, and Acinetobacter spp. was seen in Type 3 patients. Extended-spectrum beta-lactamase-producing gram-negative infection rates were higher in community patients than in hospital patients. Carbapenem-resistant Enterobacteriaceae rates were high in Type 3 hospitalized patients. Cumulative blood methicillin-resistant Staphylococcus aureus rates were 43% but stratification showed it only in Type 2 and Type 3 ICU patients with 0% in ward patients. Stratified antibiograms based on patient risk factors are valuable for antimicrobial stewardship and help to optimize empiric therapy and increase the understanding of antimicrobial resistance trends.

A four year old female child presented with a painless swelling of the right lower lid for 25days, which was progressively increasing in size. On palpation, a firm nodular mass just above the inferior orbital margin was noted. MRI showed homogenous enhancing mass in the orbit. Progressive axial proptosis developed in 8 days, with inability to close the eye. Bone marrow aspiration at this stage revealed Acute Myeloid Leukemia. Chemotherapy was started. Bone marrow picture after 10days showed remission phase. Symptoms and signs began to regress. The child was discharged on maintenance chemotherapy; but was admitted 3weeks later with fever; the child expired after admission 2 days due to secondary infection.

In this study, we aimed to correlate the analytical performance of SD BIOLINE TB Ag MPT64 Rapid Test kit (MPT64 assay) with the mycobacterial growth unit (GU) reported by the BACTEC MGIT 960 (MGIT 960) instrument. A total of 394 culture isolates reported positive by MGIT 960 were processed daily (until 'day 4') with the MPT64 assay until a positive MPT64 result was obtained and their GU values were noted daily before MPT64 testing. Based on this correlation of MPT64 positivity and corresponding GU values, a GU cut-off was determined. In the validation phase, with the experimentally determined GU cut-off value, 99.1% (576/581) of culture isolates were correctly identified as MTB within 2 days from instrument positivity. All results were available using a single-MPT64 assay strip, making the assay cost-effective. Thus, systematic implementation of the MPT64 assay proved to be cost-effective in a high-throughput laboratory without any delay in patient reporting.