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Introduction Evidenced based medicine (EBM) is necessary to standardize or treatment for infection since EBM is established based on the results of clinical trials. Entry criteria for clinical trials are very strict, and many patients have difficulties in being enrolled in any clinical trials regarding candidemia. It is questionable if the results of clinical trials reflect the real world of general medicine in this case. Patients and methods For the purpose of examining how many patients could join any randomized clinical trials for the treatment of candidemia, we reviewed all the candidemia patients in our institute during 2014–2018. The patients were divided into two groups: patients who were eligible for clinical trials (participation possible group), and those who were not (participation impossible group). Exclusion criteria for clinical trials were set based on previous clinical trials. Results A total of 70 patients was enrolled in this study. The median age was 73 years (range 36–93 years). Of these, 41 patients (59%) were male. As for site of infections, catheter related blood stream infection was most frequently seen in 37 (53%). Seventeen patients (24%) were classified as participation possible group and 53 patients (76%) were participation impossible group. Comparing the two groups, participation possible group patients have much better performance status, have less comorbidities and have longer overall survival times than participation impossible group patients. Conclusion Only 24% of candidemia patients were eligible for the clinical trials. Thus, we can see that clinical trials might not correctly reflect the real world among candidemia patients.

In recent years, perivascular adipose tissue (PVAT) research has gained special attention in an effort to understand its involvement in vascular function. PVAT is recognized as an important endocrine organ that secretes pro- and anti-contractile factors, including components of the renin-angiotensin-aldosterone system, in particular angiotensinogen. This review critically addresses the occurrence of angiotensinogen in PVAT, its release into the blood stream, and its contribution to the generation and effects of angiotensins (notably angiotensin-(1-7) and angiotensin II) in the vascular wall. It describes that the introduction of transgenic animals, expressing angiotensinogen at 0, 1 or more specific location(s), combined with the careful measurement of angiotensins, have revealed that the assumption that PVAT independently generates angiotensins from locally synthesized angiotensinogen is incorrect. Indeed, selective deletion of angiotensinogen from adipocytes did not lower circulating angiotensinogen, neither under a control diet nor under a high-fat diet, and only liver-specific angiotensinogen deletion resulted in the disappearance of angiotensinogen from blood plasma and adipose tissue. An entirely novel scenario therefore develops, supporting local angiotensin generation in PVAT that depends on the uptake of both angiotensinogen and renin from blood, in addition to the possibility that circulating angiotensins exert vascular effects. The review ends with a summary of where we stand now, and recommendations for future research.

Central line associated blood stream infection (CLABSI), is a substantial contributor to in-hospital morbidity and death, as well as increased cost and length of stay in the intensive care unit (ICU). CLABSIs are one of the most deadly for each infection is expected to have a mortality rate of 12-25 percent. CLABSI prevention is important, and nurses play a vital role. Nurses are required to complete initial training as well as annual competence tests for central venous catheter protocol and other skills to ensure that they are delivering direct care to patients using the most up-to-date evidence-based practices. Conclusion: CLABSI prevention bundles are the best method for implementing many interventions at once in addition to standardizing practice. Standard prevention bundles in addition to routine CLABSI education for staff are the most effective methods for preventing infection; it is inevitable that compliance with bundles will vary across healthcare institutions.

Background: In recent years much research has been devoted to the deployment of biomarkers in the field of heart failure. Objectives: To study the potential of post-transcriptional regulation by microRNAs on the diagnosis, management and therapy of heart failure. Methods: Literature search focus on the role of microRNAs in heart failure. Results: MicroRNAs are expressed and regulated in the course of the pathological manifestations of heart failure (HF). This wide and uncharted area of genetic imprints consisting of small non-coding RNA molecule is upregulated and released into the bloodstream from organs under certain conditions and or stress. The use of genetically based strategies for the management of HF has gained great interest in the field of biomedical science because they can be used as biomarkers providing information regarding cardiac status and function. They also appear as promising tools with therapeutic potential because of their ability to induce changes at the cellular level without creating alterations in the gene sequence. In addition, with the advances in genomic sequencing, quantification and synthesis in technologies of microRNAs identification as well as the growing knowledge of the biology of miRNAs and their involvement in HF, it is expected to favorably affect the prognosis of HF patients. Conclusion: MicroRNAs are involved in the regulation of multibiological processes involved in the progress of heart failure. More studies are needed to achieve a clinical valuable implementation of microRNAs in the management of HF.

Background: Device-associated infections (DAIs) like ventilator-associated pneumonia (VAP), central-line-associated blood stream infections (CLABSI), and catheter-related urinary tract Infection (CAUTI) constitute predominant healthcare-associated infections (HAIs) in intensive care units (ICUs). Objectives: The study aims to elucidate their trends in an adult ICU. Methods: Over 21 months, monthly VAP, CLABSI, and CAUTI rate, and device utilization ratios were calculated in an adult ICU of a tertiary care hospital as part of routine surveillance activity. All cases of VAP, CLABSI, and CAUTI during these 21 months were included. In addition, monthly hand hygiene compliance rates were assessed during the latter period of the study by direct observation method. Results: Nosocomial DAI rate was 49.38 DAI/1000 ICU days. CAUTI, CLABSI, and VAP rates were 17.38, 26.85, 21.08 per 1000 device days, and device utilization ratios were 0.99, 0.61, and 0.02, respectively. Conclusion: The institute had high DAI rates in comparison to other studies from the same city. The declining trend of CAUTI rates roughly coincided with surveillance for hand hygiene compliance in ICU. Thus, it establishes baseline data and underscores the need for focused HIC to maximize patient outcomes.

Active population-based surveillance determined clinical factors, susceptibility patterns, incidence rates (IR), and genomics among Enterobacter cloacae complex (n = 154) causing blood stream infections in a centralized Canadian region (2015–2017). The annual population IR was 1.2/100,000 (95% CI 0.9–16) in 2015, 1.4/100,000 (95% CI 1.1–1.9) in 2016, and 1.5/100,000 (95% CI 1.2–2.0) in 2017, affecting mainly elderly males with underlying comorbid conditions in the hospital setting. E. cloacae complex was dominated by polyclonal subspecies (i.e., E. hormaechei subsp. steigerwaltii, subsp. hoffmanni and subsp. xiangfangesis). Antimicrobial resistant determinants were rare. This study provided novel information about Enterobacter genomics in a well-defined human population.

Root canal system acts as an ‘affluent sanctuary’ for the growth and survival of endodontic microbiota. This is attributed to the special environment which the microbes get inside the root canals. Although variety of microbes such as viruses and fungi have been isolated from the root canal system, bacteria are the most commonly found to be associated with Endodontic infections. These are the first to reach the pulp and initiate the pulpal reaction through direct pulp exposure, lateral/accessory canals or through periodontal membrane and blood stream. The oral cavity is home to multiple anatomic micro niches which may vary from birth to old age due to changes in oral environment however root canal being the closed space harbours different microbiota including gram negative and positive microorganisms. To achieve the best results with root canal therapy it becomes important to have knowledge about the residing microbiota and how to combat them.

Background: Flavonifractor plautii is a strictly anaerobic rod shaped bacterium belonging to the family of Clostridiales. It is a commensal of the human intestinal microbiota which was seldom isolated from clinical samples, therefore clinical data are scarce. To date, only four cases of F. plautii infections were described, all occurring in immunosuppressed patients. Case presentation: We report a case where F. plautii was isolated from the blood culture of a severe burn victim and identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Discussion: To the best of our knowledge, this is the first case of F. plautii blood stream infection described in a burn patient.

Extravascular cardiac resynchronization therapy (CRT) defibrillators (CRT-Ds) are ideal for recurrent blood stream infections. Furthermore, CRT is useful for patients intolerant to right ventricular (RV) pacing. The case was a 65-year-old man with a CRT-D who presented with a blood stream infection. Because he was hemodynamically unstable with temporary RV pacing, an epicardial CRT device was re-implanted concomitantly through a surgical procedure. After the operation, a subcutaneous implantable cardioverter defibrillator (S-ICD) was placed. However, not all pacing is eligible for S-ICD screening. Combination therapy with an epicardial CRT device and S-ICD might be an alternate option for cardiac surgery cases.

Objective This study examined the in vitro activity of iclaprim and comparators against 40 Listeria monocytogenes clinical isolates mostly (95%) from patients with bloodstream infections (BSI) from the United States, Australia/New Zealand, Latin America, and Europe collected between 2012-2018 were tested. Methods Susceptibility testing was performed according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Minimum inhibitory concentration (MIC) interpretations were based on CLSI criteria. Results The iclaprim MIC90 value for all L. monocytogenes was 0.015 µg/ml. The MIC50/90 values for iclaprim were 4-fold lower than trimethoprim, the only FDA approved dihydrofolate reductase inhibitor, against all L. monocytogenes. Conclusions Iclaprim demonstrated lower MIC values than trimethoprim against a collection (2012-2018) of L. monocytogenes clinical isolates mostly from patients with blood stream infections from the United States, Australia/New Zealand, Latin America, and Europe.

The recent outbreak of Elizabethkingia anophelis in the Midwestern states of USA caused a number of deaths. Notably, these deaths occurred due to E. anophelis causing neonatal meningitis, bacteraemia, sepsis, blood stream infections and respiratory infections. These infections may pose serious threats to public health. This systematic review is meant to develop a deeper insight into the current status of E. anophelis related evidence and to highlight areas that need further research. Reviewing the existing literature will help other researchers to identify and address the knowledge gaps. Various free access databases such as Google Scholar, Scopus, PubMed, and Science Direct were employed for literature survey. All articles published since 2011, when the outbreak was reported for the first time, were consulted for this systematic review. Research related to this subject is in its earlier stages and little information is currently available. Future studies must focus on the molecular basis, control, prevention, and therapeutics of E. anophelis to mitigate its increasing risk. This review is meant to provide baseline data for future research. Scientific community must carry out research on the infections caused by E. anophelis mosquito, else it may result in a disastrous outbreak. Copyright (c) 2021 NoshabaRani, BrairaWahid

Background Complications of percutaneous central venous catheters (PCVCs) include catheter-related blood stream infection (CRBSI), occlusion, leakage, and phlebitis, which may lead to sepsis or prolonged hospitalization. The primary objective of this randomized controlled trial was to determine the appropriate frequency of dressing for percutaneous central venous catheters in preventing CRBSI, every week regularly vs. non-regularly, in premature neonates in NICU. Methods Patients in NICU requiring PCVCs from March 2019–May 2020 were enrolled. Enrolled patients were randomly assigned into 2 groups: regular dressing group (RD), for which dressings were changed every week regularly, or additionally when oozing was noticed; and non-regular dressing group (ND), for which dressings were changed only when oozing was visible. The incidence of CRBSI, occlusion, leakage, and phlebitis were compared between the two groups using the Chi-squared test. The incidence of catheter-related complications was defined as numbers of episodes per 1,000 catheter-days. Results A total of 197 PCVCs were enrolled. The ND and RD groups had 99 and 98 PCVCs, respectively. The average CD interval was 9.3 days in ND group and 5.8 days in RD group. The incidence of CRBSI in RD group was 0‰, which was significantly lower than that of ND group, which was 2.0‰ (p = 0.048), but no significant differences were found between groups in the incidence of occlusion, leakage, and phlebitis of PCVCs. Conclusion Regular dressing changes every week and when oozing occurs while maintaining the protocol of maximum sterile barrier precautions is the best method and frequency of dressings of PCVCs.

BACKGROUND Septicaemia is a leading cause of morbidity and mortality in neonates. Antimicrobial prescription for neonatal septicaemia (NS) should be wisely used depending on the regional spectra of infecting microbes and their antimicrobial resistance (AMR) patterns which vary over time, place and host factors. METHODS This was a descriptive cross-sectional study conducted from January 2017 to June 2017 among 102 cases of NS admitted in neonatal intensive care units (NICU). Demographic data of the concerned neonates was collected through a predesigned checklist. Blood collected from neonates was processed for culture and sepsis screen. Antimicrobial susceptibility testing was performed for the cultured isolates and phenotypic AMR patterns were observed. RESULTS Most of the studied neonates had subnormal birth weight (86). Blood culture showed predominance of gram-negative bacilli (GNB) among which Klebsiella pneumoniae was the most common followed by Burkholderia cepacia complex. Coagulase negative staphylococcus species (CoNS) was most numerous among the cultured gram-positive cocci (GPC). Candidemia of late onset was confirmed in 25 neonates. Early onset sepsis was predominantly caused by GNB (29 / 31) predominated by Klebsiella pneumoniae. Multi drug resistant (MDR) pathogens viz., extended spectrum beta-lactamase (ESBL) producing GNB, carbapenem resistant-GNB (CR-GNB) and methicillin resistant staphylococcus (MRS) phenotypes were notably prevalent. CONCLUSIONS Multidrug resistant microorganisms are notably prevalent in neonatal septicaemia. In clinically suspected very sick septicaemic neonates not showing much improvement with guideline-led empirical antimicrobial therapy, an early antibiogram guided change over to meropenem and amikacin or even to colistin in case of reported carbapenem resistance, is highly recommended. KEYWORDS Antimicrobial Resistance, Blood Culture, Multi Drug Resistance, Neonatal Septicaemia

Background Blood stream infection (BSI) and sepsis are serious clinical conditions and identification of the disease-causing pathogen is important for patient management. The RISE (Rapid Identification of SEpsis) study was carried out to collect a cohort allowing high-quality studies on different aspects of BSI and sepsis. The aim of this study was to identify patients at high risk for BSI who might benefit most from new, faster, etiological testing using neutrophil to lymphocyte count ratio (NLCR) and Shapiro score. Methods Adult patients (≥ 18 years) presenting at the emergency department (ED) with suspected BSI were prospectively included between 2014 and 2016 at Örebro University Hospital. Besides extra blood sampling, all study patients were treated according to ED routines. Electronic patient charts were retrospectively reviewed. A modified Shapiro score (MSS) and NLCR were extracted and compiled. Continuous score variables were analysed with area under receiver operator characteristics curves (AUC) to evaluate the ability of BSI prediction. Results The final cohort consisted of 484 patients where 84 (17%) had positive blood culture judged clinically significant. At optimal cut-offs, MSS (≥3 points) and NLCR (> 12) showed equal ability to predict BSI in the whole cohort (AUC 0.71/0.74; sensitivity 69%/67%; specificity 64%/68% respectively) and in a subgroup of 155 patients fulfilling Sepsis-3 criteria (AUC 0.71/0.66; sensitivity 81%/65%; specificity 46%/57% respectively). In BSI cases only predicted by NLCR> 12 the abundance of Gram-negative to Gram-positive pathogens (n = 13 to n = 4) differed significantly from those only predicted by MSS ≥3 p (n = 7 to n = 12 respectively) (p Conclusions MSS and NLCR predicted BSI in the RISE cohort with similar cut-offs as shown in previous studies. Combining the MSS and NLCR did not increase the predictive performance. Differences in BSI prediction between MSS and NLCR regarding etiology need further evaluation.

Background Blood stream infection (BSI) is one of the major causes of morbidity and mortality worldwide. It has poses significant challenge to the clinicians and clinical microbiologists alike. Therefore its accurate diagnosis, isolation and identification of causative agents with appropriate antibiotics is required. This study is aimed to find out resistance pattern, e.g. extended-spectrum-beta-lactamase (ESBL), AmpC, K1, carbapenemase and metallo-β-lactamase (MBL) among isolates obtained from BSI. Methods A cross-sectional study was conducted in the Department of Microbiology, BPKIHS from 1st September 2014 to 31st August 2015. Isolates were screened for ESBL, AmpC, K1, and carbapenemase production by ten disk method. Confirmation for ESBL was done phenotypically by using combined disk method recommended by CLSI, AmpC sterile disk method for AmpC and K1 by combined disk method. Metallo-beta-lactamase (MBL) production was detected by imipenem-ethylene-diamine-tetra acetic acid double disk synergy test. Results A total of 11,264 blood samples were collected from the patients suspected of Blood Stream Infection. Of these isolates, 192 (1.70%) were Enterobacteriaceae. Among them, 94 (49%) were ESBL, 51 (26.5%) were carbapenemase and 10 (5%) were AmpC producers. Of 51 carbapenemase producers, 22 (11.5%) were MBL producers. None of the isolates were found to produce K1 β-lactamase. A total of 64 (33.4%) isolates were MDR. Conclusion MDR Enterobacteriaceae is found to be prevalent in our set up as important cause of BSI.

Aim: To estimate the prevalence of murA, uhpT, glpT and fosA resistance genes of fosfomycin in multidrug resistant Escherichia coli isolated from patients suffering from hematological malignancies with on top blood stream infection together with correlating this distribution to the rate of expression of AmpC, ESBLs and MBLs in such isolates. Methods: 205 blood samples collected from patients with underlying hematological malignancies were cultured to isolate E. coli strains. Multidrug resistance was detected. PCR was done to determine fosfomycin resistance genes; murA, uhpT, glpT and fosA. Results: A total of 83 (40.5%) E. coli strains were isolated from blood samples. 58 (69.9%) were found to be multidrug resistant. AmpC beta-lactamase production was deduced in 15 (25.8%) isolates. 43 (74.1%) isolates were ESBLs producers whereas 9 (15.5%) were MBL class A carbapene-mases producers. Depending on PCR results, murA gene was detected in one isolate (1.7%), uhpT gene in 3 (5.2%), glpT gene in 4 (6.9%) whereas fosA gene was found in 7 E. coli strains (12.1%). Conclusion: Fosfomycin is a promising antibiotic with limited degree of prevalence of its resistant genes; however disseminating resistance might increase in multidrug resistant E. coli

Over the last decade, Gram-negative bacteria have become the most predominant pathogens in blood stream infections (BSIs), accounting for over 1.8 million cases in Europe and North America [1]. At ...

Rapidly growing nontuberculous mycobacteria should be considered if GPRs gram‐positive rods are detected in blood cultures 2‐3 days after the blood sample collection.

Objective: To compare catheter related blood stream infection (CRBSI) rate between cuffed tunnelled and non-cuffed tunnelled PICC. Methods: We prospectively followed 100 patients (50:50 cuffed and non-cuffed PICC) and compared CRBSI rate between these groups. Daily review and similar catheter care were performed until a PICC-related complication, completion of therapy, death or defined end-of-study date necessitate removal. CRBSI was confirmed in each case by demonstrating concordance between isolates colonizing the PICC at the time of infection and from peripheral blood cultures. Results: A total of 50 cuffed PICC were placed for 1864 catheter-days. Of these, 12 patients (24%) developed infection, for which 5 patients (10%) had a CRBSI for a rate of 2.7 per 1000 catheter-days. Another 50 tunnelled non-cuffed PICCs were placed for 2057 catheter-days. Of these, 7 patients (14%) developed infection, for which 3 patients (6%) had a CRBSI. for a rate of 1.5 per 1000 catheter-days. The mean time to development of infection is 24 days in cuffed and 19 days in non-cuffed groups. The mean duration of utilization was significantly longer in non-cuffed than in cuffed group (43 days in non-cuffed vs 37 days in cuffed group, p = 0.008). Conclusions: Cuffed PICC does not further reduce the rate of local or bloodstream infection. Tunnelled non-cuffed PICC is shown to be as effective if not better at reducing risk of CRBSI and providing longer catheter dwell time compared to cuffed PICC.

Citrullinated fibrinogen (C-Fbg) has been detected in rheumatoid arthritis; however, few studies have reported the role of C-Fbg in other inflammatory diseases. This study aimed to clarify the changes in serum C-Fbg associated with the bacteremia phase.We measured serum C-Fbg concentration in bacteremia patients. C-Fbg levels at each phase of bacteremia, classified by white blood cell (WBC) count and neutrophil left shift change, were compared with those of healthy control (HC). The correlation between C-Fbg concentration and certain inflammatory markers, or citrullinated histone H3 concentration was assessed. Multiple linear regression (MLR) analysis was used to examine the association of log C-Fbg with certain inflammatory markers.Serum C-Fbg levels were significantly higher in bacteremia patients than in HC (p 0.001) and positively correlated with WBC and neutrophil count. Further, C-Fbg levels were significantly higher in phases III and IV of bacteremia than in HC (p 0.001). MLR analysis indicated that log C-Fbg had a stronger relationship with log neutrophil counts than other certain inflammatory markers (p 0.01).Serum C-Fbg levels increased in bacteremia patients, and this was consistent with an influx of neutrophils into the blood stream in accordance with the bacteremia phase.

Central tunneled catheter (CTC)-related infections are a leading cause of a catheter loss, thus being the source of significant morbidity and mortality. The study aims at evaluating the impact of the implementation of the innovative redness, edema, discharge and tenderness, symptoms (REDS) scale (devised by the authors) for the description of the tunnel condition on the frequency of infection in long-term catheter users. The same cohort of the 40 patients was observed for 4 years altogether: 2 years before and 2 years after REDS application. The results, as well as follow-up evaluation of participants, were compared. The 2-year cumulative incidence of the CTC exit site infection (ESI) dropped significantly (log-rankp< 0.001) from 0.89 episode/1,000 catheter days (53.5%, 95% CI [35.9%; 66.2%]) in the period before REDS was used—to 0.26 episode/1,000 catheter days (18.6%, 95% CI [6.1%; 29.4%]) in the time of REDS application. There were also significantly fewer episodes of ESI complicated with catheter-related blood stream infection (CRBSI) requiring the CTC removal (0.6 episode/1,000 catheter days; 18.6%, 95% CI [6.1%; 29.4%] vs. 0.3 episode/1,000 catheter days; 4.7%, 95% CI [0.0; 10.7%]; log-rankp= 0.04, in pre-REDS and REDS time, respectively). The REDS scale appears to be a simple, cost-effective tool reducing the frequency of the tunneled CTC exit site infection and associated bloodstream infections.

OBJECTIVE: To determine the frequency of most common bacterial organisms in nosocomial blood stream infections STUDY DESIGN: A Cross-sectional descriptive study PLACE AND DURATION: In Department of Paediatric Medicine, Fauji Foundation Hospital, Rawalpindi, Tertiary care hospital over a period of 06 months from 6th July 2017 to 6th Jan 2018 METHODOLOGY: Total 385 patients admitted in PICU were included in the study according to the inclusion criteria. Patients were monitored from the time of admission to their final outcome for development of hospital acquired infections, based on standard definitions. Blood sample for culture were collected aseptically according to the protocol of the microbiology laboratory. The bottles were incubated for 7 days. Patients were monitored from time of the blood culture yielding growth until culture report becomes available. Data was calculated through a structured Performa confidentiality of patient was maintained. RESULTS: Pseduomonas Aeruginosa and Salmonellia Tpyhi were the most common bacterial organism 83 (21.6) in nosocomial blood stream infection whereas E.Coli and Klebsiella found in 77 (20.0) and 67 (17.4) patients respectively. CONCLUSION: The study concluded that the frequency of most common bacterial organisms in nosocomial blood stream infections is substantial. Thus, early initiation of appropriate antibiotic therapy help in contributing significantly towards decrease in mortality rates due to blood stream infections. KEYWORDS: Nosocomial, Bloodstream infection, Intensive care unit

Background: Phlebitis incidents become indicator of hospital minimum service quality with standard occurrence

A muscle spasm can be clarified as an automatically and persuasively contracted muscle that doesn't relax. Muscle squeezing of the feet, and legs is genuinely basic on hemodialysis. The reason for muscle squeezing is not known. Nonetheless, three conditions that appear to increment squeezing are hypotension, the patient being underneath dry weight and utilization of low sodium dialysate arrangement. Allen practices for the confined muscle is the best treatment, May help in on the other hand crushing and delivering the confined muscle. This mechanical plying reestablishes blood stream and for the most part assists with loosening up the fit and snugness. Hence the study aimed to assess the effectiveness of Allen exercise in reduction of muscle cramps among hemodialysis patients. Quasi Experimental research design was employed with 80 samples which matched the inclusion criteria were selected by convenience sampling technique. Demographic variables data were collected by using a structured interview questionnaire followed by assessing the muscle cramps by using the Ashworth muscle cramps scale. The findings of the study clearly infers that the Allen Exercise administered to hemodialysis patients was found to be effective in reducing the level of muscle cramps among hemodialysis patients in the post test of experimental group than the hemodialysis patients in the control group.

Introduction: Neonates are very susceptible to Pseudomonas aeruginosa. Single case of Pseudomonas aeruginosa in preterm neonates is a sign for immediate action. Aim: To describe control of an outbreak of Pseudomonas aeruginosa bloodstream infections (PA-BSI) by being vigilant and by immediate intervention, that occurred in the neonatal intensive care unit (NICU) of a teaching institution and hospital in Dewas, India. Materials and Methods: The outbreak investigations included hunt for additional cases, evaluation of patient’s records, environmental and health care worker screening, immediate reporting to authority, and detection of source by minimal available aid i.e. quantitative antibiogram. Results: Health care worker screening samples were negative on culture for Pseudomonas aeruginosa and an environmental source was detected to be a curtain near washroom. Conclusion: This study described control of an outbreak of PA-BSI occurring over a week among neonates which was controlled following vigorous infection control measures. Quantitative antibiogram data should be routinely used for typing purposes as an essential part of hospital associated infection control procedure in source limited settings. Keywords: Outbreak control, Pseudomonas aeruginosa, Curtain, Quantitative antibiogram.

The global burden of death due to sepsis is considerable. Early diagnosis is essential to improve the outcome of this deadly syndrome. Yet, the diagnosis of sepsis is fraught with difficulties. Patients with blood stream infection (BSI) are at an increased risk of complications and death. The aim of this study was to determine the diagnostic accuracy of four readily available biomarkers to diagnose BSI in patients with suspected sepsis.In this retrospective, observational, Electronic Medical Record based study we compared the accuracy of procalcitonin (PCT), serum lactate concentration, total white blood cell (WBC) count and the neutrophil-lymphocyte count ratio (NLCR) to diagnose BSI in adult patients presenting to hospital with suspected sepsis. Based on the blood culture results patients were classified into 1 of the following 5 groups: i) negative blood cultures, ii) positive for a bacterial pathogen, iii) positive for a potential pathogen, iv) fungal pathogen and v) potential contaminant. Group 2 was further divided into Gram -ve and Gram +ve pathogens. Receiver operating characteristic (ROC) curves were constructed to compare the diagnostic performance of the biomarkers.There were 1767 discreet patient admissions. The median PCT concentration differed significantly across blood culture groups (p 0.0001). The highest median PCT concentration was observed in patients with a Gram-negative pathogen (17.1 ng/mL; IQR 3.6-49.7) and the lowest PCT in patients with negative blood cultures (0.6 ng/mL; IQR 0.2-2.8). The AUROC was 0.83 (0.79-0.86) for PCT, 0.68 (0.64-0.72) for the NLCR, 0.55 (0.51-0.60) for lactate concentration and 0.52 (0.48-0.57) for the WBC count. The AUROC for PCT was significantly greater than that of the NLCR (p 0.0001). A PCT less than 0.5 ng/mL had a negative predictive value of 95% for excluding BSI. The best cut-off value of PCT for predicting BSI was 1.5 ng/ml.Our results suggest that PCT of less than 0.5 ng/mL may be an effective screening tool to exclude BSI as the cause of sepsis, while the diagnosis of BSI should be considered in patients with a PCT above this threshold. The total WBC count and blood lactate concentration may not be reliable biomarkers for the diagnosis of BSI. The NLCR may be a useful screening test for BSI when PCT assays are not available.

This study tracks and analyses the culture results of 3615 blood samples received in Popular Diagnostic Centre, Dhanmondi, Dhaka 1205, throughout twelve month from suspected patients with blood stream infections. The samples were prepared by exploitation machine-controlled Fluorescent-Sensor Technology by BACTEC 9120® Culture System (Becton Dickinson and Company, Sparks, USA) choosing a 5 days incubation protocol. A total of 668/3615(18.50%) BACTEC 9120® system positive samples were then sub-cultured in 7% sheep blood agar, MacConkey agar, and chocolate agar plates. A sum of 346/668 (51.8%) were infective organisms and 312/668 (46.70%) positive vial cultures were contaminants. False positivism rate was 1.5% (10/668). The mean detection time for the clinical vital isolates was 17.7 h and for all the isolates was 38.1 h. Microorganisms characterization and antibiotic sensitivity testing was done using typical ways. The majorities (342, 98.84%) of those were Gram-negative microorganisms and solely 4 (1.16%) isolates were Gram-positive pathogens. Clinically vital pathogens recouped on day one, two and three were 91.0%, 7.5% and 1.5% severally. Most of the bacterial isolates were found extremely susceptible to a number of antibiotics along with ceftriaxone (95%), ceftazidine (95%), and cefepime (96%), whereas moderately sensitive to ciprofloxacin (81%), levofloxacin (89%) and chloramphenicol (81%); whereas all bacterial isolates were found to be resistant of nalidic acid (100%). Since all of our cultures were positive at intervals the primary 72 hrs, our data supported 5 day incubation system for the recuperation of medically vital microorganisms in BACTEC 9120® Culture System. [ J Adv Biotechnol Exp Ther 2020; 3(3.000): 165-170]

Background: I analyzed the organisms isolated from the blood of patients with acute cholangitis and determined their antibiotic resistance characteristics. In addition, I evaluated risk factors associated with antibiotic-resistant bacteria and their impact on clinical outcomes. Methods: 113 consecutive cases of acute cholangitis who met the diagnostic criteria were included in the study. Acute cholangitis was defined by TG18 criteria. Blood culture was obtained from every patient. The microbiological results of blood cultures & the antibiotic susceptibility pattern of the organisms were analyzed by SPSSv22.0. Multivariate analysis was performed to identify risk factors associated with antibiotic resistance & mortality. Result: Among 113 patients, 71(62.8%) were male & the median age was 51 years. Choledocholithiasis was the most common underlying biliary disease followed by malignant and benign strictures. Severe cholangitis occurred in 17(15%) cases. 32(28.3%) cases had nosocomial infection. Causative organisms were isolated from 55(48.7%) of 113 blood cultures. Escherichia coli was the most common bacterium isolated (36.36%) from blood, followed by Klebsiella pneumoniae (23.64%), Pseudomonas aeruginosa (7.27%) & Enterococcus (7.27%). Anaerobic bacteria were isolated from 5(9.09%) specimens. Multiple organisms were isolated in 6(10.91%) specimens. Most organisms were susceptible to meropenem (86.7%), imipenem (83.1%), colistin (89.1%), amikacin (76.1%), piperacillin-tazobactam (79.6%) & polymyxin-B (83.3%). Multidrug resistant bacteria comprised 30.91% of blood isolates. Risk factors associated with antibiotic resistance were presence of an indwelling biliary device (OR:7.7), prior biliary intervention (OR:6.167) and a nosocomial source of infection (OR:9.09). Thirteen (11.5%) patients died from acute cholangitis. Risk factors associated with mortality were severe cholangitis (OR:6.9), malignant biliary obstruction (OR:8.4), nosocomial infection (OR:7.5) and isolation of multidrug resistant organisms in blood (OR:6.9). Conclusion: E. coli was the most common organism isolated, followed by Klebsiella, Pseudomonas & Enterococcus. Colistin, meropenem, polymyxin-B, imipenem, amikacin & piperacillin-tazobactam were the most effective of all antibiotics. Risk factors associated with isolation of multidrug resistant bacteria from blood were presence of an indwelling biliary device, prior biliary intervention and a nosocomial source of infection. Risk factors associated with mortality were severe cholangitis, malignant biliary obstruction, nosocomial infection and isolation of multidrug resistant organisms in blood. Bangladesh Crit Care J September 2020; 8(2): 68-75

Aerosol particles have been shown to trigger cardiovascular and respiratory diseases in populations living in polluted regions, depending on their size and composition. Although fine aerosol particles have been found to reach the lungs and the blood stream, their acute effects are related to the fraction of ultrafine aerosol particles (i.e., UFPs, d 0.03 μm), PM10, PM2.5, criteria gases, and meteorological variables, were also monitored. The average UFPs concentration over the full sampling period was found to be 2,070 ± 1,831 cm-3, with events of peak concentrations as high as 55,117 cm−3. The average daily UFP profile is bimodal, with peak concentrations observed around 07:00 and 20:00 h LT. The correlation of the UFP with other measured variables suggests that the UFPs peaks observed in the morning and at night are likely caused by primary vehicular combustion particles. In contrast, atypical high concentrations of UFPs were occasionally observed around noon LT, which are likely of secondary origin and the result of new particle formation promoted by photochemistry. Overall, UFPs are the major contributor to the total particle number concentration, and they are likely an important contributor to PM2.5 in Merida during the morning hours, with clear anthropogenic sources.

To study the risk factors and outcome of blood stream infection caused by non-fermenting gram negative bacilli (NFGNB) and their pattern of antibiotic susceptibility and genes. We included sepsis cases with blood culture positive for NFGNB. MIC for colistin was determined by broth microdilution method. Multiplex PCR was used to detect BlaIMP, BlaVIM, BlaKPC, BlaNDM-1 genes in cephalosporin and carbapenems resistant Acinetobacter spp. isolates. Out of 4,664 cases of sepsis, 50 (1.07%) were positive for NFGNB. Acinetobacter spp. 29 (58%) was the predominant isolate, of which 16 (55.17%) isolates were resistant to cephalosporins and carbapenems. We detected BlaKPC and BlaNDM-1 genes in two of these isolates. We did not detect BlaIMP, BlaVIM, BlaKPC and BlaNDM-1 genes in any other NFGNB isolates. Majority of the strains of Pseudomonas spp. showed sensitivity to all the antibiotics tested. NFGNB sepsis patients with respiratory illness correlated well with fatal outcome (p

Haemoparasites are either intracellular or extracellular organisms that inhabit the blood stream of vertebrate hosts. This study was conducted in Zaria Nigeria inorder to investigate the prevalence of haemoparasites in polo horses and their effects on haematological parameters. Blood samples were collected from a total of 100 randomly selected horses from polo stables across Zaria. The blood samples were screened and examined using thin blood smear, buffy coat technique, and differential white blood cell count. From the results thirteen horses 100(13%) were found infected with haemoparasites. The prevalence of Theileria equi in local and exotic breeds was 5(9.4%) and4 (8.5%) while for microfilaria it was 3(5.3%) and1 (2.1%). There were no Babesia or Trypanosomes found in the samples 0%. Among sexes the prevalence of Theileria equi and microfilaria in males was 1(7.7%) while in females it was (9.3%) and 3(3.4%).A high prevalence of Theileria equi and microfilaria was seen among old horses 6(9.3%) and4 (3.4%) compared to young 3(7.7%) and1 (7.7%).There was no significant association between the presence of the infection and its effect on haematological values (p>0.05). In conclusion some haemoparasites were found in polo horses in Zaria. It is hereby recommended that routine vector control and prophylactic treatment should be carried out in stables