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Background: Consideration of non-diphtheriae Corynebacteria as an infective organism in mastitis, is usually neglected. So, infections due to Corynebacterium species may remain undiagnosed or misdiagnosed. The aim of our study was to focus on non-diphtheriae Corynebacterium as causative organisms in breast infections using scientific logic and technology of Matrix Assisted Laser Desorption Ionisation Time of Flight Mass Spectrometry (MALDITOF MS) to categorize the isolates upto species level. The clinical correlation and response to management especially targeted antimicrobials was also recorded. Methods: All the consecutive pus/tissue samples from Breast abscess received during study period were processed as per the standard guidelines. The identification of the isolate was done by automated methods. The cytopathological/histopathological and clinical details of the patients with infection due to Corynebacterium sp. were recorded and analyzed. Results: Out of 52 non-duplicate samples, five showed growth of non-diphtheriae Corynebacteria. These were identified as C. kroppenstedtii and C. amycolatum. The antimicrobial susceptibility testing showed 100% susceptibility to Amoxicillin-clavulanate, Tetracycline, Vancomycin and Linezolid for all the five isolates. Histopathological examination was suggestive of chronic inflammatory mastitis/Granulomatous mastitis. Conclusion: Non diphtheriae Corynebacteria particularly lipophilic Corynebacteria have a predilection to cause infections of breast tissue and Breast abscess which may mimic as tubercular abscess or chronic non-specific mastitis leading to unnecessary usage of antimicrobials. So, these isolates from breast tissue/pus should not be ignored rather definitely identified. This would also ensure diagnostic stewardship.

Background and Purpose: Trichosporon species are ubiquitous in nature which are associated with fatal opportunistic invasive infections, especially in immunocompromised patients. The present study aimed to evaluate the epidemiological and clinical details, as well as the antifungal susceptibility pattern of the patients with Trichosporon infections. Materials and Methods: In total, 50 clinical isolates of Trichosporon species from various samples were included in this study. The samples were isolated over a period of 18 months from patients in a tertiary hospital in North India. The isolates were characterised phenotypically with Vitek MS (bioMérieux, France). Trichosporon spp. were isolated from urine (30%), nail (30%), tissue (16%), pleural fluid (14%), and sputum (5%). In total, majority of the isolates were of Trichosporon asahii (92%),followed by Trichosporon mucoides (6%), and Trichosporon ovoides (2%). It is noteworthy that most of the reported cases were from intensive care unit (34%). Results: Intravenous catheters, antibiotics, and antifungal uptake were significantly associated risk factors with Trichosporon infection. All invasive isolates were observed to be resistant in vitro to caspofungin and exhibited high minimum inhibitory concentration (MIC) values against amphotericin B, fluconazole, and 5-flucytosine. The MICs for voriconazole and posaconazole were low. Conclusion: Trichosporonosis is being increasingly reported all around the world,including India. The results of this study highlighted the importance of early detection and treatment for this emerging yeast and also added to the ongoing surveillance for the antifungal susuceptibility pattern for this fungus.

Introduction: An increase in the number of primary total joint arthroplasties has correspondingly led to an increase in revisions as a result of various complications. The prosthetic joint infection (PJI) is a major complication with concordantly increased morbidity and costs. Through this study, we aimed to determine the bacteriological profiles of PJI diagnosed at our institute and analyze them in the context of patient profiles, joints affected, and the center where the index procedure was done. Materials and Methods: A retrospective study of the revision surgeries for PJI in hip and knee arthroplasties during the period between 2014 and 2019 was conducted. An analysis of 43 patient profiles, with 29 of those being knees and the rest 14 being hips was done, concerning the clinical picture, microbiological profile, and co-morbidities. Results: PJI constituted 31.03% of the revision cases. The knee joint was involved in 67.44% (n = 29) and the hip joint in 32.56% (n = 14). Early infection was seen in 2 (4.65%) and late infections in the remaining 41 (95.34%). 51.66% (n = 22) were culture-positive PJI, whereas 48.34% (n = 21) were culture-negative (CN) PJI. Preoperative C-reactive protein was elevated in 46.51% of the patients (48.27% knees and 42.87% hips). The erythrocyte sedimentation rate was preoperatively elevated by 65.12%. Of the comorbidities PJI was associated with, diabetes mellitus in 30.23%, hypertension in 39.53%, hypothyroidism in 16.28%, skin disorders in 4.65% (psoriasis and eczema), and immunosuppression in 4.65% cases. Conclusions: Microbial growth on routine culture is not mandatorily positive in several clinically suspected PJI. Hence, a stringent protocol requires to be followed in the use of antibiotics, the collection and transportation of samples, and in the selection of media for cultures in the cases of PJI. Notwithstanding the limitations of this study, we conclude that bacterial infections do not follow any predictable patterns, and constant vigilance with a low threshold to suspect and investigate PJI is needed in the management of PJI. We propose based on our study findings that no antibiotics should be used only after a bacteriological diagnosis and antibiotic sensitivity is obtained, else it results in a high rate of CN PJIs.

Introduction Coronavirus disease-2019 (COVID-19) systemic illness caused by a novel coronavirus severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been spreading across the world. The objective of this study is to identify the clinical and laboratory variables as predictors of in-hospital death at the time of admission in a tertiary care hospital in India. Materials and methods Demographic profile, clinical, and laboratory variables of 425 patients admitted from April to June 2020 with symptoms and laboratory-confirmed diagnosis through real-time polymerase chain reaction (RT-PCR) were studied. Descriptive statistics, an association of these variables, logistic regression, and CART models were developed to identify early predictors of in-hospital death. Results Twenty-two patients (5.17%) had expired in course of their hospital stay. The median age [interquartile range (IQR)] of the patients admitted was 49 years (21–77 years). Gender distribution was male — 73.38% (mortality rate 5.83%) and female—26.62% (mortality rate 3.34%). The study shows higher association for age (>47 years) [odds ratio (OR) 4.52], male gender (OR 1.78), shortness of breath (OR 2.02), oxygen saturation 24 (OR 5.31), comorbidities like diabetes (OR 2.70), hypertension (OR 2.12), and coronary artery disease (OR 3.18) toward overall mortality. The significant associations in laboratory variables include lymphopenia (

Background The epidemiology, clinical profile and outcome of paediatric candidemia vary considerably by age, healthcare settings and prevalent Candida species. Despite these differences, few comprehensive studies are undertaken. This nationwide study addresses this knowledge gap. Methods 487 children who contracted ICU-acquired candidemia at 23 Indian tertiary care centres were assessed for 398 variables spanning demography, clinical characteristics, microbiology, treatment and outcome. Results Both neonates (5.0 days; range = 3.0-9.5) and non-neonatal children (7.0 days; range = 3.0-13.0) developed candidemia early after ICU admission. Majority of neonates were premature (63.7%) with low birthweight (57.1%). Perinatal asphyxia (7.3%), pneumonia (8.2%), congenital heart disease (8.4%) and invasive procedures were common comorbidities, and antibiotic use (94.1%) was widespread. C tropicalis (24.7%) and C albicans (20.7%) dominated both age groups. Antifungal treatment (66.5%) and removal of central catheters (44.8%) lagged behind. Overall resistance was low; however, emergence of resistant C krusei and C auris needs attention. The 30-day crude mortality was 27.8% (neonates) and 29.4% (non-neonates). Logistic regression identified admission to public sector ICUs (OR = 5.64), mechanical ventilation (OR = 2.82), corticosteroid therapy (OR = 8.89) and antifungal therapy (OR = 0.22) as independent predictors of 30-day crude mortality in neonates. Similarly, admission to public sector ICUs (OR = 3.62), mechanical ventilation (OR = 3.13), exposure to carbapenems (OR = 2.18) and azole antifungal therapy (OR = 0.48) were independent predictors for non-neonates. Conclusions Our findings reveal a distinct epidemiology, including early infection with a different spectrum of Candida species, calling for appropriate intervention strategies to reduce candidemia morbidity and mortality. Independent factors identified in our regression models can help tackle these challenges.

Background: Susceptibility testing for polymyxins is a great challenge for a Clinical Microbiology laboratory. There are several methodological issues associated with MIC (Minimum Inhibitory Concentration) determination of colistin. Methods: In our study, we have compared the results of colistin susceptibility testing by Automated system (Vitek-2, Biomerieux, France) with the reference Broth Microdilution method (BMD) to identify the type of discrepancies by Vitek-2 method and thus develop a practical and accurate approach for colistin susceptibility testing in a Clinical Microbiology laboratory. A total of 730 strains of Gram negative bacteria [Escherichia coli (325), Klebsiella sp.(346), Acinetobacter baumanii complex (37) and Pseudomonas aeruginosa (22)] from 485 patents were tested simultaneously by BMD and Vitek-2 method for colistin susceptibility testing. Results: The Essential agreement (EA), Categorical agreement (CA), Very major error (VME) and Major error (ME) rates for Klebsiella sp. were 87.3%, 89.3%, 8% and 2.3% respectively, for Escherichia coli were 88.3%, 89.5%, 9.2% and 1.2% respectively, for Acinetobacter baumannii complex were 89.1%, 91.8%, 8.1% and 0% respectively, for Pseudomonas aeruginosa were 68.1%, 72.7%, 0% and 27.2% respectively. Conclusions: Colistin susceptibility testing by Vitek-2 method is an easily adoptable method and the results of Vitek-2 with reference to BMD are acceptable to a great extent in Klebsiella sp., Escherichia coli and Acinetobacter baumanii complex. So, we believe that Vitek-2 method may be used for colistin susceptibility testing in low risk patients. However, BMD should be used in high risk immunosupressed and immunocompromised patients who are admitted in critical care units. For Pseudomonas aeruginosa, BMD should be routinely used.

Introduction: Nocardia otitidiscaviarum is a rare cause of human infections, mostly causing cutaneous and lymphocutaneous infections of mild severity. We report two cases of fatal pulmonary infection caused by Nocardia otitidiscaviarum in elderly patients. Methodology: Case 1: A 70-year old woman presented with fever and cough with expectoration for a month. On physical examination, she had tachypnea and inspiratory crepitations in bilateral basal regions. Case 2: A 74-year old man presented with productive cough with foul smelling expectoration, fever and shortness of breath for one week. On examination, he had tachypnea, bilateral wheezing and inspiratory crepitations. In both cases, sputum was sent to microbiology laboratory. On direct microscopy Gram-positive, finely branching filaments were observed which were acid fast with 1% sulphuric acid. Chalky white opaque wrinkled colonies with musty basement type odour were seen on blood agar. Both patients were treated empirically with trimethoprim-sulfamethoxazole for Nocardia infection after notification of microscopy findings however both expired on Day 2 and Day 5 of admission, respectively. Both isolates were susceptible to amikacin, linezolid, ciprofloxacin and gentamicin. They were resistant to trimethoprim-sulfamethoxazole, ampicillin, amoxicillin-clavulanic acid, erythromycin, and imipenem. Based on biochemical identification and antimicrobial susceptibility pattern, the organism was identified as Nocardia otitidiscaviarum. The identification was confirmed using MALDI-TOF (Vitek MS, Biomerieux, France). Conclusion: Our report highlights the importance of early identification of Nocardia to species level to improve treatment outcomes especially in critically ill patients. Mass spectrometry can become an integral part of diagnostic algorithms for nocardiosis.

Group “G” Streptococcus is an ubiquitous non-pathogenic commensal organism found in the skin, throat, gut, appendix and the female genital tract. As per our review of the available literature we present the first reported case of localized intra-abdominal abscess caused by Group g streptoccoccus (GGS) also seen first time in our institution which is a rare but an important cause when after the requisite Surgical procedure-drainage and antibiotic regimens the post-operative pyrexia/symptoms do not settle down with rising counts then one should start thinking about upgrading the antibiotics to meropenem+ciprofloxacin/vancomycin/teichoplanin along-with the existing anaerobic cover. In our case blood cultures were negative, only the pus culture-liquid subcultures grew large colony gram positive cocci on the 1st postoperative day with further identification as Group G Streptococcus (GGS) with the sensitivity pattern on the 3rd postoperative day identified the organism as large-so a very good microbiology department team is necessary which in our case was instrumental in the management of our patient with a very high index of suspicion. This case is being reported for the reason of its rarity. Especially reported in patients who are diabetics/ malignancies/respiratory infections/immunosuppressed/chronic leg ulcers/pet dogs at home it is gaining importance as an organism for causing deep-seated abscesses in the body especially the abdomen which are usually multiple or as peritonitis. Another important reason mentioned in literature for immediate and urgent drainage of abscess caused by GGS infections is that this may lead to a very serious streptococcal toxic shock syndrome having a very fulminant and rapid downhill course with GGS bacteremia having a high 30 days mortality rate of to 15%.

Context Time to detection (TTD) given by continuous monitoring automated blood culture systems (CMABS) have been found to be a predictor of clinical outcome, drug resistance and type of microorganism in cases of bacteremia but the studies evaluating TTD with respect to fungemia are scarce especially from India. Aims To evaluate TTD for yeast isolates in fungal bloodstream infections with respect to the type of yeast isolates, risk factors and outcome and to study yeast susceptibility and distribution of yeast isolates with respect to patient population. Materials and methods All blood culture specimens were processed in CMABS. The TTD for yeast isolates were recorded. The identification of yeast and susceptibility testing was done by automated methods. A correlation of TTD was done with respect to prior/concurrent yeast isolates, use of antifungal, risk factors and clinical outcome. Results Out of 80 yeast isolates, the maximum was C. parapsilosis (26.25%) followed by C. albicans (16.25%) and C. tropicalis (13.75%). A statistically significant difference in the occurrence of yeasts with early TTD (TTD < = 48 hours) and late TTD (TTD > 48 hours) was found. TTD of C. glabrata was significantly longer (p = 0.002) while TTD of C. tropicalis was significantly shorter (p = 0.013). There was an observable favorable outcome in shorter TTD (< = 48 hours). C. albicans and C. tropicalis depicted 100% susceptibility for Azoles, Amphotericin B and Echinocandins. Conclusion TTD may be used as both diagnostic and prognostic adjunct in fungal bloodstream infections. This study is a step towards this novel approach. We also emphasize on the importance of speciation of yeast isolates and susceptibility testing. How to cite this article Butta H, Sardana R, Mendiratta L, Sibal A, Gupta V, Chawla R, Jafri AA. Time to Detection of Yeast Isolates in Pediatric and Adult Patients with Fungemia and its Relevance to Clinical Profile and Outcome. Indian Journal of Critical Care Medicine, January 2019;23(1):27-30.

In many developed countries, brucellosis has been successfully eradicated. However, brucellosis, with its myriad presentations, continues to be a clinical and diagnostic challenge in primarily agrarian countries such as India. We present a case of a rare manifestation of brucellosis i.e., septic arthritis of the knee joint associated with a lytic lesion of the proximal tibia. The patient belonged to a Brucella endemic country, and clinical features were of chronic reactive knee arthritis with synovial hypertrophy and effusion. Advanced diagnostic methods played a pivotal role in excluding the diagnosis of tuberculosis, and thus unnecessary administration of antitubercular therapy and initiating focused narrowed anti-Brucella management, achieving the goal of antimicrobial stewardship also.

To document the prevalence of non-alcoholic fatty liver disease (NAFLD) and metabolic parameters among normalweight and overweight schoolchildren. Cross-sectional study. Thirteen private schools in urban Faridabad, Haryana. 961 school children aged 5-10 years. Ultrasound testing was done, and 215 with fatty liver on ultrasound underwent further clinical, biochemical and virological testing. Prevalence of fatty liver on ultrasound, and NAFLD and its association with biochemical abnormalities and demographic risk factors. On ultrasound, 215 (22.4%) children had fatty liver; 18.9% in normal-weight and 45.6% in overweight category. Presence and severity of fatty liver disease increased with body mass index (BMI) and age. Among the children with NAFLD, elevated SGOT and SGPT was observed in 21.5% and 10.4% children, respectively. Liver enzyme derangement was significantly higher in overweight children (27% vs 19.4% in normal-weight) and severity of fatty liver (28% vs 20% in mild fatty liver cases). Eleven (8.1%) children with NAFLD had metabolic syndrome. Higher BMI (OR 35.9), severe fatty liver disease (OR 1.7) and female sex (OR 1.9) had strong association with metabolic syndrome. 22.4% of normal-weight and overweight children aged 5-10 years had fatty liver. A high proportion (18.9%) of normal-weight children with fatty liver on ultrasound indicates the silent burden in the population.

Infection after arthroplasty is disastrous both for the patient and surgeon. Infection by certain micro-organisms have additional important systemic implications. Streptococcus galloyticus is one such organism which has been implicated in colon carcinoma. We report a case of S. gallolyticus infection of a total knee prosthesis implant in a 72-year-old female who was managed successfully by two-stage revision. A thorough work-up did not show any evidence of gastro-intestinal malignancy, but nonspecific colitis was present on biopsy.

In many developed countries, brucellosis has been successfully eradicated. However, brucellosis, with its myriad presentations, continues to be a clinical and diagnostic challenge in primarily agrarian countries such as India. We present a case of a rare manifestation of brucellosis i.e., septic arthritis of the knee joint associated with a lytic lesion of the proximal tibia. The patient belonged to a Brucella endemic country, and clinical features were of chronic reactive knee arthritis with synovial hypertrophy and effusion. Advanced diagnostic methods played a pivotal role in excluding the diagnosis of tuberculosis, and thus unnecessary administration of antitubercular therapy and initiating focused narrowed anti-Brucella management, achieving the goal of antimicrobial stewardship also.

Objectives To identify the risk factors associated with Candida auris candidaemia, as this fungus now poses a global threat. Methods We performed a subgroup analysis of a previously reported study of 27 Indian ICUs. The clinical data of candidaemia cases due to C. auris and other Candida species were compared to determine significant risk factors associated with C. auris infection. Results Of the 1400 candidaemia cases reported earlier, 74 (5.3%) from 19 of 27 ICUs were due to C. auris . The duration of ICU stay prior to candidaemia diagnosis was significantly longer in patients with C. auris candidaemia (median 25, IQR 12-45 days) compared with the non- auris group (median 15, IQR 9-28, P < 0.001). Based on logistic regression modelling, admission to north Indian ICUs [OR 2.1 (1.2-3.8); P = 0.012], public-sector hospital [OR 2.2 (1.2-3.9); P = 0.006], underlying respiratory illness [OR 2.1 (1.3-3.6); P = 0.002], vascular surgery [OR 2.3 (1.00-5.36); P = 0.048], prior antifungal exposure [OR 2.8 (1.6-4.8); P < 0.001] and low APACHE II score [OR 0.8 (0.8-0.9); P = 0.007] were significantly associated with C. auris candidaemia. The majority (45/51, 88.2%) of the isolates were clonal. A considerable number of isolates were resistant to fluconazole ( n = 43, 58.1%), amphotericin B ( n = 10, 13.5%) and caspofungin ( n = 7, 9.5%). Conclusions Although C. auris infection has been observed across India, the number of cases is higher in public-sector hospitals in the north of the country. Longer stay in ICU, underlying respiratory illness, vascular surgery, medical intervention and antifungal exposure are the major risk factors for acquiring C. auris infection even among patients showing lower levels of morbidity.

By definition, a brain abscess is an intraparenchymal collection of pus. Nocardia shows to have a special tropism for the neural tissue. Solitary abscess represents the most common manifestation in the central nervous system, accounting for 1%–2% of all cerebral abscesses. In this report, we present a case of primary multiple brain abscesses due to Nocardia farcinica in an immune competent patient. Early diagnosis and surgical intervention is significant for the patient.

A 62-year-old man with asthma sought care for intermittent fever, cough with expectoration, breathlessness and orthopnoea with grunting. Computed tomography revealed clusters of centrilobular nodules on both sides with a tree-in-bud appearance and mild diffuse bronchial wall thickening. Sputum sample grew pure colonies of Actinobacillus ureae which was confirmed by MALDI-TOF and 16SrRNA gene sequencing. A. ureae may be an additional bacteriologic causative agent of the tree-in-bud pattern on computed tomographic scan.

Escherichia vulneris is an opportunistic human pathogen. It has been primarily reported in adult patients and invasive infections have been observed in immune-suppressed individuals. This is the first report of E. vulneris causing complicated diarrhoea and sepsis in an infant.Two month old sick infant, born full-term, was admitted to the paediatrics department with loose motions and refusal to feed for four days. E. vulneris was isolated from blood in pure culture. The isolate was characterized for diarrhoeal virulence markers: heat labile and heat stable toxins (LT, ST) and hemolysin (hlyA) by PCR. The presence of LT enterotoxin and hemolysin provides strong evidence of the diarrhoeagenic potential of E. vulneris, further leading to the invasive infection triggering sepsis.As E. vulneris can lead to serious complications, an attempt should be made in clinical laboratories to identify and further characterize this new Escherichia species.

Corynebacterium amycolatum has been rarely reported from cases of breast abscess/mastitis. We describe a case of Corynebacterium amycolatum causing breast abscess with fistula formation. The identification of the organism was done by MALDI- TOF (Matrix assisted Laser Desorption Ionization Time of Flight) Vitek MS (Mass spectrometry) [Biomerieux, France] and Vitek-2 (Biomerieux, France). The clinical significance of the organism was ascertained in view of presence of many polymorphonuclear cells along with Gram positive bacilli on Gram stain examination. The patient was successfully managed with surgical treatment followed by antimicrobial therapy. DOI: 10.21276/APALM.1456

Objectives To describe the epidemiology, management and outcome of individuals with mucormycosis; and to evaluate the risk factors associated with mortality. Methods We conducted a prospective observational study involving consecutive individuals with proven mucormycosis across 12 centres from India. The demographic profile, microbiology, predisposing factors, management and 90-day mortality were recorded; risk factors for mortality were analysed. Results We included 465 patients. Rhino-orbital mucormycosis was the most common (315/465, 67.7%) presentation followed by pulmonary (62/465, 13.3%), cutaneous (49/465, 10.5%), and others. The predisposing factors included diabetes mellitus (342/465, 73.5%), malignancy (42/465, 9.0%), transplant (36/465, 7.7%), and others. Rhizopus species (231/290, 79.7%) were the most common followed by Apophysomyces variabilis (23/290, 7.9%), and several rare Mucorales. Surgical treatment was performed in 62.2% (289/465) of the participants. Amphotericin B was the primary therapy in 81.9% (381/465), and posaconazole was used as combination therapy in 53 (11.4%) individuals. Antifungal therapy was inappropriate in 7.6% (30/394) of the individuals. The 90-day mortality rate was 52% (242/465). On multivariate analysis, disseminated and rhino-orbital (with cerebral extension) mucormycosis, shorter duration of symptoms, shorter duration of antifungal therapy, and treatment with amphotericin B deoxycholate (versus liposomal) were independent risk factors of mortality. A combined medical and surgical management was associated with a better survival. Conclusions Diabetes mellitus was the dominant predisposing factor in all forms of mucormycosis. Combined surgical and medical management was associated with better outcomes. Several gaps surfaced in the management of mucormycosis. The rarer Mucorales identified in the study warrant further evaluation.

Prosthetic joint infection (PJI) is a challenging complication of total joint arthroplasty for both a microbiologist and an Arthroplasty surgeon with respect to diagnosis and management. The various investigations used for diagnosis of PJI based on different reference criteria have their own fallacies. Amongst the newer biomarkers evaluated to strengthen the diagnosis of PJI, Alpha defensins has been found to be a useful synovial fluid biomarker. In this review, we have discussed the various laboratory investigations, their benefits and shortcomings for the diagnosis of PJI. Other newer diagnostic methods like molecular methods and modified culture techniques to increase the performance characteristics for the diagnosis of PJI have also been presented.

Introduction: Fungal infections of the skin and soft tissue can be an important cause of morbidity and mortality in both immunocompromised and immunocompetent patients and usually pose a major diagnostic challenge. Aim: The present study was done to study the type of fungal isolates from pus and soft tissue specimens and to clinically correlate these fungal isolates. Materials and Methods: A retrospective analysis of fungal isolates from pus and soft tissue specimens was done over a period of one year and their clinical history was studied from medical records department. The identification of yeast isolates was done by automated (MALDI-TOF-Vitek MS and Vitek-2) and conventional methods and mycelial fungi were identified by lactophenol cotton blue mount of growth and/or slide culture. Results: Out of 288 pus/tissue specimens received for fungal culture during the study period, 37 showed growth of fungi. Out of 37 fungi, 24 were yeast isolates and 13 were mycelial fungi. Candida albicans (24.3%) constituted the majority of the fungal infections followed by Candida glabrata (21.6%), Aspergillus sp. (18.9%) and Dematiaceous fungi (13.5%). All the Dematiaceous fungi were isolated from post-transplant patients. Out of 37 patients, 12 were immunocompromised and 22 had history of surgery. Antifungal resistance was not seen in C. albicans while Candida haemulonii/auris showed 100% resistance to amphotericin B and fluconazole. All the patients in our study had history of prior antibiotic intake for one or other reasons. In contradiction to leucopenia, many of the patients in our study had leucocytosis at the time of isolation of fungi. Conclusion: A variety of fungi may cause pus and soft tissue infections in both immunocompromised and immunocompetent individuals. The results signify the importance of clinicomycological awareness, correlation, fungal speciation and trend of antifungal susceptibility pattern for the optimum treatment of the patients.

Bifidobacterium sp. are anaerobic, Gram-positive, short, irregular rods with rudimentary branching. These organisms are reported to be associated with health benefits and their significance as a pathogen is not much reported. We are reporting two cases of mixed pyogenic infections due to Bifidobacterium sp. In the first patient, the infection mimicked tubercular bone infection. The second patient was a case of hydronephrosis with double J (DJ) stent blockage. In both cases, Bifidobacterium sp. was isolated in combination with Escherichia coli from the evacuated pus samples. The factors which contributed significantly for detecting Bifidobacterium sp. were gram stain examination, use of rapid and automatic anaerobic cultivation system (Anoxomat, MART Microbiology B.V., The Netherlands), and quick identification by MALDI-TOF (Matrix-Assisted Laser Desorption-Time-of-Flight) Mass Spectrometry (Biomerieux, France). Both strains were found to be resistant to metronidazole and both patients showed a good clinical response to treatment with beta-lactam antibiotics. So, we highlight the importance of seeking Bifidobacterium species in all clinical pyogenic samples.

Yokenella regensburgei is an opportunistic human pathogen of the Enterobacteriaceae family rarely reported to cause human infections. Here, we present a case report of Y. regensburgei bacteraemia from India clinically resembling enteric fever in an apparently immunocompetent paediatric patient.

Introduction Enterococci are part of the normal intestinal flora and have been recognized as important human pathogens. Vancomycin Resistant Enterococci (VRE) are global threat as this resistance is transmissible and also poses a challenge for infection control. Aim This study was undertaken to study phenotypic and genotypic characteristics of VRE from clinically significant infections among hospitalized patients and their association with gut colonization. Materials and methods Clinically significant isolates of enterococci (n=250) were studied. Species confirmation was done by Polymerase Chain Reaction (PCR). Minimum Inhibitory Concentration (MIC) for vancomycin was determined by E-test. PCR for VanA, VanB and VanC1 gene was done for genotypic characterization. MIC for teicoplanin, linezolid, tigecycline, daptomycin and quinupristin-dalfopristin was determined by E test. Patients with VRE infection were screened for gut colonization using vancomycin screen agar (6 μg/mL). Continuous data was analysed using the Student's t-test. Categorical data was assessed using Pearson's Chi-square test. A value of p ≤ 0.05 was considered statistically significant. Results There was good correlation between the phenotypic and genotypic methods used for species identification and detection of vancomycin resistance. E. faecium (162, 64.8%) was most common followed by E. faecalis (82, 32.84%) and E. gallinarum (6, 2.4%). Overall higher resistance was observed among E. faecium. Vancomycin MIC ≥ 2 μg/mL was noted in 63 (25.2%) isolates. Fifty seven isolates showed presence of vanA and vanC1 was detected in six isolates of E. gallinarum. Isolates with VanB genotype was not detected in the present study. MIC50 (μg/mL) for teicoplanin, linezolid, tigecycline, daptomycin and quinupristin-dalfopristrin was 24, 0.75, 0.064, 2 and 0.064 respectively. Resistance to linezolid (1, 1.6%) and tigecycline (2, 3.2%) was rare. Majority (33/47, 70.2%) patients with clinically significant VRE infection showed gut colonization. Conclusion Vancomycin resistance among enterococci is emerging. Emergence of tigecycline and linezolid resistance is also posing a challenge for clinicians. Thus, further investigations are warranted to control vancomycin resistance among pathogens.

Background Though the rise in number of mucormycosis cases has been reported globally, the rise in India is alarming especially in uncontrolled diabetics. However, multiple gaps exist in the understanding of the disease in this country. Methods To describe the epidemiology, diagnosis, treatment practices, and outcome of mucormycosis in India. A single-arm prospective observational study was conducted in the network of 17 tertiary care centres across India during April 2016 through September 2017. All consecutive proven mucormycosis patients were enrolled in this study. Clinical data including risk factors, investigations, and treatment were collected. All isolates and histopathological specimens were sent to Mycology Reference Laboratory at Chandigarh for final identification (phenotypic and sequencing) and drug susceptibility testing. Results A total of 474 cases were enrolled between the study period. Rhino-orbito-cerebral mucormycosis was common (42.7%) presentation with 22.8% patients had brain involvement, followed by pulmonary (14.6%), cutaneous (11.8%), isolated renal (3.9%), and intra-abdominal (2.8%) mucormycosis. The underlying disease or predisposing factors were noted in 79.7% cases (84.9% diabetes mellitus, 12.9% steroids, 10.3% trauma or history of surgery, 9.7% malignancy, and 9.2% transplant). The most common agents isolated were Rhizopus species (75.9%, R. arrhizus [74.3%] and R. homothallicus [6.7%]) followed by Apophysomyces variabilis (7.4%), Mucor species (6%), and Lichtheimia corymbifera (4%). The patients were managed by medical therapy in 82.8%, surgery in 56.8% while 51.7% received combined medical and surgical management. Amphotericin B (96.8%) either lipid formulations (65.7%) or conventional form (39.1%) was the common antifungal used. The mortality of patients was 30.4%; of which, 80.3% patients died within 6 weeks of their diagnosis. 24.3% patients left hospital against medical advice while 50.1% survived. Conclusion Rhino-orbital-cerebral mucormysosis in uncontrolled diabetics is common presentation in India. R. arrhizus followed by A. variabilis are common species isolated from those patients. Survival was noted only in half of the patients despite increased awareness and diagnosis. Disclosures All authors: No reported disclosures.

Background/Objectives: Catheter-related bloodstream infection (CR-BSI) is one of the common causes of healthcare-associated infections. Minimizing CR-BSI by implementing the various components of the indigenized Bundle was our main objective. Methods: Measurement of CR-BSI was done using the Centers for Disease Control (CDC) criteria. The strategy for re-enforcement of the Bundle aimed at intensifying hand-hygiene, increased awareness drives, creating in-house video training programs and creation of an individualized complete central-line insertion kit. Results: The CR-BSI decreased from 5.4 in 2006 to 1.41 in 2010 per 1000 central line days. Certain challenges like reforming the behavioral attitude required to be tackled. Further measures like use of ATP-based hand-hygiene monitor, chlorohexidine patches and 'scrub the hub' drive were implemented. Conclusion: The CR-BSI decreased to 0.92 per 1000 central line days in 2011. This study showed that indigenized measures for implementing the Bundle approach can work out as a fruitful strategy for decreasing CR-BSI.

We report an unusual morphological mucoid variant of Staphylococcus haemolyticus associated with linezolid resistance from a patient with sepsis. Linezolid resistance and mucoid character together made this pathogen difficult to treat. To our knowledge this is the first such report.

BACKGROUND: Blood transfusion of contaminated components is a potential source of sepsis by a wide range of known and unknown pathogens. Collection mechanism and storage conditions of platelets make them vulnerable for bacterial contamination. Several interventions aim to reduce the transfusion of contaminated platelet units; however, data suggest that contaminated platelet transfusion remains very common. AIM: A pathogen inactivation system, “INTERCEPT”, to inactivate bacteria in deliberately contaminated platelet units was implemented and evaluated. MATERIALS AND METHODS: Five single-donor platelets (SDP) and five random donor platelets (RDP) were prepared after prior consent of donors. Both SDP and RDP units were deliberately contaminated by stable stock ATCC Staphylococcus aureus and Escherichia coli, respectively, with a known concentration of stock culture. Control samples were taken from the infected units and bacterial concentrations were quantified. The units were treated for pathogen inactivation with the INTERCEPT (Cerus Corporation, Concord, CA) Blood system for platelets (Amotosalen/UVA), as per the manufacturer's instructions for use. Post illumination, test samples were analyzed for any bacterial growth. RESULTS: Post-illumination test samples did not result in any bacterial growth. A complete reduction of >6 log10 S. aureus in SDP units and >6 log10 Escherichia coli in RDP units was achieved. CONCLUSION: The INTERCEPT system has been shown to be very effective in our study for bacterial inactivation. Implementation of INTERCEPT may be used as a mitigation against any potential bacterial contamination in platelet components.

A 22 year old Indian woman presented to the orthopaedic clinic with excruciating pain and swelling in multiple joints (knee, ankle, wrist, and elbow) for the past two weeks. She also had on and off high grade fevers for the past month, associated with a rash all over her body. There were no ophthalmic or urinary symptoms. Investigations on presentation to the clinic showed anti-chikungunya immunoglobulin M and G antibodies. She had been managed with simple analgesia. At the current presentation, on examination, her joints were mildly swollen and tender (fig 1⇓). Plain radiographs of the hand, knee, and ankle did not show any juxta-articular osteopenia or bone erosion. Fig 1 Asymmetrical swelling of knees (right more than left) The results of a full blood count showed a haemoglobin of 120 g/L (reference range 135-180 g/L), total leucocyte count of 8700 cells/µL (3500 to 10 500 cells/µL). Her erythrocyte sedimentation rate (15 mm/h) and C reactive protein (0.5 mg/L) were found to be within normal limits. Rheumatoid arthritis factor, antibodies against the cyclic citrullinated protein, antinuclear antibodies, and human leucocyte antigen B27 were also negative.