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Comparison of culture and antigen detection method from cerebrospinal fluid for diagnosis of acute pyogenic meningitis due to Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b
journal of patient safety & infection control 3 ( 2 0 1 5 ) 70–117
83
caused by Gram negative bacilli, followed by Gram positive cocci. A retrospective study was undertaken for a period of six months to find out the incidence of neonatal septicemia in this hospital, common bacteria isolated from cases of sepsis and their antimicrobial susceptibility pattern. Method: One to two milliliters blood was collected in 10–20 ml of tryptic soy broth from all neonates admitted in Neonatal Intensive Care Unit (NICU), clinically suspected of sepsis. Standard techniques were followed for isolation and all isolates were identified by standard biochemical tests. Antibiotic susceptibility testing was performed on Muller Hinton Agar by Kirby Bauer Disc Diffusion method, according to CLSI guidelines. Result: Total blood cultures received during six months from suspected cases of sepsis were 587, of which 21.3% (125) showed growth. Gram negative bacilli (56%) outnumbered Gram positive cocci (44%). Predominant bacteria were Acinetobacter species (28%), followed by Enterococcus species and methicillin sensitive Staphylococcus aureus (15.2%) each. Overall susceptibility of amikacin and cefotaxime to Gram negative bacilli (GNB) were only 23% and 17% respectively. Tigecycline and colistin showed 100% susceptibility to Acinetobacter species. Multidrug resistant (MDR)-GNB encountered were 55.7% and carbapenem resistance seen was 11.43%. All methicillin resistant Staphylococcus aureus and Enterococcus species were susceptible to vancomycin and linezolid. High Level Aminoglycoside Resistance (HLAR) in Enterococcus species was 36.8%. Conclusions: Incidence of MDR-GNB and HLAR in Enterococci were high in cases of neonatal sepsis. So prudent use of antibiotics and good infection control practices are advocated in NICUs. Conflicts of interest: The authors have none to declare.
lized to identify SSIs. SSI rate was expressed as the number of infections per 100 CABG procedures. Results: The overall rate of SSI in CABG procedures at our center over the five year period was 2.08% (62/2890). The superficial sternal wound infection rate was 1.37%, leg harvest site infection rate was 0.34% and deep sternal wound infection rate was 1.21%. Analysis of data reveals that Gram-negative bacteria accounted for 51.66% of the total isolates obtained from the wound swabs from CABG surgical site. However, overall Staphylococcus aureus (23.66%) was the most common isolate followed by Pseudomonas aeruginosa (21.66%), Klebsiella pneumoniae and Coagulase negative Staphylococci (13.66%) each. Polymicrobial infections were observed in 4.83% cases. Conclusions: The apparently increased proportion of CABG SSIs caused by Gram negative bacteria in Indian setup has important implications for clinical practice. Local antibiograms should be considered prior to selecting surgical prophylactic antibiotics for patients undergoing CABG procedures. Conflicts of interest: The author has none to declare.
http://dx.doi.org/10.1016/j.jpsic.2015.10.112
Introduction: The common bacteria encountered in acute pyogenic meningitis in children and young adults are Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b. Though culture methods are available but the fastidious nature of these bacteria prompted us to go for rapid detection test in cerebrospinal fluid (CSF). Objectives: This study was intended to isolate and identify S. pneumoniae, N. meningitidis and H. influenzae type b in cases of acute pyogenic meningitis from CSF samples and to compare with antigen detection test. Method: The common bacteria encountered in acute pyogenic meningitis in children and young adults are S. pneumoniae, N. meningitidis and H. influenzae type b. Though culture methods are available but the fastidious nature of these bacteria prompted us to go for rapid detection test in cerebrospinal fluid (CSF). Objectives: This study was intended to isolate and identify S. pneumoniae, N. meningitidis and H. influenzae type b in cases of acute pyogenic meningitis from CSF samples and to compare with antigen detection test. Result: Out of 50 cases, majority were adults (64%), maximum were in the age group of 16–40 years (38%) and with male preponderance (64%). On culture, three S. pneumoniae was grown in CSF samples. H. influenzae and N. meningitidis did not grow in culture. Antigen detection test positivity in CSF was 30% for S. pneumoniae 16%, followed by N. meningitidis 10% and H. influenzae 4%. Antigen detection test was
P035 Incidence and microbiology of surgical site infections following coronary artery bypass graft (CABG) surgery at a tertiary care hospital in Jaipur, India Smita Sood 1,2 1
Department of Laboratory Medicine (SRL Ltd.), Fortis Escorts Hospital, Jaipur, India 2 Department of Cardiothoracic Vascular Surgery, Fortis Escorts Hospital, Jaipur, India Introduction: Surgical site infections (SSIs) complicating CABG procedures remain a significant clinical problem as they are associated with substantial mortality and morbidity and impose severe demands on healthcare resources. There is limited data from India on the incidence of SSIs and causative pathogens following CABG surgery. Method: 2890 consecutive patients undergoing CABG surgery over a period of 5 years (2009–2013) at Fortis Escorts Hospital Jaipur, India were included in this study. Surveillance definitions from the Centers for Disease Control and Prevention (CDC)/National Healthcare Safety Network (NHSN) were uti-
http://dx.doi.org/10.1016/j.jpsic.2015.10.113
P036 Comparison of culture and antigen detection method from cerebrospinal fluid for diagnosis of acute pyogenic meningitis due to Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b N. Mehta, P. Bhakare, A. De, A. Sonavane, S. Baveja L.T.M. Medical College, Mumbai, India
84
journal of patient safety & infection control 3 ( 2 0 1 5 ) 70–117
significant than culture (p = 0.002). In the positive cases, CSF protein value of >100 mg/dl and sugar 100 cells/l and polymorphonuclear leucocyte >80% were seen in 93.3% and 73.3% respectively. Conclusions: Antigen detection test of CSF sample is superior to culture in diagnosis of acute pyogenic meningitis. It is rapid, easy to perform and does not require much expertise. Conflicts of interest: The authors have none to declare.
http://dx.doi.org/10.1016/j.jpsic.2015.10.114
P037 Study of cerebrospinal fluid shunt infections with special reference to organisms isolated and their antimicrobial susceptibility pattern V. Gharde, A. Sonavane, A. De, S. Baveja Department of Microbiology, L.T.M. Medical College, Mumbai, India Introduction: Cerebrospinal fluid (CSF) shunt infection is one of the most devastating complication leading to significant morbidity and chronic ill health. A retrospective study was carried out to find out the organisms isolated from central nervous system (CNS) shunts and their antimicrobial susceptibility pattern. Method: Sixty shunt fluids sent for bacteriological work up for a period of one year (January to December 2014) in this tertiary care hospital were studied. Laboratory diagnosis was established by subjecting the CSF to cell count, biochemical tests and bacteriological culture. Organisms were identified by standard microbiological techniques. Antimicrobial susceptibility test was performed by Kirby Bauer disc diffusion method, as per CLSI guidelines. Result: Out of 60 shunt fluids, 36.6% (22) were culture positive. Enterococcus species was the most common isolate accounting for 31.9%, followed by Pseudomonas aeruginosa (18.2%) and Klebsiella pneumoniae (13.6%). Methicillin resistant Staphylococcus aureus (MRSA) was 9.1%. High level aminoglycoside resistance (HLAR) among Enterococcus species was 28.6%. Majority of the Gram negative isolates were susceptible to amikacin and chloramphenicol. Multidrug resistant Gram negative bacilli were seen in 36.4% cases. One Candida albicans was isolated from an adult male from postoperative case of cerebral hematoma. Conclusions: Appropriate diagnosis, treatment and prevention of infections are important elements to optimise care for patients with CSF shunt infection. Outcome of the patients is better if these shunt infections are identified early and managed with appropriate antibiotics. Conflicts of interest: The authors have none to declare.
P038 Bacteriological monitoring of dialysis fluid in a hemodialysis centre B. Behera AIIMS, Bhubaneswar, India Introduction: Microbiological contamination of water is a serious health concern for patients on dialysis. High levels of bacteria and/or endotoxin can harm patients by causing acute pyrogenic reactions. Long term exposure to low levels of endotoxin activates cytokine induction which may lead to adverse outcomes like cardiovascular diseases, malnutrition etc. The aim of this study was to investigate the bacteriological quality of dialysis water in a hemodialysis centre of South India. Method: This study was conducted over a period of approximately one year (January 2012 to December 2012) in a newly commissioned haemodialysis centre located in a tertiary care hospital of South India. A total of 432 water samples were collected from the product water distribution piping at the following locations (distal to 1st RO plant, first storage tank, second storage tank, HD room faucets, dialysate) in two dialysis rooms, designated rooms A and B. In addition 36 samples were taken from 19 dialysis machines, during patient changeover, after they were disinfected. Bacteriological quantification was done in duplicate on Tryptone Glucose Extract agar Endotoxin detection was estimated by Limulus Amoebocyte Lysate Assay. As recommended by the Association for the Advancement of Medical Instrumentation (AAMI), water and dialysate samples were considered unacceptable, if one or more of the following criteria were found, (>200 CFU/mL heterotrophic bacteria and 0.25 endotoxin Units/mL (EU/mL). Result: Out of 432 samples, 376 samples (87%) had heterotrophic plate count <200 CFU/mL, acceptable according to AAMI guidelines. By LAL assay, 37% were unacceptable. The percentages of acceptable samples were nearly similar in HD units A and B. Our study has less discrepancies between HPC and LAL assay compared to other studies Conclusions: Monitoring of endotoxin level (which is currently not checked in majority of Indian Dialysis set ups), should be integrated in the routine bacteriological monitoring of dialysis fluid. Conflicts of interest: The present study results are part of the Quality improvement system in the Hospital. No pharmaceutical grants were used for this study.
http://dx.doi.org/10.1016/j.jpsic.2015.10.116
P039 A study assessing knowledge of hand hygiene in nosocomial infection prevention at a tertiary health care hospital R. Benson 1 , V. Narinder 1 , D. Deodhar 2 , R. Jairus 3 , A. Panu 4 1
http://dx.doi.org/10.1016/j.jpsic.2015.10.115
Infection Control Nurses, Christian Medical College and Hospital, Ludhiana, Punjab, India
83
caused by Gram negative bacilli, followed by Gram positive cocci. A retrospective study was undertaken for a period of six months to find out the incidence of neonatal septicemia in this hospital, common bacteria isolated from cases of sepsis and their antimicrobial susceptibility pattern. Method: One to two milliliters blood was collected in 10–20 ml of tryptic soy broth from all neonates admitted in Neonatal Intensive Care Unit (NICU), clinically suspected of sepsis. Standard techniques were followed for isolation and all isolates were identified by standard biochemical tests. Antibiotic susceptibility testing was performed on Muller Hinton Agar by Kirby Bauer Disc Diffusion method, according to CLSI guidelines. Result: Total blood cultures received during six months from suspected cases of sepsis were 587, of which 21.3% (125) showed growth. Gram negative bacilli (56%) outnumbered Gram positive cocci (44%). Predominant bacteria were Acinetobacter species (28%), followed by Enterococcus species and methicillin sensitive Staphylococcus aureus (15.2%) each. Overall susceptibility of amikacin and cefotaxime to Gram negative bacilli (GNB) were only 23% and 17% respectively. Tigecycline and colistin showed 100% susceptibility to Acinetobacter species. Multidrug resistant (MDR)-GNB encountered were 55.7% and carbapenem resistance seen was 11.43%. All methicillin resistant Staphylococcus aureus and Enterococcus species were susceptible to vancomycin and linezolid. High Level Aminoglycoside Resistance (HLAR) in Enterococcus species was 36.8%. Conclusions: Incidence of MDR-GNB and HLAR in Enterococci were high in cases of neonatal sepsis. So prudent use of antibiotics and good infection control practices are advocated in NICUs. Conflicts of interest: The authors have none to declare.
lized to identify SSIs. SSI rate was expressed as the number of infections per 100 CABG procedures. Results: The overall rate of SSI in CABG procedures at our center over the five year period was 2.08% (62/2890). The superficial sternal wound infection rate was 1.37%, leg harvest site infection rate was 0.34% and deep sternal wound infection rate was 1.21%. Analysis of data reveals that Gram-negative bacteria accounted for 51.66% of the total isolates obtained from the wound swabs from CABG surgical site. However, overall Staphylococcus aureus (23.66%) was the most common isolate followed by Pseudomonas aeruginosa (21.66%), Klebsiella pneumoniae and Coagulase negative Staphylococci (13.66%) each. Polymicrobial infections were observed in 4.83% cases. Conclusions: The apparently increased proportion of CABG SSIs caused by Gram negative bacteria in Indian setup has important implications for clinical practice. Local antibiograms should be considered prior to selecting surgical prophylactic antibiotics for patients undergoing CABG procedures. Conflicts of interest: The author has none to declare.
http://dx.doi.org/10.1016/j.jpsic.2015.10.112
Introduction: The common bacteria encountered in acute pyogenic meningitis in children and young adults are Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b. Though culture methods are available but the fastidious nature of these bacteria prompted us to go for rapid detection test in cerebrospinal fluid (CSF). Objectives: This study was intended to isolate and identify S. pneumoniae, N. meningitidis and H. influenzae type b in cases of acute pyogenic meningitis from CSF samples and to compare with antigen detection test. Method: The common bacteria encountered in acute pyogenic meningitis in children and young adults are S. pneumoniae, N. meningitidis and H. influenzae type b. Though culture methods are available but the fastidious nature of these bacteria prompted us to go for rapid detection test in cerebrospinal fluid (CSF). Objectives: This study was intended to isolate and identify S. pneumoniae, N. meningitidis and H. influenzae type b in cases of acute pyogenic meningitis from CSF samples and to compare with antigen detection test. Result: Out of 50 cases, majority were adults (64%), maximum were in the age group of 16–40 years (38%) and with male preponderance (64%). On culture, three S. pneumoniae was grown in CSF samples. H. influenzae and N. meningitidis did not grow in culture. Antigen detection test positivity in CSF was 30% for S. pneumoniae 16%, followed by N. meningitidis 10% and H. influenzae 4%. Antigen detection test was
P035 Incidence and microbiology of surgical site infections following coronary artery bypass graft (CABG) surgery at a tertiary care hospital in Jaipur, India Smita Sood 1,2 1
Department of Laboratory Medicine (SRL Ltd.), Fortis Escorts Hospital, Jaipur, India 2 Department of Cardiothoracic Vascular Surgery, Fortis Escorts Hospital, Jaipur, India Introduction: Surgical site infections (SSIs) complicating CABG procedures remain a significant clinical problem as they are associated with substantial mortality and morbidity and impose severe demands on healthcare resources. There is limited data from India on the incidence of SSIs and causative pathogens following CABG surgery. Method: 2890 consecutive patients undergoing CABG surgery over a period of 5 years (2009–2013) at Fortis Escorts Hospital Jaipur, India were included in this study. Surveillance definitions from the Centers for Disease Control and Prevention (CDC)/National Healthcare Safety Network (NHSN) were uti-
http://dx.doi.org/10.1016/j.jpsic.2015.10.113
P036 Comparison of culture and antigen detection method from cerebrospinal fluid for diagnosis of acute pyogenic meningitis due to Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae type b N. Mehta, P. Bhakare, A. De, A. Sonavane, S. Baveja L.T.M. Medical College, Mumbai, India
84
journal of patient safety & infection control 3 ( 2 0 1 5 ) 70–117
significant than culture (p = 0.002). In the positive cases, CSF protein value of >100 mg/dl and sugar 100 cells/l and polymorphonuclear leucocyte >80% were seen in 93.3% and 73.3% respectively. Conclusions: Antigen detection test of CSF sample is superior to culture in diagnosis of acute pyogenic meningitis. It is rapid, easy to perform and does not require much expertise. Conflicts of interest: The authors have none to declare.
http://dx.doi.org/10.1016/j.jpsic.2015.10.114
P037 Study of cerebrospinal fluid shunt infections with special reference to organisms isolated and their antimicrobial susceptibility pattern V. Gharde, A. Sonavane, A. De, S. Baveja Department of Microbiology, L.T.M. Medical College, Mumbai, India Introduction: Cerebrospinal fluid (CSF) shunt infection is one of the most devastating complication leading to significant morbidity and chronic ill health. A retrospective study was carried out to find out the organisms isolated from central nervous system (CNS) shunts and their antimicrobial susceptibility pattern. Method: Sixty shunt fluids sent for bacteriological work up for a period of one year (January to December 2014) in this tertiary care hospital were studied. Laboratory diagnosis was established by subjecting the CSF to cell count, biochemical tests and bacteriological culture. Organisms were identified by standard microbiological techniques. Antimicrobial susceptibility test was performed by Kirby Bauer disc diffusion method, as per CLSI guidelines. Result: Out of 60 shunt fluids, 36.6% (22) were culture positive. Enterococcus species was the most common isolate accounting for 31.9%, followed by Pseudomonas aeruginosa (18.2%) and Klebsiella pneumoniae (13.6%). Methicillin resistant Staphylococcus aureus (MRSA) was 9.1%. High level aminoglycoside resistance (HLAR) among Enterococcus species was 28.6%. Majority of the Gram negative isolates were susceptible to amikacin and chloramphenicol. Multidrug resistant Gram negative bacilli were seen in 36.4% cases. One Candida albicans was isolated from an adult male from postoperative case of cerebral hematoma. Conclusions: Appropriate diagnosis, treatment and prevention of infections are important elements to optimise care for patients with CSF shunt infection. Outcome of the patients is better if these shunt infections are identified early and managed with appropriate antibiotics. Conflicts of interest: The authors have none to declare.
P038 Bacteriological monitoring of dialysis fluid in a hemodialysis centre B. Behera AIIMS, Bhubaneswar, India Introduction: Microbiological contamination of water is a serious health concern for patients on dialysis. High levels of bacteria and/or endotoxin can harm patients by causing acute pyrogenic reactions. Long term exposure to low levels of endotoxin activates cytokine induction which may lead to adverse outcomes like cardiovascular diseases, malnutrition etc. The aim of this study was to investigate the bacteriological quality of dialysis water in a hemodialysis centre of South India. Method: This study was conducted over a period of approximately one year (January 2012 to December 2012) in a newly commissioned haemodialysis centre located in a tertiary care hospital of South India. A total of 432 water samples were collected from the product water distribution piping at the following locations (distal to 1st RO plant, first storage tank, second storage tank, HD room faucets, dialysate) in two dialysis rooms, designated rooms A and B. In addition 36 samples were taken from 19 dialysis machines, during patient changeover, after they were disinfected. Bacteriological quantification was done in duplicate on Tryptone Glucose Extract agar Endotoxin detection was estimated by Limulus Amoebocyte Lysate Assay. As recommended by the Association for the Advancement of Medical Instrumentation (AAMI), water and dialysate samples were considered unacceptable, if one or more of the following criteria were found, (>200 CFU/mL heterotrophic bacteria and 0.25 endotoxin Units/mL (EU/mL). Result: Out of 432 samples, 376 samples (87%) had heterotrophic plate count <200 CFU/mL, acceptable according to AAMI guidelines. By LAL assay, 37% were unacceptable. The percentages of acceptable samples were nearly similar in HD units A and B. Our study has less discrepancies between HPC and LAL assay compared to other studies Conclusions: Monitoring of endotoxin level (which is currently not checked in majority of Indian Dialysis set ups), should be integrated in the routine bacteriological monitoring of dialysis fluid. Conflicts of interest: The present study results are part of the Quality improvement system in the Hospital. No pharmaceutical grants were used for this study.
http://dx.doi.org/10.1016/j.jpsic.2015.10.116
P039 A study assessing knowledge of hand hygiene in nosocomial infection prevention at a tertiary health care hospital R. Benson 1 , V. Narinder 1 , D. Deodhar 2 , R. Jairus 3 , A. Panu 4 1
http://dx.doi.org/10.1016/j.jpsic.2015.10.115
Infection Control Nurses, Christian Medical College and Hospital, Ludhiana, Punjab, India