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Containment of Klebsiella outbreak in neonatalogy ward in a tertiary care hospital
journal of patient safety & infection control 3 ( 2 0 1 5 ) 50–69
C044 Containment of Klebsiella outbreak in neonatalogy ward in a tertiary care hospital S. Shivani ∗ , G. Poonam, J. Manoj, R. Valinderjeet Singh, A. Suraiya, S. Seema Lady Hardinge Medical College, India Introduction: Neonates hospitalized in neonatal Intensive care unit are at risk for healthcare associated infections because of their poor immune defences, colonization of mucous membranes and skin with nosocomial microorganisms, exposure to antibiotics, invasive procedures and frequent contacts with healthcare workers. Method: The Infection Control Team (ICT) carries active surveillance in the neonatal ward (NNW) routinely every year. The data was analysed and infection rates were calculated on monthly basis and compared. Attack rate was calculated as number of patients who acquired HAI/Total number of admissions during that month. Result: A sudden increase in bloodstream infection (BSI) from 2 to 16 cases was observed in the month of December 2013. Therefore an outbreak was suspected. 16 cases of primary bloodstream infections caused by Ceftazidime/Amoxicillinclavulanic acid- resistant Klebsiella pneumoniae were observed over a one month period. Case definition was made. Incharge of the NNW was immediately informed. Recommendations for infection control practices with immediate effect were sent. The ICT visited NNW and main labour room. Relevant samples were collected and Klebsiella species was isolated from suction tubing, baby cot, feeding katori, finger tip of health care worker (HCW) and soap sludge. Bacterial identification and Antimicrobial susceptibility testing was performed by using the automated Vitek 2 instrument. The antibiogram of Klebsiella species from the samples and cases was found to be similar. It was also found that the staff in NNW was changed recently without any training in Infection control practices in high risk areas like NNW which led to breach in infection control practices. Conclusions: Active surveillance plays a very important role in detection of early onset of outbreak. All the HCWs which includes resident doctors, nursing staff and others must be trained in Infection control practices before they are posted in high risk areas. Funding: The present study was funded from institution/research funds of the authors. No pharmaceutical grants were used for this study. http://dx.doi.org/10.1016/j.jpsic.2015.10.050
C045 Comparison of antibiograms of community-acquired and catheter-associated urinary tract infections: Are community acquired urinary tract infections really docile? A. Deep 1,∗ , M. Gupta 2 , U. Chaudhary 2 1
Department of Microbiology, Pt. B. D. Sharma, PGIMS, Rohtak, India 2 Pt. B. D. Sharma, PGIMS, Rohtak, India
67
Introduction: Urinary tract infections (UTIs) are a major source of morbidity and associated healthcare costs both in community and health-care associated infections. Majority of the community acquired UTIs are caused by single pathogen. Rising antibiotic resistance among uropathogens, and especially the emergence of multi-drug resistant clonal groups is a cause of concern. The present study was carried out to compare the antimicrobial susceptibility (AST) profiles of aerobic bacterial isolates recovered from patients with UTI from both outdoor and inpatient settings. Method: Urine microscopy and culture was performed for all samples from clinically diagnosed cases of UTI. This included patients from outdoor settings and indoor patients with suspected catheter associated UTI, CA-UTI. The identification of the aerobic bacterial isolates and their AST was performed following standard guidelines. Result: The commonest bacterial isolate recovered was E. coli, both in case of community acquired UTI (49%) & CA-UTI (45%). Lower sensitivity rates were observed for urinary tract specific antimicrobial agent, nitrofurantoin in case of outdoor patients for organisms such as E. coli, Citrobacter spp., Proteus spp. and Acinetobacter spp. Similar disturbing pattern was seen for norfloxacin in case of Klebsiella spp., Citrobacter spp. and Proteus spp. Overall, higher prevalence of resistance rates were seen for orally administered antimicrobial agents in case of outdoor patients as compared to patients admitted indoor. Conclusions: Over the counter sale of extended spectrum antimicrobial agents, in absence of prescription, especially for newer fluoroquinolones and the carbapenems is making the problem of antimicrobial resistance from bad to worse. Institution specific surveillance for organisms and formulating guidelines for instituting empirical therapy can help contain the spread of multi-drug resistant organisms. http://dx.doi.org/10.1016/j.jpsic.2015.10.051
C046 Emergence of extremely drug resistant Citrobacter in ventilator associated pneumonia A. Sultan, M. Rizvi, F. Khan ∗ , N. Garg, S. Jahan, R. Gupta, I. Shukla, H.M. Khan Department of Microbiology, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, India Introduction: Intensive care settings are burdened with high frequency of nosocomial infection often caused by multidrug resistant pathogens. Nosocomial pneumonia is one of the most common cause of morbidity and mortality in ICU settings. Objectives: This study was done to assess changing trends in aetiology and antimicrobial resistance among pathogens causing nosocomial pneumonia in ICU settings. Materials and methods: This study was conducted in department of microbiology, JNMCH Aligarh from Jan 2011 to Dec 2013. Patients admitted to ICU requiring mechanical ventilation for more than 48 hours were included in the study. Endotracheal aspirates were collected in suspected cases of pneumonia. Gram staining was done to assess the quality of
C044 Containment of Klebsiella outbreak in neonatalogy ward in a tertiary care hospital S. Shivani ∗ , G. Poonam, J. Manoj, R. Valinderjeet Singh, A. Suraiya, S. Seema Lady Hardinge Medical College, India Introduction: Neonates hospitalized in neonatal Intensive care unit are at risk for healthcare associated infections because of their poor immune defences, colonization of mucous membranes and skin with nosocomial microorganisms, exposure to antibiotics, invasive procedures and frequent contacts with healthcare workers. Method: The Infection Control Team (ICT) carries active surveillance in the neonatal ward (NNW) routinely every year. The data was analysed and infection rates were calculated on monthly basis and compared. Attack rate was calculated as number of patients who acquired HAI/Total number of admissions during that month. Result: A sudden increase in bloodstream infection (BSI) from 2 to 16 cases was observed in the month of December 2013. Therefore an outbreak was suspected. 16 cases of primary bloodstream infections caused by Ceftazidime/Amoxicillinclavulanic acid- resistant Klebsiella pneumoniae were observed over a one month period. Case definition was made. Incharge of the NNW was immediately informed. Recommendations for infection control practices with immediate effect were sent. The ICT visited NNW and main labour room. Relevant samples were collected and Klebsiella species was isolated from suction tubing, baby cot, feeding katori, finger tip of health care worker (HCW) and soap sludge. Bacterial identification and Antimicrobial susceptibility testing was performed by using the automated Vitek 2 instrument. The antibiogram of Klebsiella species from the samples and cases was found to be similar. It was also found that the staff in NNW was changed recently without any training in Infection control practices in high risk areas like NNW which led to breach in infection control practices. Conclusions: Active surveillance plays a very important role in detection of early onset of outbreak. All the HCWs which includes resident doctors, nursing staff and others must be trained in Infection control practices before they are posted in high risk areas. Funding: The present study was funded from institution/research funds of the authors. No pharmaceutical grants were used for this study. http://dx.doi.org/10.1016/j.jpsic.2015.10.050
C045 Comparison of antibiograms of community-acquired and catheter-associated urinary tract infections: Are community acquired urinary tract infections really docile? A. Deep 1,∗ , M. Gupta 2 , U. Chaudhary 2 1
Department of Microbiology, Pt. B. D. Sharma, PGIMS, Rohtak, India 2 Pt. B. D. Sharma, PGIMS, Rohtak, India
67
Introduction: Urinary tract infections (UTIs) are a major source of morbidity and associated healthcare costs both in community and health-care associated infections. Majority of the community acquired UTIs are caused by single pathogen. Rising antibiotic resistance among uropathogens, and especially the emergence of multi-drug resistant clonal groups is a cause of concern. The present study was carried out to compare the antimicrobial susceptibility (AST) profiles of aerobic bacterial isolates recovered from patients with UTI from both outdoor and inpatient settings. Method: Urine microscopy and culture was performed for all samples from clinically diagnosed cases of UTI. This included patients from outdoor settings and indoor patients with suspected catheter associated UTI, CA-UTI. The identification of the aerobic bacterial isolates and their AST was performed following standard guidelines. Result: The commonest bacterial isolate recovered was E. coli, both in case of community acquired UTI (49%) & CA-UTI (45%). Lower sensitivity rates were observed for urinary tract specific antimicrobial agent, nitrofurantoin in case of outdoor patients for organisms such as E. coli, Citrobacter spp., Proteus spp. and Acinetobacter spp. Similar disturbing pattern was seen for norfloxacin in case of Klebsiella spp., Citrobacter spp. and Proteus spp. Overall, higher prevalence of resistance rates were seen for orally administered antimicrobial agents in case of outdoor patients as compared to patients admitted indoor. Conclusions: Over the counter sale of extended spectrum antimicrobial agents, in absence of prescription, especially for newer fluoroquinolones and the carbapenems is making the problem of antimicrobial resistance from bad to worse. Institution specific surveillance for organisms and formulating guidelines for instituting empirical therapy can help contain the spread of multi-drug resistant organisms. http://dx.doi.org/10.1016/j.jpsic.2015.10.051
C046 Emergence of extremely drug resistant Citrobacter in ventilator associated pneumonia A. Sultan, M. Rizvi, F. Khan ∗ , N. Garg, S. Jahan, R. Gupta, I. Shukla, H.M. Khan Department of Microbiology, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, India Introduction: Intensive care settings are burdened with high frequency of nosocomial infection often caused by multidrug resistant pathogens. Nosocomial pneumonia is one of the most common cause of morbidity and mortality in ICU settings. Objectives: This study was done to assess changing trends in aetiology and antimicrobial resistance among pathogens causing nosocomial pneumonia in ICU settings. Materials and methods: This study was conducted in department of microbiology, JNMCH Aligarh from Jan 2011 to Dec 2013. Patients admitted to ICU requiring mechanical ventilation for more than 48 hours were included in the study. Endotracheal aspirates were collected in suspected cases of pneumonia. Gram staining was done to assess the quality of