Browsing by Author "Rahul Garg"

Now showing 1 - 5 of 5

Evaluation Report of the Colistin Broth Disk Elution Method with Acinetobacter baumannii Isolates from a Low-Resource Setting
(American Society for Microbiology, 2022) Swati Sharma; Tuhina Banerjee; Rahul Garg; Padma Das
The rapid emergence of drug resistance in Acinetobacter baumannii has put forward the use of colistin as a last-resort treatment for infections with A. baumannii. Empirical colistin use without prior susceptibility testing has been one of the factors that has been promoting drug resistance in low-resource settings. In this regard, while the advocated broth microdilution (BMD) method for colistin susceptibility testing is often considered cumbersome, the preferable colistin broth disk elution (CBDE) method has not yet been approved for A. baumannii. To prevent the underreporting of colistin susceptibility, we tested the CBDE method for A. baumannii and compared the results with those of BMD. A total of 125 A. baumannii, including 100 susceptible and 25 resistant isolates were tested via the CBDE method and compared with the standard BMD method. The essential agreement, categorical agreement, sensitivity, and specificity for CBDE were 97.6% (n = 122), 98.4% (n = 123), 100%, and 98.40%, respectively. The percentage of major error found was 1.6% (n = 2), and no very major error was found. CBDE in A. baumannii could be considered in low-resource settings. IMPORTANCE The relatively cumbersome broth microdilution (BMD) method for routine colistin susceptibility testing has not been adopted, especially in low-resource settings, often leading to the underreporting of colistin susceptibility and the promotion of the empirical use of colistin. In this regard, the much-preferred colistin broth disk elution (CBDE) method has not yet been approved for A. baumannii. We evaluated colistin susceptibility via the CBDE method, compared the results with those of the BMD method in 125 A. baumannii isolates with various profiles, and inferred that the CBDE method using 50 mL inoculum could be helpful, at least in resource-limited setups, versus not reporting susceptibility testing for colistin. © 2022 Sharma et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license.
Implementation of infection prevention and control practices in an upcoming COVID-19 hospital in India: An opportunity not missed
(Public Library of Science, 2022) Arghya Das; Rahul Garg; E. Sampath Kumar; Dharanidhar Singh; Bisweswar Ojha; H. Larikyrpang Kharchandy; Bhairav Kumar Pathak; Pushkar Srikrishnan; Ravindra Singh; Immanuel Joshua; Sanket Nandekar; J. Vinothini; Reenu Reghu; Nikitha Pedapanga; Tuhina Banerjee; Kamal Kumar Yadav
Infection prevention and control (IPC) program is obligatory for delivering quality services in any healthcare setup. Lack of administrative support and resource-constraints (under-staffing, inadequate funds) were primary barriers to successful implementation of IPC practices in majority of the hospitals in the developing countries. The Coronavirus Disease 2019 (COVID-19) brought a unique opportunity to improve the IPC program in these hospitals. A PDSA (Plan—Do—Study- Act) model was adopted for this study in a tertiary care hospital which was converted into a dedicated COVID-19 treatment facility in Varanasi, India. The initial focus was to identify the deficiencies in existing IPC practices and perceive the opportunities for improvement. Repeated IPC training (induction and reinforce) was conducted for the healthcare personnel (HCP) and practices were monitored by direct observation and closed-circuit television. Cleaning audits were performed by visual inspection, review of the checklists and qualitative assessment of the viewpoints of the HCP was carried out by the feedbacks received at the end of the training sessions. A total of 2552 HCP and 548 medical students were trained in IPC through multiple offline/onsite sessions over a period of 15 months during the ongoing pandemic. Although the overall compliance to surface disinfection and cleaning increased from 50% to >80% with repeated training, compliance decreased whenever newly recruited HCP were posted. Fear psychosis in the pandemic was the greatest facilitator for adopting the IPC practices. Continuous wearing of personal protective equipment for long duration, dissatisfaction with the duty rosters as well as continuous posting in high-risk areas were the major obstacles to the implementation of IPC norms. Recognising the role of an infection control team, repeated training, monitoring and improvisation of the existing resources are keys for successful implementation of IPC practices in hospitals during the COVID-19 pandemic. © 2022 Das et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Infection Control in Lower Limb Oedema
(Springer Nature, 2022) Tuhina Banerjee; Rahul Garg; Aradhana Singh
Infections of lower limbs with underlying oedema are one of the most important causes responsible for considerable morbidity often requiring repeated hospitalizations. While lower extremities are prone to infections due to biomechanical complexities, underlying oedema aggravates it. Cellulitis is the simple form of bacterial infection of the skin and soft tissue. Severe infections in form of necrotizing fasciitis can involve the lower limb leading to unforeseen circumstances. Several events lead to the progress of these infections, which if identified early results in better management. Prudent and timely use of antibiotics help in early management of infections. However, all types of infections might not require antibiotics and it is very important to realize the microbiological basis of such infections to ensure the best choice of antibiotics. Treatment strategies have been evolving with time and many technical and nonpharmacological breakthroughs have now emphasized the importance of dedicated self-care in controlling infections in lower limb oedema. Infection control in lower limb oedema is a real challenge owing to the multiple factors involved and therefore it often requires a multidisciplinary approach involving expertise in specific care to tackle the challenges. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.
Reservoir of Carbapenem-Resistant Acinetobacter baumannii in the Hospital Environment and Colonization Pressure: A Surveillance-Based Study in Indian Intensive Care Unit
(Mary Ann Liebert Inc., 2022) Swati Sharma; Arghya Das; Rahul Garg; Sangita Pramanik; Pooja Marndi; Ravindra Singh; Tuhina Banerjee; Ghanshyam Yadav; Ashok Kumar
The endemicity of Acinetobacter baumannii in intensive care units (ICUs) is a serious concern. We studied the reservoirs of A. baumannii in the ICU and their effects on colonization pressure and transmission. A prospective surveillance (6 months) was conducted. Screening culture (rectal and axillary) swabs were collected within 48 hours admission and in 120 hours. Surveillance cultures from patients' surroundings, health care workers (HCWs), and hospital sewage were collected. A. baumannii was identified by phenotypic and genotypic methods. Carbapenem resistance and insertion sequence element were detected. Typing was done by repetitive extragenic palindromic-polymerase chain reaction and multilocus sequence typing. Colonization pressure was calculated and compared with environment colonizers. Of the 87 patients, 21.83% (19) were colonized with A. baumannii, 73.68% (14/19) were imported, and 26.31% (5/19) acquired carriers. Axilla was the commonest site. From the environment (15), bed rails 33.33% (5/15) and suction tubes 26.66% (4/15) were the common sites. HCWs showed 7.5% (3/40) carriage. Carbapenem resistance with blaOXA-51, blaOXA-23, and ISAba1 were 91.89% (34/37). Strong correlation between colonization pressures and environmental colonizers was seen (r2 = 0.719, p = 0.032). Carbapenem and polymyxin B were (p ≤ 0.05) significant exposures. Sequence type 623 was the predominant cluster with isolates from carriers, HCWs, and environment. Colonization pressure of carbapenem-resistant A. baumannii depends on their presence in the hospital. Hands of HCWs were an important vehicle for transmission. Infection control measure should consider reducing the environmental reservoir. © Copyright 2022, Mary Ann Liebert, Inc., publishers 2022.
Strictly adhering to infection control practices is the key to safe surgical procedures amidst the COVID-19 crisis
(Journal of Pure and Applied Microbiology, 2020) Rahul Garg; Arghya Das; Tuhina Banerjee
Currently, the world is facing a challenge to curb the outbreak of the highly contagious COviD-19, which has significantly impacted many lives and is affecting the practice of healthcare professionals as well. During this containment phase, an influx of COVID-19 patients requiring surgical interventions is expected. To combat the situation, every health care staff must implement and adhere to various infection prevention and control measures. In this article, we have addressed the importance of basic infection prevention and control practices required for handling COVID-19 cases, especially, those requiring acute surgical care. On one hand, certain non-emergency procedures need to be delayed, on the other hand, all surgeries during this period need to be proactively performed with appropriate infection control precautions regardless of the COVID-19 status of the patient. Prudent decisions and a conservative approach while making the best choices regarding surgeries will not only ensure personal protection but will also preserve important resources, manpower, hospital beds, and equipment for repurposing during this urgent crisis. © The Author(s) 2020.