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An outbreak of Burkholderia cepacia bloodstream infections in a tertiary-care facility in northern India detected by a healthcare-associated infection surveillance network
- Bashir Fomda, Anoop Velayudhan, Valan A. Siromany, Gulnaz Bashir, Shaista Nazir, Aamir Ali, Omika Katoch, Alphina Karoung, Jacinta Gunjiyal, Nayeem Wani, Indranil Roy, Daniel VanderEnde, Neil Gupta, Aditya Sharma, Paul Malpiedi, Kamini Walia, Purva Mathur
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 44 / Issue 3 / March 2023
- Published online by Cambridge University Press:
- 07 June 2022, pp. 467-473
- Print publication:
- March 2023
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Objective:
The burden of healthcare-associated infections (HAIs) is higher in low- and middle-income countries, but HAIs are often missed because surveillance is not conducted. Here, we describe the identification of and response to a cluster of Burkholderia cepacia complex (BCC) bloodstream infections (BSIs) associated with high mortality in a surgical ICU (SICU) that joined an HAI surveillance network.
Setting:A 780-bed, tertiary-level, public teaching hospital in northern India.
Methods:After detecting a cluster of BCC in the SICU, cases were identified by reviewing laboratory registers and automated identification and susceptibility testing outputs. Sociodemographic details, clinical records, and potential exposure histories were collected, and a self-appraisal of infection prevention and control (IPC) practices using assessment tools from the World Health Organization and the US Centers for Disease Control and Prevention was conducted. Training and feedback were provided to hospital staff. Environmental samples were collected from high-touch surfaces, intravenous medications, saline, and mouthwash.
Results:Between October 2017 and October 2018, 183 BCC BSI cases were identified. Case records were available for 121 case patients. Of these 121 cases, 91 (75%) were male, the median age was 35 years, and 57 (47%) died. IPC scores were low in the areas of technical guidelines, human resources, and monitoring and evaluation. Of the 30 environmental samples, 4 grew BCC. A single source of the outbreak was not identified.
Conclusions:Implementing standardized HAI surveillance in a low-resource setting detected an ongoing Burkholderia cepacia outbreak. The outbreak investigation and use of a multimodal approach reduced incident cases and informed changes in IPC practices.
Surveillance of Healthcare-Associated Bloodstream and Urinary Tract Infections in a National Level Network of Indian Hospitals
- Purva Mathur, Paul Malpiedi, Kamini Walia, Rajesh Malhotra, Padmini Srikantiah, Omika Katoch, Sonal Katyal, Surbhi Khurana, Mahesh Chandra Misra, Sunil Gupta, Subodh Kumar, Sushma Sagar, Naveet Vig, Pramod Garg, Arti Kapil, Manoj Sahu, Arunaloke Chakrabarti, Pallab Ray, Manisha Biswal, Neelam Taneja, Priscilla Rupali, Vellore Binila Chacko, Joy Sarojini Michael, Veeraraghavan Balaji, Camilla Rodrigues, Vijaya Lakshmi Nag, Vibhor Tak, Vimala Venkatesh, Chiranjay Mukhopadhyay, KE Vandana, Muralidhar Varma, Vijayshri Deotale, Ruchita Attal, Kanne Padmaja, Chand Wattal, Neeraj Goel, Sanjay Bhattacharya, Tadepalli Karuna, Saurabh Saigal, Bijayini Behera, Sanjeev Singh, MA Thirunarayan, Reema Nath, Raja Ray, Sujata Baveja, Mammen Chandy, Sudipta Mukherjee, Manas Roy, Gaurav Goel, Swagata Tripathy, Satyajeet Misra, Anupam Dey, Tushar Mishra, Hirak Raj, Bashir Fomda, Gulnaz Bashir, Shaista Nazir, Sulochana Devi, Khuraijam Ranjana Devi, Langpoklakpam Chaoba Singh, Padma Das, Anudita Bhargava, Ujjwala Gaikwad, Neeta Khandelwal, Geeta Vaghela, Tanvi Sukharamwala, Prachi Verma, Mamta Lamba, Shristi Jain, Prithwis Bhattacharyya, Anil Phukan, Clarissa Lyngdoh, Rajeev Sharma, Rajni Gaind, Rushika Saksena, Lata Kapoor, Neil Gupta, Aditya Sharma, Daniel VanderEnde, Anoop Velayudhan, Valan Siromany, Kayla Laserson, Randeep Guleria
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s398-s399
- Print publication:
- October 2020
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Background: Healthcare-associated infections (HAIs) are a major global threat to patient safety. Systematic surveillance is crucial for understanding HAI rates and antimicrobial resistance trends and to guide infection prevention and control (IPC) activities based on local epidemiology. In India, no standardized national HAI surveillance system was in place before 2017. Methods: Public and private hospitals from across 21 states in India were recruited to participate in an HAI surveillance network. Baseline assessments followed by trainings ensured that basic microbiology and IPC implementation capacity existed at all sites. Standardized surveillance protocols for central-line–associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) were modified from the NHSN for the Indian context. IPC nurses were trained to implement surveillance protocols. Data were reported through a locally developed web portal. Standardized external data quality checks were performed to assure data quality. Results: Between May 2017 and April 2019, 109 ICUs from 37 hospitals (29 public and 8 private) enrolled in the network, of which 33 were teaching hospitals with >500 beds. The network recorded 679,109 patient days, 212,081 central-line days, and 387,092 urinary catheter days. Overall, 4,301 bloodstream infection (BSI) events and 1,402 urinary tract infection (UTI) events were reported. The network CLABSI rate was 9.4 per 1,000 central-line days and the CAUTI rate was 3.4 per 1,000 catheter days. The central-line utilization ratio was 0.31 and the urinary catheter utilization ratio was 0.57. Moreover, 3,542 (73%) of 4,742 pathogens reported from BSIs and 868 (53%) of 1,644 pathogens reported from UTIs were gram negative. Also, 1,680 (26.3%) of all 6,386 pathogens reported were Enterobacteriaceae. Of 1,486 Enterobacteriaceae with complete antibiotic susceptibility testing data reported, 832 (57%) were carbapenem resistant. Of 951 Enterobacteriaceae subjected to colistin broth microdilution testing, 62 (7%) were colistin resistant. The surveillance platform identified 2 separate hospital-level HAI outbreaks; one caused by colistin-resistant K. pneumoniae and another due to Burkholderia cepacia. Phased expansion of surveillance to additional hospitals continues. Conclusions: HAI surveillance was successfully implemented across a national network of diverse hospitals using modified NHSN protocols. Surveillance data are being used to understand HAI burden and trends at the facility and national levels, to inform public policy, and to direct efforts to implement effective hospital IPC activities. This network approach to HAI surveillance may provide lessons to other countries or contexts with limited surveillance capacity.
Funding: None
Disclosures: None
Strategies for Optimizing the Supply of N95 Filtering Facepiece Respirators During the Coronavirus Disease 2019 (COVID-19) Pandemic
- Marie A. de Perio, Chad H. Dowell, Lisa J. Delaney, Lewis J. Radonovich II, David T. Kuhar, Neil Gupta, Anita Patel, Satish K. Pillai, Maryann D’Alessandro
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- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 14 / Issue 5 / October 2020
- Published online by Cambridge University Press:
- 19 May 2020, pp. 658-669
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N95 respirators are personal protective equipment most often used to control exposures to infections transmitted via the airborne route. Supplies of N95 respirators can become depleted during pandemics or when otherwise in high demand. In this paper, we offer strategies for optimizing supplies of N95 respirators in health care settings while maximizing the level of protection offered to health care personnel when there is limited supply in the United States during the 2019 coronavirus disease pandemic. The strategies are intended for use by professionals who manage respiratory protection programs, occupational health services, and infection prevention programs in health care facilities to protect health care personnel from job-related risks of exposure to infectious respiratory illnesses. Consultation with federal, state, and local public health officials is also important. We use the framework of surge capacity and the occupational health and safety hierarchy of controls approach to discuss specific engineering control, administrative control, and personal protective equipment measures that may help in optimizing N95 respirator supplies.
Multiple importations and transmission of colistin-resistant Klebsiella pneumoniae in a hospital in northern India
- Purva Mathur, Surbhi Khurana, Tom J.B. de Man, Neha Rastogi, Omika Katoch, Balaji Veeraraghavan, Ayyan Raj Neeravi, Manigandan Venkatesan, Subodh Kumar, Sushma Sagar, Amit Gupta, Richa Aggarwal, Kapil Dev Soni, Rajesh Malhotra, Anoop Velayudhan, Valan Siromany, Paul Malpiedi, Joseph Lutgring, Kayla Laserson, Neil Gupta, Padmini Srikantiah, Aditya Sharma
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 40 / Issue 12 / December 2019
- Published online by Cambridge University Press:
- 18 October 2019, pp. 1387-1393
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- December 2019
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Objective:
Resistance to colistin, a last resort antibiotic, has emerged in India. We investigated colistin-resistant Klebsiella pneumoniae(ColR-KP) in a hospital in India to describe infections, characterize resistance of isolates, compare concordance of detection methods, and identify transmission events.
Design:Retrospective observational study.
Methods:Case-patients were defined as individuals from whom ColR-KP was isolated from a clinical specimen between January 2016 and October 2017. Isolates resistant to colistin by Vitek 2 were confirmed by broth microdilution (BMD). Isolates underwent colistin susceptibility testing by disk diffusion and whole-genome sequencing. Medical records were reviewed.
Results:Of 846 K. pneumoniae isolates, 34 (4%) were colistin resistant. In total, 22 case-patients were identified. Most (90%) were male; their median age was 33 years. Half were transferred from another hospital; 45% died. Case-patients were admitted for a median of 14 days before detection of ColR-KP. Also, 7 case-patients (32%) received colistin before detection of ColR-KP. All isolates were resistant to carbapenems and susceptible to tigecycline. Isolates resistant to colistin by Vitek 2 were also resistant by BMD; 2 ColR-KP isolates were resistant by disk diffusion. Moreover, 8 multilocus sequence types were identified. Isolates were negative for mobile colistin resistance (mcr) genes. Based on sequencing analysis, in-hospital transmission may have occurred with 8 case-patients (38%).
Conclusions:Multiple infections caused by highly resistant, mcr-negative ColR-KP with substantial mortality were identified. Disk diffusion correlated poorly with Vitek 2 and BMD for detection of ColR-KP. Sequencing indicated multiple importation and in-hospital transmission events. Enhanced detection for ColR-KP may be warranted in India.
Contributors
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- By Mowaffaq Almikhlafi, Osama Al-muslim, Robert Arntfield, Ian M Ball, Sue Berney, Mohit Bhutani, Clay A Block, Ken Blonde, Rudi Brits, Ron Butler, Lois Champion, Chris Clarke, Linda Denehy, Joseph Dreier, A Ebersohn, Shane W English, Ari Ercole, Darren H Freed, John Fuller, Julio P Zavala Georffino, RT Noel Gibney, Jeff Granton, Donald EG Griesdale, Arun K Gupta, Wael Haddara, Ahmed F Hegazy, Umjeet Singh Jolly, Philip M Jones, Ilya Kagan, Kala Kathirgamanathan, Harneet Kaur, John Kellett, Bhupesh Khadka, Biniam Kidane, Carlos Kidel, Anand Kumar, Alejandro Lazo-Langner, David Leasa, W Robert Leeper, Stephen Y Liang, Tania Ligori, Jaimie Manlucu, Janet Martin, Ian McConachie, Alan McGlennan, Lauralyn McIntyre, Tina Mele, MJ Naisbitt, Raj Nichani, Daniel H Ovakim, Neil Parry, Daniel Castro Pereira, Thomas Piraino, Brian Pollard, Valerie Schulz, Michael D Sharpe, Rohit K Singal, Pierre Singer, Mark Soth, Christian P Subbe, Jaffer Syed, Ravi Taneja, Tom Varughese, Jennifer Vergel Del Dios, Jessie R Welbourne, Christopher W White, Rebecca P Winsett, Titus C Yeung, G Bryan Young, Shelley R Zieroth
- Edited by John Fuller, University of Western Ontario, Jeff Granton, University of Western Ontario, Ian McConachie, University of Western Ontario
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- Handbook of ICU Therapy
- Published online:
- 05 February 2015
- Print publication:
- 04 December 2014, pp vii-xii
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- By Ghazi Al-Rawas, Vazken Andréassian, Tianqi Ao, Stacey A. Archfield, Berit Arheimer, András Bárdossy, Trent Biggs, Günter Blöschl, Theresa Blume, Marco Borga, Helge Bormann, Gianluca Botter, Tom Brown, Donald H. Burn, Sean K. Carey, Attilio Castellarin, Francis Chiew, François Colin, Paulin Coulibaly, Armand Crabit, Barry Croke, Siegfried Demuth, Qingyun Duan, Giuliano Di Baldassarre, Thomas Dunne, Ying Fan, Xing Fang, Boris Gartsman, Alexander Gelfan, Mikhail Georgievski, Nick van de Giesen, David C. Goodrich, Hoshin V. Gupta, Khaled Haddad, David M. Hannah, H. A. P. Hapuarachchi, Hege Hisdal, Kamila Hlavčová, Markus Hrachowitz, Denis A. Hughes, Günter Humer, Ruud Hurkmans, Vito Iacobellis, Elena Ilyichyova, Hiroshi Ishidaira, Graham Jewitt, Shaofeng Jia, Jeffrey R. Kennedy, Anthony S. Kiem, Robert Kirnbauer, Thomas R. Kjeldsen, Jürgen Komma, Leonid M. Korytny, Charles N. Kroll, George Kuczera, Gregor Laaha, Henny A. J. van Lanen, Hjalmar Laudon, Jens Liebe, Shijun Lin, Göran Lindström, Suxia Liu, Jun Magome, Danny G. Marks, Dominic Mazvimavi, Jeffrey J. McDonnell, Brian L. McGlynn, Kevin J. McGuire, Neil McIntyre, Thomas A. McMahon, Ralf Merz, Robert A. Metcalfe, Alberto Montanari, David Morris, Roger Moussa, Lakshman Nandagiri, Thomas Nester, Taha B. M. J. Ouarda, Ludovic Oudin, Juraj Parajka, Charles S. Pearson, Murray C. Peel, Charles Perrin, John W. Pomeroy, David A. Post, Ataur Rahman, Liliang Ren, Magdalena Rogger, Dan Rosbjerg, José Luis Salinas, Jos Samuel, Eric Sauquet, Hubert H. G. Savenije, Takahiro Sayama, John C. Schaake, Kevin Shook, Murugesu Sivapalan, Jon Olav Skøien, Chris Soulsby, Christopher Spence, R. ‘Sri’ Srikanthan, Tammo S. Steenhuis, Jan Szolgay, Yasuto Tachikawa, Kuniyoshi Takeuchi, Lena M. Tallaksen, Dörthe Tetzlaff, Sally E. Thompson, Elena Toth, Peter A. Troch, Remko Uijlenhoet, Carl L. Unkrich, Alberto Viglione, Neil R. Viney, Richard M. Vogel, Thorsten Wagener, M. Todd Walter, Guoqiang Wang, Markus Weiler, Rolf Weingartner, Erwin Weinmann, Hessel Winsemius, Ross A. Woods, Dawen Yang, Chihiro Yoshimura, Andy Young, Gordon Young, Erwin Zehe, Yongqiang Zhang, Maichun C. Zhou
- Edited by Günter Blöschl, Technische Universität Wien, Austria, Murugesu Sivapalan, University of Illinois, Urbana-Champaign, Thorsten Wagener, University of Bristol, Alberto Viglione, Technische Universität Wien, Austria, Hubert Savenije, Technische Universiteit Delft, The Netherlands
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- Runoff Prediction in Ungauged Basins
- Published online:
- 05 April 2013
- Print publication:
- 18 April 2013, pp ix-xiv
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- By Robert Adler, Dinesh Bhugra, Sharon Brownie, Kenneth Busch, Julian Freidin, Susham Gupta, Helen Herrman, James W. Holsinger, Gillian Lewando Hundt, Sir Donald Irvine, Vikram Jha, Neil Johnson, Amit Malik, H. Steven Moffic, Jonathan Montgomery, Katinka Morton, Robert A. Murden, David W. Page, Vikram Patel, Trudie Roberts, James E. Sabin, Norman Sartorius, Donna J. Schmutzler, Zeryab Setna, Bruce Singh, John A. Talbott, Allan Tasman, Jill Thistlethwaite, Kathy M. Vincent, Sidney Weissman
- Edited by Dinesh Bhugra, Institute of Psychiatry, London, Amit Malik
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- Professionalism in Mental Healthcare
- Published online:
- 10 November 2010
- Print publication:
- 28 October 2010, pp vi-viii
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- By Jennifer Alvarez, Ananda B. Amstadter, Metin Başoğlu, David M. Benedek, Charles C. Benight, George A. Bonanno, Evelyn J. Bromet, Richard A. Bryant, Barbara Lopes Cardozo, M. L. Somchai Chakkraband, Claude Chemtob, Roman Cieslak, Lauren M. Conoscenti, Joan M. Cook, Judith Cukor, Carla Kmett Danielson, JoAnn Difede, Charles DiMaggio, Anja J.E. Dirkzwager, Cristiane S. Duarte, Jon D. Elhai, Diane L. Elmore, Yael L.E. Errera, Julian D. Ford, Carol S. Fullerton, Sandro Galea, Freya Goodhew, Neil Greenberg, Lindsay Greene, Linda Grievink, Michael J. Gruber, Sumati Gupta, Johan M. Havenaar, Alesia O. Hawkins, Clare Henn-Haase, Kimberly Eaton Hoagwood, Christina W. Hoven, Sabra S. Inslicht, Krzysztof Kaniasty, Ronald C. Kessler, Rachel Kimerling, Richard V. King, Rolf J. Kleber, Jessica Mass Levitt, Brett T. Litz, Maria Livanou, Katelyn P. Mack, Paula Madrid, Shira Maguen, Paul Maguire, Donald J. Mandell, Charles R. Marmar, Andrea R. Maxwell, Shannon E. McCaslin, Alexander C. McFarlane, Thomas J. Metzler, Summer Nelson, Yuval Neria, Elana Newman, Thomas C. Neylan, Fran H. Norris, Carol S. North, Lawrence A. Palinkas, Benjaporn Panyayong, Maria Petukhova, Betty Pfefferbaum, Marleen Radigan, Beverley Raphael, James Rodriguez, G. James Rubin, Kenneth J. Ruggiero, Ebru Şalcıoğlu, Nancy A. Sampson, Arieh Y. Shalev, Bruce Shapiro, Laura M. Stough, Prawate Tantipiwatanaskul, Warunee Thienkrua, Phebe Tucker, J. Blake Turner, Robert J. Ursano, Bellis van den Berg, Peter G. van der Velden, Frits van Griensven, Miranda Van Hooff, Edward Waldrep, Philip S. Wang, Simon Wessely, Leslie H. Wind, C. Joris Yzermans, Heidi M. Zinzow
- Edited by Yuval Neria, Columbia University, New York, Sandro Galea, University of Michigan, Ann Arbor, Fran H. Norris
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- Mental Health and Disasters
- Published online:
- 07 May 2010
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- 20 July 2009, pp xi-xvi
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Early introduction of water and complementary feeding and nutritional status of children in northern Senegal
- Neil Gupta, Mario Gehri, Nicolas Stettler
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- Public Health Nutrition / Volume 10 / Issue 11 / November 2007
- Published online by Cambridge University Press:
- 01 November 2007, pp. 1299-1304
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Objective
Malnutrition is responsible globally for 60% of deaths among children under 5 years and is often attributed to suboptimal feeding practices. In response, the World Health Organization recommends exclusive breast-feeding for the first 6 months of life. The objective of this study was to determine if an association exists between the early introduction of water and complementary foods (CFs) and the nutritional status of children in northern Senegal.
Design/Setting/SubjectsA cross-sectional study of 374 children in the Podor Health District between the ages of 6 and 23 months was conducted. Knowledge and behaviours of mothers regarding introduction of water and CFs were assessed via individual interviews.
ResultsWater was introduced to about 85% of the children in the first 3 months of life and 62% were fed CFs before 6 months. Overall, 16% had clinically significant wasting (weight-for-length Z-score (WHZ) less than − 2) and 20% had stunting (height-for-age Z-score (HAZ) less than − 2). There was no significant association between wasting or stunting and introduction of water before 3 months (WHZ: odds ratio = 0.99, 95% confidence interval 0.46–2.14, P = 0.97; HAZ: 0.68, 0.34–1.36, P = 0.3) or introduction of CFs before 6 months (WHZ: 0.81, 0.46–1.42, P = 0.5; HAZ: 0.79, 0.46–1.35, P = 0.4). A significant association was found between wasting and male sex, age, living in Guede community, drinking river/pond water and large family size, while stunting was associated with age and drinking tap water.
ConclusionThe results of the present study suggest that early introduction of water and CFs is frequent and is not associated with increased risk for malnutrition among children from this region of northern Senegal, but the possibility of reverse causality cannot be excluded.