Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp . (20.3%), Escherichia coli (15.8%), and Pseudomonas spp . (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06944-2.

Background: Surgical access to abdomen is required for many operative procedures. The subcutaneous tissue of the anterior abdominal wall can either be sutured or left unsutured with drain in situ. The purpose of this study was to compare the two methods of closure of the subcutaneous tissue and determine the benefit of one over the other.Methods: The study was conducted in a tertiary care centre with sample size of 30 each in study and control group. Patients fulfilling the inclusion criteria were selected and depending on the randomisation the closure of subcutaneous tissue was done either by polyglactin 910, 2-0 or left unsutured with indigenously designed syringe suction drain kept in situ. The patients were followed up till the day of suture removal and further in case of any complications.Results: Total duration taken for the procedure was significantly increased in the study group. There was a significant level of discomfort among the participants due to drain. The rate of surgical site infection, hospital readmission morbidity was significantly higher in the study group.Conclusions: The type of drain studied was indigenously designed where the closed system was not maintained during charging the drain, hence further studies need to be conducted which will compare this with the other closed suction drains to determine the difference in the risk of wound complications.

Aim:To analyze the perinatal mortality rate in a tertiary care center. Background: To identify possibly responsible maternal risk factors in a tertiary care hospital in developing country. Methodology: Data of perinatal deaths from 1 January 2019 to 31 December 2019 was collected from monthly perinatal mortality records. All patients with fetal death after 28 weeks of pregnancy till the period of 7 days after neonatal birth were included in this study. Results:The study conducted at our hospital aimed at investigating the causes of perinatal mortality and related maternal risk factors resulting in perinatal mortality. The total confinement number was 6,688; among these, the number of fresh stillbirth was 155, macerated stillbirth was 137, and neonatal death was 24. Among the 316 perinatal deaths, 241 deaths (69.6%) were noted before 37 weeks of pregnancy and 75 deaths were noted after 37 weeks of pregnancy (15.18%). Out of 316 deaths, 100 deaths observed in patients induced for labor. Of these, 100 neonates, 88 delivered vaginally and 12 neonates delivered by cesarean section. The 69 neonates (21.83%) deaths observed in the patients who had undergone cesarean section. A total of 33 (10.44%) deaths resulted due to birth asphyxia, 72 (22.78%) deaths observed due to preterm delivery, 22 (6.96%) deaths were due to congenital anomalies. Preterm was one of the most important risk factors observed in 72 (22.78%) women with perinatal deaths. Conclusion: Prematurity, low birth weight (LBW), no proper wrapping of newborns, and no guidance and proper training to mothers were significantly associated with higher probability of neonatal mortality.

We report a case of haemorrhage in early pregnancy following suction evacuation for a complete hydatidiform mole which later turned out to be case of placenta increta. Morbidly adherent placenta in early pregnancy a is rare event. There are few reported cases of obstetric hysterectomy in early pregnancy due to undiagnosed morbidly adherent placenta.

A randomised single blind control study to assess the effect of intrapartum amnioinfusion on maternal caesarean section rate and fetal outcome in a tertiary care centre Michelle Fonseca, Jyotsna S. Dwivedi* INTRODUCTIONThe procedure of instilling normal saline/ Ringer's lactate into the uterine cavity is called amnioinfusion. The procedure can be done in antepartum and intrapartum period. The aim of this procedure is to replace the amniotic fluid. Amnioinfusion is considered as a method of preventing or relieving umbilical cord compression. 1Meconium aspiration syndrome complicates 1.7 to 35.8% of deliveries. [2][3][4][5] It has been proved that amnioinfusion significantly decreases the rate of meconium aspiration syndrome in fetus and also the rate of caesarean section in mother. 6 The objective of the present study was to assess the effect of intrapartum amnioinfusion on maternal caesarean section rate and fetal outcome in a tertiary care center.Objective of present study were to assess the rate of operative delivery (LSCS) in patients with meconium stained amniotic fluid following amnioinfusion and to assess the fetal outcome in patients receiving the amnioinfusion. ABSTRACT Background:The procedure of instilling normal saline/Ringer's lactate into the uterine cavity is called amnioinfusion. Objective of present study was to assess the effect of intrapartum amnioinfusion on maternal caesarean section rate and fetal outcome in a tertiary care centre in cases of meconium stained amniotic fluid. Methods: A total of 160 women at term in labor with meconium stained amniotic fluid were randomized into two groups: study and control group. The study group received transcervical amnioinfusion at detection of MSAF. The control group was given the routine obstetric care. Both groups were started on O2 and intrapartum monitoring. The outcomes in both groups were analyzed statistically. Results: The control group had caesarean section rate of 45% and in the study group it was 31.25%. The difference was statistically significant. The outcome in the neonate was assessed on the parameters such as respiratory distress, neonatal intensive care unit admission, meconium aspiration syndrome, neonatal deaths. Conclusions: Amnioinfusion in cases of meconium stained amniotic fluid cases significantly reduces the risk of meconium aspiration syndrome. It also decreases the need for operative intervention thus reducing the risk of maternal morbidity and mortality.