A 6-month-old male infant from North Delhi area brought to Hindu Rao Hospital in December 2013, belonging to low socio-economic status presented with multiple episodes of watery diarrhea, vomiting, high grade fever, dry cough and difficulty in breathing from past one week. Infant was immunized appropriately for age and was born in hospital as a full term child with a birth weight of 2.5 kg. The child was on bottle feed along with breast feeding. On physical examination, the infant weighing 4.66 kg was ill looking, malnourished, lethargic, abdomen distended and with peripheral cyanosis. The heart rate was 160/min, respiratory rate 68/min and BP was not recordable on examination [Table/ Fig-1]. On auscultation crepitations and ronchi were noticed. Infant developed seizures on the day of admission. The infant was treated in the emergency ward with mechanical ventilation, intravenous antibiotics (amikacin, amoxicillin/clavulanic acid), anticonvulsants, fluids and ionotropics. Later on vancomycin, meropenem and metronidazole was added to the treatment regime. The infant subsequently received two units of blood along with fresh frozen plasma and platelet transfusion. Blood culture was performed using BACTEC 9120 and identification and susceptibility testing was done by Vitek 2C. Considering septic shock, blood culture, stool culture and other relevant investigations were done. Stool as well as blood culture yielded Shigella flexneri. The isolates were resistant to cotrimoxazole (>320µg/ml), piperacillin (MIC> 128µg/ml), piperacillin-tazobactam (MIC>128µg/ml) combination, cefotaxime (MIC 32µg/ml), ceftriaxone (MIC 8µg/ml), cefepime (MIC 64µg/ml), aztreonam (MIC>64µg/ml), imipenem (MIC 4µg/ml), amikacin (MIC 16µg/ml), gentamicin (MIC 4µg/ml), tobramycin (MIC 4µg/ml), ciprofloxacin (MIC>4µg/ml), levofloxacin (MIC>8 µg/ml) and sensitive to ertapenem (MIC< 0.5µg/ml), meropenem (MIC 0.5µg/ ml) and tigecycline (MIC< 0.5µg/ml). However the patient expired. DISCUSSIONShigellosis is mainly caused by Shigella dysentery, Shigella flexneri, Shigella boydi, and Shigella sonnei. Shigella dysentery type 1 and Shigella flexneri are among the most toxic of serotypes associated with septicemia [1,2]. Infection is transmitted through feco-oral route with incubation time of 12 hours to one week. Clinically, the infection can result into mild to severe and fatal disease. Risk factors for developing septicemia in shigellosis include young age, malnutrition and immune-suppression. There are limited reports available in India regarding Septicaemia due to Shigella species [2][3][4][5][6]. Shigella infection is generally restricted to the gastrointestinal tract. Bloodstream invasion is rare and is reported to occur in 0.4%-7% of patients [1,4]. Blood cultures are not routinely done in diarrhoea or dysentery patients which may account for apparently lower incidence of septicemia due to Shigella sp. Young age and malnutrition are the two most important risk factors associated with bacteremia [1]. It is locally invasive due to effect of enterotoxi...

Drug resistance continues to be a major concern in isolates from intra-abdominal infections. Treatment with appropriate antibiotics preceded by antimicrobial resistance testing aided by early diagnosis, adequate surgical management, and knowledge of antibiotic - resistant organisms appears effective in reducing morbidity and mortality in IAI cases.

Introduction : Health care workers (HCW) are among the most vulnerable for contracting the COVID-19 infection. Understanding the extent of human-to-human transmission of the COVID-19 infection among HCW is critical in management of this infection and for policy making. We did this study to observe seropositivity and estimate new infection by seroconversion among HCW and predict the risk factors for infection.  Methods : A cohort study was conducted at a tertiary dedicated COVID-19 hospital in New Delhi during first and second wave of the COVID-19 pandemic. All HCW working in the hospital during the study period who come in contact with the patients, were our study population. The data was collected by a detailed face to face interview along with serological assessment for anti- COVID-19 antibodies at baseline and endline, and assessment of daily symptoms.  Prediction of potential risk factors for seroprevalence and seroconversion was done by logistic regression keeping the significance at p<0.05.  Results : A total of 192 HCW were recruited in this study, out of which, 119 (61.97%) at baseline and 108 (77.7%) at endline were seropositive for COVID-19. About two-third (63.5%) had close contact, 5.2% had exposure during aerosol procedures, 30.2% had exposure with a patient’s body fluid while majority (85.4%) had exposure to contact surface around the patient. Almost all were wearing PPE and following IPC measures during their recent contact with a COVID-19 patient. Seroconversion was observed among 36.7% of HCWs while 64.0% had a serial rise in titer of antibodies during the follow-up period. Association of seropositivity was observed negatively with doctors [OR:0.353, CI:0.176-0.710], COVID-19 symptoms [OR:0.210, CI:0.054-0.820], comorbidities [OR:0.139, CI: 0.029 - 0.674], and recent Infection Prevention Control (IPC) training [OR:0.250, CI:0.072 -0.864], while positively associated with partially [OR:3.303, CI: 1.256-8.685], as well as fully vaccination for COVID-19 [OR:2.428, CI:1.118-5.271]. Seroconversion was positively associated with doctor as profession [OR: 13.04, CI: 3.39 - 50.25] and with partially [OR: 4.35, CI: 1.070 -17.647], as well as fully vaccinated for COVID-19 [OR: 6.08, CI: 1.729 - 21.40]. No significant association was observed between adherence to any of the IPC measures and PPE (personal protective equipment) adopted by the HCW during the recent contact with COVID-19 patients and seroconversion. Conclusion : A high seropositivity and seroconversion could be either due to exposure to COVID-19 patients or concurrent immunization against COVID-19 disease. In this study the strongest association of seropositivity and seroconversion was observed with recent vaccination. IPC measures were practiced by almost all the HCW in these settings, and thus were not found to be affecting seroconversion. Further study using anti N antibodies serology, which are positive following vaccination may help us to find out the reason for the seropositivity and seroconversion in HCW.

Introduction Healthcare workers (HCW) are most vulnerable to contracting COVID-19 infection. Understanding the extent of human-to-human transmission of the COVID-19 infection among HCWs is critical in managing this infection and for policy making. We did this study to estimate new infection by seroconversion among HCWs in recent contact with COVID-19 and predict the risk factors for infection. Methods A cohort study was conducted at a tertiary care COVID-19 hospital in New Delhi during the first and second waves of the COVID-19 pandemic. All HCWs working in the hospital during the study period who came in recent contact with the patients were our study population. The data was collected by a detailed face-to-face interview, serological assessment for anti- COVID-19 antibodies at baseline and end line, and daily symptoms. Potential risk factors for seroprevalence and seroconversion were analyzed by logistic regression keeping the significance at p<0.05. Results A total of 192 HCWs were recruited in this study, out of which 119 (62.0%) were seropositive. Almost all were wearing Personal protective equipment (PPE) and following Infection prevention and control (IPC) measures during their recent contact with a COVID-19 patient. Seroconversion was observed among 36.7% of HCWs, while 64.0% had a serial rise in the titer of antibodies during the follow-up period. Seropositivity was negatively associated with being a doctor (odds ratio [OR] 0.35, 95% Confidence Interval [CI] 0.18–0.71), having COVID-19 symptoms (OR 0.21, 95% CI 0.05–0.82), having comorbidities (OR 0.14, 95% CI 0.03–0.67), and received IPC training (OR 0.25, 95% CI 0.07–0.86), while positively associated with partial (OR 3.30, 95% CI 1.26–8.69), as well as complete vaccination for COVID-19 (OR 2.43, 95% CI 1.12–5.27). Seroconversion was positively associated with doctor as a profession (OR 13.04, 95% CI 3.39–50.25) and with partially (OR 4.35, 95% CI 1.07–17.65), as well as fully vaccinated for COVID-19 (OR 6.08, 95% CI 1.73–21.4). No significant association was observed between adherence to any IPC measures and PPE adopted by the HCW during the recent contact with COVID-19 patients and seroconversion. Conclusion Almost all the HCW practiced IPC measures in these settings. High seropositivity and seroconversion are most likely due to concurrent vaccination against COVID-19 rather than recent exposure to COVID-19 patients. Further studies using anti-N antibodies serology may help us find the reason for the seropositivity and seroconversion among HCWs.