Background:Growing antimicrobial resistance and limited therapeutic options to treat carbapenem-resistant bacteremia prompted us to evaluate the clinical outcomes associated with healthcare-associated bacteremia.Methods:This was a retrospective observational study of carbapenem-resistant Gram-negative bacteremia performed at a tertiary care facility in Chennai, India between May 2011 and May 2012.Results:In our study, patients had mean 11.76 days of intensive care unit (ICU) care and mean time to onset of bacteremia was 6.4 days after admission. The commonest organism was Klebsiella pneumoniae (44%). Patients with combination treatment had lower mortality (44.8%) compared with colistin monotherapy (66.6%); (P = 0.35).Conclusion:Carbapenem resistant bacteremia is a late onset infection in patients with antibiotic exposure in the ICU and carries a 30 days mortality of 60%; K. pneumoniae is the most common organism at our center. Two drug combinations appear to carry a lower mortality compared with monotherapy.

Background?Meningitis following neurosurgical procedure is a well-recognized and potentially fatal complication. The Indian literature on microbiological epidemiology is scarce. The aim of our study was to know clinical, microbiological profile and treatment outcomes of patients with neurosurgical meningitis at our center. Methods?This was a retrospective observational cohort study of 25 culture-proven neurosurgical meningitis cases performed at the Apollo Speciality Hospital, Chennai, India, between January 2009 and May 2012. Results?In our study, nine patients had skull fracture and cerebrospinal fluid leak, nearly 50% of the patients underwent craniotomy, and five patients had endoscopic surgery while 64% of the patients required shunt placement or drains. Only nine patients (36%) had definite clinical signs of meningitis and mean duration of onset of symptoms from surgery was 11.12 days. A total of 18 patients (72%) had gram-negative bacterial meningitis and majority (83.3%) was due to carbapenem-resistant organisms. Predominant isolate was Pseudomonas aeruginosa (44.4%), and the second most common isolate was Acinetobacter baumannii (33.3%). Among cases of gram-negative bacterial meningitis, patients who had carbapenem-resistant isolates were given combination antimicrobials (carbapenem/cefepime tazobactam with colistin/gentamicin) as per susceptibility via intravenous and intrathecal through the drain (extraventricular or lumbar). Only five patients (27.7%) had a complete cure. Conclusion?Gram-negative organisms, mainly Pseudomonas and Acinetobacter, are predominant pathogen in neurosurgical meningitis in our center. While treating multidrug-resistant gram-negative meningitis, device removal and a combination of antimicrobial agents via both intravenous and intraventricular routes are crucial to achieve cure.

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Invasive mold infections (IMIs) are a major cause of morbidity and mortality in hospitalized and immunocompromised patients. Over the last decade, the incidence of IMIs has increased at an alarming rate in India. Radiology, histopathology, and validated biomarkers play an important role in the diagnosis of IMIs, including aspergillosis and mucormycosis. Despite major advances in the field of diagnostics, newer diagnostic aids are not available in India. Further, the cost is a major consideration in the Indian context. While antifungal therapies are the mainstay of treatment for aspergillosis, surgery along with antifungal therapy is the mainstay treatment for patients with mucormycosis. Furthermore, there is a paucity of data regarding the diagnosis and management of IMIs, especially in India. This study presents an expert opinion on the diagnosis and management of IMIs in Indian settings. The key opinions proposed by the subject expert group are summarized in this paper.