Hospital Practices and Research

Abstract Background: Emergence and dissemination of resistance to carbapenems among carbapenemase-producing Enterobacteriaceae (CPE) has led to limited therapeutic options for patients infected with CPE. Objectives: This study aimed to determine the prevalence of CPE colonization among newly admitted patients scheduled for surgery, identify the risk factors for acquiring CPE, and assess post-surgical outcomes among CPE carriers. Methods: A total of 152 patients scheduled for various types of planned surgery were included in the study. Two rectal swabs were collected from each patient and processed following the CDC-recommended method for screening Carbapenem-resistant Enterobacteriaceae (CRE). Probable CRE colonies were then tested using the mCIM for carbapenemase production according to CLSI guidelines. Patients were followed up after two months to monitor for any post-surgical infections. Surveillance swab sampling was conducted to detect the spread of CPE in the hospital environment by CPE carriers. Results: A high occurrence (15.13%) of CPE colonization was recorded in patients admitted for different planned surgeries. A history of antibiotic therapy was significantly associated with CPE acquisition (P<0.001). A significantly higher proportion of CPE carriers developed post-surgical infections compared to non-carriers (87% vs. 13.1%; P<0.0001). All the patients who developed post-surgical infections with CRE were already harboring CPE in their intestines. On environmental sampling, 15 (65.2%) of the 23 CPE-colonized patients were found to be positive for CPE. Conclusion: High rates of intestinal carriage of CPE among freshly admitted patients, as detected in our study, pose a risk to individuals for CPE infection, leading to antibiotic therapy, long-term hospital stays, and loss of daily wages. Therefore, infection control policies should be formulated by hospitals to screen for CPE carriage during hospital admission, followed by containment of CPE to prevent transmission.

Abstract Introduction: Histoplasmosis is a granulomatous fungal disease, caused by Histoplasma capsulatum; an intracellular dimorphic fungus, usually found in soil contaminated with bird and bat excreta; transmitted by aerosolized microconidia inhalation. The most common clinical presentation is acute or chronic Pulmonary Histoplasmosis.
Case Presentation: In this case report, a perplexing diagnostic scenario involving a 56-year-old patient who was HIV-negative but had diabetes mellitus and hypertension, in conjunction with unclear dermatological lesions has been presented. Despite treatment, the lesions did not respond favourably, posing a diagnostic dilemma. The identification of yeast forms in skin biopsy indicated progressive disseminated histoplasmosis, a diagnosis validated by PCR analysis, detection of Histoplasma galactomannan antigen in urine, and a positive fungal culture. A course of IV Liposomal Amphotericin B followed by oral Itraconazole, resulted in a favourable response.
Conclusion: Immunocompromised patients often exhibit mucocutaneous involvement, which is uncommon in immunocompetent individuals without specificity, leading to diagnostic difficulties. Although the patient lived in a non-endemic region, a travel history to Gangetic Plains, an endemic area for histoplasmosis, was elicited. Therefore, a comprehensive patient history is essential for diagnosis, in addition to microbiological and histopathological results.