1
|
Dhakal A, Pokharel M, Madhup S, Khadka L, Sapkota B. Rhino-Orbital Mucormycosis in a COVID-19 Patient: A Dreadful Challenge. Kathmandu Univ Med J (KUMJ) 2022; 20:249-251. [PMID: 37017177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a pandemic disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). COVID-19 infections may be associated with a wide range of bacterial and fungal co-infections. Recent studies are reporting invasive fungal infection associated with severe COVID-19. Herein, we report a case of COVID-19 rhino-orbital mucormycosis infection caused by Rhizopus sps in a 32 year old diabetic patient who was successfully managed with early aggressive debridement of infected tissue endoscopically with extended ethmoidectomy by modified Denker's approach along with orbital decompression and antifungal therapy with Liposomal Amphotericin B and Posaconazole. Serial diagnostic nasal endoscopy showed no evidence of progression of the infection. The patient was discharged on 21st day of hospitalization still on oral Posaconazole for a total of 3 months.
Collapse
Affiliation(s)
- A Dhakal
- Department of ENT-HNS, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - M Pokharel
- Department of ENT-HNS, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - S Madhup
- Department of ENT-HNS, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - L Khadka
- Department of ENT-HNS, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - B Sapkota
- Department of ENT-HNS, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| |
Collapse
|
2
|
Koju P, Liu X, Zachariah R, Bhattachan M, Maharjan B, Madhup S, Shewade HD, Abrahamyan A, Shah P, Shrestha S, Li H, Shrestha R. Incidence of healthcare-associated infections with invasive devices and surgical procedures in Nepal. Public Health Action 2021; 11:32-37. [PMID: 34778013 PMCID: PMC8575378 DOI: 10.5588/pha.21.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/21/2021] [Indexed: 11/10/2022] Open
Abstract
SETTING Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu, Nepal. OBJECTIVES 1) To report the incidence of health-care-associated infections (HAIs), 2) to compare demographic, clinical characteristics and hospital outcomes in those with and without HAIs; and 3) to verify bacterial types in HAI and community-acquired infections (CAIs) among inpatients with invasive devices and/or surgical procedures. DESIGN This was a cohort study using secondary data (December 2017 to April 2018). RESULTS Of 1,310 inpatients, 908 (69.3%) had surgical procedures, 125 (9.5%) had invasive devices and 277 (21.1%) both. Sixty-six developed HAIs (incidence = 5/100 patient admissions, 95% CI 3.9-6.3). Individuals with HAIs had a 5.5-fold higher risk of longer hospital stays (⩾7 days) and a 6.9-fold risk of being in intensive care compared to the surgical ward. Unfavourable hospital exit outcomes were higher in those with HAIs (4.5%) than in those without (0.9%, P = 0.02). The most common HAI bacteria (n = 70) were Escherichia coli (44.3%), Enterococcus spp. (22.9%) and Klebsiella spp. (11.4%). Of 98 CAIs with 41 isolates, E. coli (36.6%), Staphylococcus aureus (22.0%) and methicillin-resistant S. aureus (14.6%) were common. CONCLUSION We found relatively low incidence of HAIs, which reflects good infection prevention and control standards. This study serves as a baseline for future monitoring and action.
Collapse
Affiliation(s)
- P Koju
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - X Liu
- School of Health Sciences, Global Health Institute, Wuhan University, Wuhan, China
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - R Zachariah
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - M Bhattachan
- World Health Organization, Country Office, Kathmandu, Nepal
| | - B Maharjan
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - S Madhup
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - H D Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
- The Union South East Asia, New Delhi, India
| | - A Abrahamyan
- Tuberculosis Research and Prevention Centre, Yerevan, Armenia
| | - P Shah
- School of Health Sciences, Global Health Institute, Wuhan University, Wuhan, China
| | - S Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - H Li
- School of Health Sciences, Global Health Institute, Wuhan University, Wuhan, China
| | - R Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| |
Collapse
|
3
|
Shrestha R, Koju P, Xinliang L, Maharjan B, Madhup S, Shah P, Hao L. Health Care Associated Infection and Trend of Antimicrobial Resistance in Tertiary Care Hospital -A Study in Low Income Setting. Kathmandu Univ Med J (KUMJ) 2019; 17:329-335. [PMID: 33311044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background Antimicrobial resistance (AMR) and healthcare-associated infections (HAIs) are among the most serious public health problems and overall estimate indicates that at any point, over 1.4 million people are suffering from health care associated infection globally. According to the WHO report, the frequency of nosocomial infection is 10% in South East Asia where as 7% in developed countries. The increasing trend of AMR in pathogenic bacteria leads to complication to treat HAIs and failure in treatment and rise in mortality. Objective The study was conducted with the objective of to explore the incidence of different types of HAIs and AMR pattern in the patients admitted in a tertiary care hospital. Method The cross-sectional study was conducted at the tertiary care hospital and the patient who are one year or older and admitted for more than 48 hours were included in this study. The criteria for classification of HAIs were adapted from Centers for Disease Control. All the samples were collected then antibiotic sensitivity testing was conducted according to CLSI standards. Data were collected using a structured data collection form. Data were entered in EpiData software and analyzed using SPSS version 22. Result Among 2326 patients, female was slightly higher than male patients, where 77 (3.3%) patients experienced at least one episode of HAIs. The surgical site infection (71.42%) is the most common infection followed by Catheter Associated Urinary Tract Infection (18.18%) and Health Care Associated Pneumonia (6.49%). Mean hospitalization days is higher with HAI (14.5 days) compared to non-HAI (6.6 days). Out of 909 specimens, urine, sputum and blood were higher in numbers, where 217 bacterial isolates were isolated with Escherichia coli (83 isolates) was the most common bacteria. It is found that Escherichia coli bacterial isolates were resistance to most common antibiotics. Conclusion The study concludes that surgical site infection is the most common healthcareassociated infection and Escherichia coli is the most common bacteria responsible for HAIs. Further, surgical site infection being the most common infection, there is an urgent need to take effective infection prevention and control prevention.
Collapse
Affiliation(s)
- R Shrestha
- Department of Pharmacology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre. Pharmacovigilance Unit/ Research and Development Division, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre
| | - P Koju
- Pharmacovigilance Unit/ Research and Development Division, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre
| | - Liu Xinliang
- School of Health Sciences /Global Health Institute, Wuhan University, No 299 Bayi Road, Wuhan, 430071, China. School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - B Maharjan
- Department ofInfection Prevention and Control, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre
| | - S Madhup
- Department of Microbiology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre
| | - P Shah
- School of Health Sciences /Global Health Institute, Wuhan University, No 299 Bayi Road, Wuhan, 430071, China
| | - Li Hao
- School of Health Sciences /Global Health Institute, Wuhan University, No 299 Bayi Road, Wuhan, 430071, China
| |
Collapse
|
4
|
Shrestha I, Pokharel M, Dhakal A, Amatya RC, Madhup S, Sherchan JB. Study of Microorganism Growth Pattern in Nasal Pack of Patients Visiting the Department of ENT, Head and Neck Surgery. Kathmandu Univ Med J (KUMJ) 2017; 13:303-7. [PMID: 27423279 DOI: 10.3126/kumj.v13i4.16828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Nasal packs are utilized nearly by otorhinolaryngologists for controlling epistaxis and post nasal procedures. Complications have been reported due to them; therefore the use of antibiotics is a common practice among otorhinolaryngologists. Objective To detect microbiological flora associated with nasal packing and find evidence to support the benefit of systemic antibiotics with it. Method A prospective, analytical study was conducted on 51 patients presenting to the Department of ENT, KUSMS from June to September 2015 who required nasal packing. Approval of the local Institutional review committee (IRC) was taken. The mid part of the pack was collected in a sterile bottle under aseptic technique and sent to microbiology department. Specimen collection, culture, identification tests were done according to the guidelines by American Society for Microbiology. Data were collected using the individual patient records and Microsoft Office Excel 2007. Statistical analysis was performed with SPSS 16.0. Result Among the 51 cultures; 33 (64.7%) were positive. In 18 (35.3%) cultures no organism was grown. Statistical analysis did not show significance between duration of pack kept with microbial growth (p=0.051) or the type of pack kept (p=0.212) .It showed significance with foul smell of the pack to the growth (p <0.001). Conclusion Microbiological flora was associated with nasal pack. Antibiotic soaked nasal packs have lesser incidence of positive bacterial growth when compared with plain nasal packs. Nasal packs kept for less than 48 hours have lesser incidence of positive bacterial growth when compared with nasal packs kept for more than 48 hours. Therefore, administering systemic antibiotics in cases when we plan to keep the pack for longer duration is recommended.
Collapse
Affiliation(s)
- I Shrestha
- Department of ENT-HNS Dhulikhel Hospital, Kathmandu University School of Medical Sciences Dhulikhel, Kavre, Nepal
| | - M Pokharel
- Department of ENT-HNS Dhulikhel Hospital, Kathmandu University School of Medical Sciences Dhulikhel, Kavre, Nepal
| | - A Dhakal
- Department of ENT-HNS Dhulikhel Hospital, Kathmandu University School of Medical Sciences Dhulikhel, Kavre, Nepal
| | - R Cm Amatya
- Department of ENT-HNS Dhulikhel Hospital, Kathmandu University School of Medical Sciences Dhulikhel, Kavre, Nepal
| | - S Madhup
- Department of Microbiology Dhulikhel Hospital, Kathmandu University School of Medical Sciences Dhulikhel, Kavre, Nepal
| | - J B Sherchan
- Department of Microbiology Dhulikhel Hospital, Kathmandu University School of Medical Sciences Dhulikhel, Kavre, Nepal
| |
Collapse
|