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Research paper thumbnail of Colletotrichum keratitis : A Rare but Definite Clinical Entity

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2013

Colletotrichum spp. is an emerging pathogen which causes a variety of human infections. Only a fe... more Colletotrichum spp. is an emerging pathogen which causes a variety of human infections. Only a few cases of Colletotrichum keratitis have been reported from India. We are reporting three cases of keratitis which were caused by three different species of Colletotrichum. Two of the three patients had a history of trauma and of a previous treatment with topical antibiotics. A direct microscopic examination of the corneas of all the three patients revealed fungal elements and Colletotrichum spp. grew in the culture. Two patients responded to topical anti-fungal therapy and the ulcer regressed, while the third patient failed to respond .The third patient was referred to a higher specialty centre for Keratoplasty.

Research paper thumbnail of Frequency of Esbl Producing Enterobacteriaceae and Their Antibiotic Sensitivity Pattern

Research paper thumbnail of Changing Prevalence and Antimicrobial Susceptibility Profiles by Uropathogens – a Study in India

To analyse the changing spectrum of uropathogens isolated from clean catch midstream urine sample... more To analyse the changing spectrum of uropathogens isolated from clean catch midstream urine samples and to evaluate the antibiotic sensitivity pattern & Multi drug resistance of those isolates. MATERIALS AND METHODS: All the urine samples collected in sterile container were received during the study period from Jan 2013 to Dec 2014 were processed & all the pathogenic isolates were identified as per the standard guideline. Antibiotic sensitivity was performed for the identified pathogens according to CLSI standards. RESULTS: A total 2306 urine specimens were processed and 43.06% showed significant bacteriuria among which 31.78% revealed GNB bacteriuria and 11.28% revealed GPC bacteriuria. The most frequently isolated pathogens were E.coli (27.8%), Klebsiella (16.7%) & Pseudomonas (6.0%) among GNB and Enterococci (11.9%) followed by CONS (8.6%) among GPC. Sensitivity tested against various antimicrobials to gram negative bacilli showed maximum sensitivity against Imipenem, Nitrofurantoin and Amikacin in order of sensitivity. Gram positive cocci showed maximum sensitivity against Vancomycin, Nitrofurantoin and Gentamicin respectively. Multidrug resistance was observed in all isolated pathogens. CONCLUSION: In this study we observed that there was a gradual shift in the prevalence of the isolated uropathogens and its antimicrobial sensitivity pattern. The reasons for this shift can be framed out as either more frequent and unnecessary usage of antibiotics or prescribing newer antibiotics with newer combinations for faster recovery of infections. Overall, both gram positive and gram negative organisms were most susceptible to Nitrofurantoin (Apart from Vancomycin in gram positives).

Research paper thumbnail of Ten Year Study of Fungal Keratitis - Tertiary Care Hospital

Research paper thumbnail of Rhino-orbital COVID-19 associated mucormycosis- A case report

IP International Journal of Medical Microbiology and Tropical Diseases

COVID-19 Associated Mucormycosis (CAM) is an emerging infectious disease that has caused increase... more COVID-19 Associated Mucormycosis (CAM) is an emerging infectious disease that has caused increased mortality & morbidity in India during this second wave of the pandemic. The country has reported more than 30,000 cases and over 2,000 deaths by Mucormycosis so far, according to sources from Union Health Ministry. CAM is now a notifiable disease. At our Tertiary care teaching hospital, which caters for COVID 19 management, we are reporting the first case of Rhino orbital CAM, which was caused by Rhizopus spp. Our patient had a history of contact with a suspected COVID 19 patient and was recently diagnosed with uncontrolled diabetes mellitus. A direct KOH microscopic examination of purulent material aspirated from the sinonasal polyp of the patient revealed fungal elements, and Rhizopus spp was isolated. Due to a shortage of Amphotericin B, the patient was referred to a government higher speciality centre for further management. The patient was followed up & was noted that he was treat...

Research paper thumbnail of Study to assess quality of antimicrobial use by point prevalence survey at a tertiary care centre

Indian Journal of Microbiology Research

Knowledge and perception of rational Antimicrobial Use (AU) help in developing interventions to i... more Knowledge and perception of rational Antimicrobial Use (AU) help in developing interventions to improve AU. Data to target AU surveillance and interventions are provided by Point Prevalence surveys, which are a resource-effective alternative to prospective surveillance. Point Prevalence Survey (PPS) on AU provides a snapshot of antibiotic use at a given point of time and can be repeated at regular intervals to monitor trends. It provides data that can be fed back to front line clinicians and used to inform discussions about stewardship. In Our 670 bedded tertiary care Hospital, we did the PPS during last week of Jan 2019 in the identified wards and ICU’s. A survey team reviewed patients’ case sheet and noted antibiotics prescriptions on the date of the survey. Other important details such as admitting ward, age, sex, total number of patients on admissions, administered antibiotics and its route, their dosages, dosing intervals, patients’ clinical diagnosis and indications for antibiotic use, Hospital-acquired infections (HAI) or Communityacquired (CAI) and surgical antibiotic prophylaxis (SAP) or Medical antibiotics prophylaxis(MAP). Of 502 patients admitted in the hospital, 325(64.7%) received 1 Antimicrobial orders (AO) on the date of the survey. Of 325 total AOs, 98 (30.2 %) were administered for (SAP) surgical prophylaxis, 19(5.84%) for Medical prophylaxis, (MAP), 23(7%) for reasons not documented in the medical record, i.e., Unknown- (UK), 167 (51.38%) were for CAI and 18(5.3%) for HAI. Parenteral Cefotaxim was the most prevalent antibiotic generally used and for all types of infection onset category.51% of all prescriptions for CAI was for respiratory infections. Broad spectrum AO treatment was prevalent, for both SAP and CAI infections. Understanding common reasons for Antibiotic use (e.g., Lower respiratory infection) can help focus education and stewardship efforts on areas in which improved use may have the greatest impact.

Research paper thumbnail of Surveillance, Auditing, and Feedback Can Reduce Surgical Site Infection Dramatically: Toward Zero Surgical Site Infection

Surgical infections, 2018

We evaluated the Surveillance of Surgical Site Infection (SSI), Auditing, and Feedback (SAF) effe... more We evaluated the Surveillance of Surgical Site Infection (SSI), Auditing, and Feedback (SAF) effect on the rate of compliance with an SSI care bundle and measured its effectiveness in reducing the SSI rate. A prospective cohort study from January 2014 to December 2016 was classified into three phases: pre-SAF, early-SAF, and late-SAF. Pre-operative baseline characteristics of 24,677 patients who underwent orthopedic, cardiovascular thoracic surgery (CTVS) or urologic operations were recorded. Univariable analyses of the SSI rates in the pre-SAF and post-SAF phases were performed. Percentage compliance and non-compliance with each care component were calculated. Correlation between reduction in the SSI rate and increase in compliance with the pre-operative, peri-operative, and post-operative care-bundle components was performed using the Spearman test. There was a significant decrease in the SSI rate in orthopedic procedures that involved surgical implantation and in mitral valve/aor...

Research paper thumbnail of Does structured educational intervention programme lead to sustainable knowledge improvement on infection control practices among under graduate medical students?

Infection, Disease & Health

Research paper thumbnail of Periodic Surveillance of Systemic Infection Antibiogram a Necessity –A Retrospective and Prospective Study

International Journal of Current Microbiology and Applied Sciences, 2016

linki mages/AMR_guideline7001495889.pdf). Antibiotic policy is one of the mandatory requirements ... more linki mages/AMR_guideline7001495889.pdf). Antibiotic policy is one of the mandatory requirements for accreditation and making an Antibiogram is the first step before framing Antibiotic policy (http://www.ncdc.gov.in/writereaddata/linki mages/AMR_guideline7001495889.pdf;

Research paper thumbnail of Trends in antibiotic resistance pattern against ESKAPE pathogens from tertiary care teaching institute – South India

Infection, Disease & Health, 2016

Introduction: This presentation describes our response to an 80% increase in the monthly rate of ... more Introduction: This presentation describes our response to an 80% increase in the monthly rate of LSCS associated surgical site infections (SSI) in a 500 bed tertiary referral hospital in NSW. The service undertakes almost 650 LSCS annually with a monthly SSI rate of 1.7% (January 2012 to July 2014). In August 2014 the SSI rate was 12.3% (nZ7). Methods: A multimodal intervention strategy was implemented which included establishing a multidisciplinary team and, following literature review, the development of a compliance bundle that was audited in tandem with the SSI surveillance process. Following implementation ongoing auditing identified any gaps that were addressed with the relevant discipline to ensure understanding of the management required and to improve bundled compliance. Results: Key stakeholder engagement provided opportunity for disciplines to take responsibility of the individual practice changes required for a standardised approach to reduce LSCS SSI rates. Initial overall bundle compliance was 63%. Timely reporting of bundle compliance enabled practice review opportunities and improved compliance. 12 months after the implementation of the bundle the compliance rate was 88% representing a 25% improvement. During the 12 months following the implementation of the bundle the number of average monthly SSI was 1 (range 0-3). The average rate being 1.9% (range 0%-5.7%) Conclusion: A multimodal approach that incorporates key stake-holder teams, active surveillance and continuous auditing of a compliance bundle can have an immediate and positive impact on surgical site infections associated with LSCS.

Research paper thumbnail of Colletotrichum keratitis : A Rare but Definite Clinical Entity

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2013

Colletotrichum spp. is an emerging pathogen which causes a variety of human infections. Only a fe... more Colletotrichum spp. is an emerging pathogen which causes a variety of human infections. Only a few cases of Colletotrichum keratitis have been reported from India. We are reporting three cases of keratitis which were caused by three different species of Colletotrichum. Two of the three patients had a history of trauma and of a previous treatment with topical antibiotics. A direct microscopic examination of the corneas of all the three patients revealed fungal elements and Colletotrichum spp. grew in the culture. Two patients responded to topical anti-fungal therapy and the ulcer regressed, while the third patient failed to respond .The third patient was referred to a higher specialty centre for Keratoplasty.

Research paper thumbnail of Frequency of Esbl Producing Enterobacteriaceae and Their Antibiotic Sensitivity Pattern

Research paper thumbnail of Changing Prevalence and Antimicrobial Susceptibility Profiles by Uropathogens – a Study in India

To analyse the changing spectrum of uropathogens isolated from clean catch midstream urine sample... more To analyse the changing spectrum of uropathogens isolated from clean catch midstream urine samples and to evaluate the antibiotic sensitivity pattern & Multi drug resistance of those isolates. MATERIALS AND METHODS: All the urine samples collected in sterile container were received during the study period from Jan 2013 to Dec 2014 were processed & all the pathogenic isolates were identified as per the standard guideline. Antibiotic sensitivity was performed for the identified pathogens according to CLSI standards. RESULTS: A total 2306 urine specimens were processed and 43.06% showed significant bacteriuria among which 31.78% revealed GNB bacteriuria and 11.28% revealed GPC bacteriuria. The most frequently isolated pathogens were E.coli (27.8%), Klebsiella (16.7%) & Pseudomonas (6.0%) among GNB and Enterococci (11.9%) followed by CONS (8.6%) among GPC. Sensitivity tested against various antimicrobials to gram negative bacilli showed maximum sensitivity against Imipenem, Nitrofurantoin and Amikacin in order of sensitivity. Gram positive cocci showed maximum sensitivity against Vancomycin, Nitrofurantoin and Gentamicin respectively. Multidrug resistance was observed in all isolated pathogens. CONCLUSION: In this study we observed that there was a gradual shift in the prevalence of the isolated uropathogens and its antimicrobial sensitivity pattern. The reasons for this shift can be framed out as either more frequent and unnecessary usage of antibiotics or prescribing newer antibiotics with newer combinations for faster recovery of infections. Overall, both gram positive and gram negative organisms were most susceptible to Nitrofurantoin (Apart from Vancomycin in gram positives).

Research paper thumbnail of Ten Year Study of Fungal Keratitis - Tertiary Care Hospital

Research paper thumbnail of Rhino-orbital COVID-19 associated mucormycosis- A case report

IP International Journal of Medical Microbiology and Tropical Diseases

COVID-19 Associated Mucormycosis (CAM) is an emerging infectious disease that has caused increase... more COVID-19 Associated Mucormycosis (CAM) is an emerging infectious disease that has caused increased mortality & morbidity in India during this second wave of the pandemic. The country has reported more than 30,000 cases and over 2,000 deaths by Mucormycosis so far, according to sources from Union Health Ministry. CAM is now a notifiable disease. At our Tertiary care teaching hospital, which caters for COVID 19 management, we are reporting the first case of Rhino orbital CAM, which was caused by Rhizopus spp. Our patient had a history of contact with a suspected COVID 19 patient and was recently diagnosed with uncontrolled diabetes mellitus. A direct KOH microscopic examination of purulent material aspirated from the sinonasal polyp of the patient revealed fungal elements, and Rhizopus spp was isolated. Due to a shortage of Amphotericin B, the patient was referred to a government higher speciality centre for further management. The patient was followed up & was noted that he was treat...

Research paper thumbnail of Study to assess quality of antimicrobial use by point prevalence survey at a tertiary care centre

Indian Journal of Microbiology Research

Knowledge and perception of rational Antimicrobial Use (AU) help in developing interventions to i... more Knowledge and perception of rational Antimicrobial Use (AU) help in developing interventions to improve AU. Data to target AU surveillance and interventions are provided by Point Prevalence surveys, which are a resource-effective alternative to prospective surveillance. Point Prevalence Survey (PPS) on AU provides a snapshot of antibiotic use at a given point of time and can be repeated at regular intervals to monitor trends. It provides data that can be fed back to front line clinicians and used to inform discussions about stewardship. In Our 670 bedded tertiary care Hospital, we did the PPS during last week of Jan 2019 in the identified wards and ICU’s. A survey team reviewed patients’ case sheet and noted antibiotics prescriptions on the date of the survey. Other important details such as admitting ward, age, sex, total number of patients on admissions, administered antibiotics and its route, their dosages, dosing intervals, patients’ clinical diagnosis and indications for antibiotic use, Hospital-acquired infections (HAI) or Communityacquired (CAI) and surgical antibiotic prophylaxis (SAP) or Medical antibiotics prophylaxis(MAP). Of 502 patients admitted in the hospital, 325(64.7%) received 1 Antimicrobial orders (AO) on the date of the survey. Of 325 total AOs, 98 (30.2 %) were administered for (SAP) surgical prophylaxis, 19(5.84%) for Medical prophylaxis, (MAP), 23(7%) for reasons not documented in the medical record, i.e., Unknown- (UK), 167 (51.38%) were for CAI and 18(5.3%) for HAI. Parenteral Cefotaxim was the most prevalent antibiotic generally used and for all types of infection onset category.51% of all prescriptions for CAI was for respiratory infections. Broad spectrum AO treatment was prevalent, for both SAP and CAI infections. Understanding common reasons for Antibiotic use (e.g., Lower respiratory infection) can help focus education and stewardship efforts on areas in which improved use may have the greatest impact.

Research paper thumbnail of Surveillance, Auditing, and Feedback Can Reduce Surgical Site Infection Dramatically: Toward Zero Surgical Site Infection

Surgical infections, 2018

We evaluated the Surveillance of Surgical Site Infection (SSI), Auditing, and Feedback (SAF) effe... more We evaluated the Surveillance of Surgical Site Infection (SSI), Auditing, and Feedback (SAF) effect on the rate of compliance with an SSI care bundle and measured its effectiveness in reducing the SSI rate. A prospective cohort study from January 2014 to December 2016 was classified into three phases: pre-SAF, early-SAF, and late-SAF. Pre-operative baseline characteristics of 24,677 patients who underwent orthopedic, cardiovascular thoracic surgery (CTVS) or urologic operations were recorded. Univariable analyses of the SSI rates in the pre-SAF and post-SAF phases were performed. Percentage compliance and non-compliance with each care component were calculated. Correlation between reduction in the SSI rate and increase in compliance with the pre-operative, peri-operative, and post-operative care-bundle components was performed using the Spearman test. There was a significant decrease in the SSI rate in orthopedic procedures that involved surgical implantation and in mitral valve/aor...

Research paper thumbnail of Does structured educational intervention programme lead to sustainable knowledge improvement on infection control practices among under graduate medical students?

Infection, Disease & Health

Research paper thumbnail of Periodic Surveillance of Systemic Infection Antibiogram a Necessity –A Retrospective and Prospective Study

International Journal of Current Microbiology and Applied Sciences, 2016

linki mages/AMR_guideline7001495889.pdf). Antibiotic policy is one of the mandatory requirements ... more linki mages/AMR_guideline7001495889.pdf). Antibiotic policy is one of the mandatory requirements for accreditation and making an Antibiogram is the first step before framing Antibiotic policy (http://www.ncdc.gov.in/writereaddata/linki mages/AMR_guideline7001495889.pdf;

Research paper thumbnail of Trends in antibiotic resistance pattern against ESKAPE pathogens from tertiary care teaching institute – South India

Infection, Disease & Health, 2016

Introduction: This presentation describes our response to an 80% increase in the monthly rate of ... more Introduction: This presentation describes our response to an 80% increase in the monthly rate of LSCS associated surgical site infections (SSI) in a 500 bed tertiary referral hospital in NSW. The service undertakes almost 650 LSCS annually with a monthly SSI rate of 1.7% (January 2012 to July 2014). In August 2014 the SSI rate was 12.3% (nZ7). Methods: A multimodal intervention strategy was implemented which included establishing a multidisciplinary team and, following literature review, the development of a compliance bundle that was audited in tandem with the SSI surveillance process. Following implementation ongoing auditing identified any gaps that were addressed with the relevant discipline to ensure understanding of the management required and to improve bundled compliance. Results: Key stakeholder engagement provided opportunity for disciplines to take responsibility of the individual practice changes required for a standardised approach to reduce LSCS SSI rates. Initial overall bundle compliance was 63%. Timely reporting of bundle compliance enabled practice review opportunities and improved compliance. 12 months after the implementation of the bundle the compliance rate was 88% representing a 25% improvement. During the 12 months following the implementation of the bundle the number of average monthly SSI was 1 (range 0-3). The average rate being 1.9% (range 0%-5.7%) Conclusion: A multimodal approach that incorporates key stake-holder teams, active surveillance and continuous auditing of a compliance bundle can have an immediate and positive impact on surgical site infections associated with LSCS.