Care Hospital In South India Research Articles

Patterns of Complementary and Alternative Medicine Use among Psoriasis Patients in a Tertiary Care Hospital in South India – A Cross-sectional Study

Background: Complementary and alternative medicine (CAM) refers to medical practices that are not part of conventional medicine. Reports in literature suggest the prevalence of CAM use ranges from 37% to 87%. There are no data on frequency of CAM use in Indian patients with psoriasis. Materials and Methods: A descriptive study was designed to look at frequency of CAM use in psoriasis patients attending the DVL outpatient department of a tertiary care hospital in South India. The clinicoepidemiological details and details of CAM use were entered into a predesigned pro forma. Results: Ninety-six psoriasis patients were included in the study. CAM use was seen in thirty (31.58%) psoriasis patients. Siddha treatment was the most common CAM used. Statistical analysis showed significant association of gender (male > female), time since diagnosis, alcohol use, and Psoriasis Area and Severity Index (PASI) score with use of CAM. Logistic regression analysis found age, education, socioeconomic status, alcohol use, time since diagnosis, presence of concomitant disease, affordability of medication, and PASI score to be independent predictors of CAM use. Limitations: The limitations of our study were the small sample size and lack of emphasis on dietary modifications followed. Conclusion: CAM is used by approximately 30% of psoriasis patients in South India, and the most common therapy used is Siddha. Knowledge of evidence regarding CAM therapies will help the dermatologist offer a balanced view of risks and benefits of indigenous CAM practices to our patients.

A Retrospective Study of Custodial Deaths in Visakhapatnam Region During 2021-24

Introduction: Custodial deaths in detention settings such as police cells, prisons, borstal schools, and asylums raise serious human rights concerns on individual dignity and state culpability. A thorough medicolegal investigation serves as the cornerstone for ensuring accountability and transparency in addressing state-sponsored crimes in modern societies. This retrospective study examines custodial deaths autopsied between October 2021-2024 in the jurisdiction of a tertiary care hospital in south India. Aims & Objectives:1. To identify the causes of deaths in custody in the Visakhapatnam region. 2. To analyse the factors which led custodial deaths, and 3. To suggest necessary reforms in prison health care. Methodology: In this study, data from the autopsy records of Andhra Medical College, Visakhapatnam, are analysed, focusing on 25 custodial deaths that occurred between October 2021 and October 2024. Due to insufficient data, only 20 cases with detailed records are included. The study examines age, type of custody, place of death, preexisting medical conditions, cause, and manner of death. Results: Out of 20 prisoner deaths, 18 (90%) were due to natural causes, primarily due to chronic lung diseases like bronchiectasis, bronchopneumonia, and lobar pneumonia (7 cases, 35%). Psychiatric illnesses were present in 4 cases (20%). The most affected age group was 31–40 years (7 cases, 35%). Unnatural deaths (10%) involved two suicides, both without a prior psychiatric history. Discussion: Despite ongoing prison reforms, custodial deaths remain a pressing issue due to systemic shortcomings at several levels. This study highlights chronic lung diseases (35%) as the leading natural cause which can be prevented by increasing access to care. Prisoners need better healthcare services, including regular screenings for respiratory conditions like TB and comprehensive mental health assessments. Conclusion: The findings of the present study highlight the urgent need for strengthening prison healthcare systems. Effective prison healthcare should address multiple aspects, including regular screenings for lifestyle diseases, improving hygiene, and fostering better health-seeking behaviors among inmates.

Prevalence and Factors Associated with Needlestick Injuries Among Healthcare Workers in a Tertiary Care Hospital in South India: A Cross-Sectional Study

Needle stick injuries (NSIs) are important occupational hazards for health care workers (HCWs), which increase the risk of blood-borne infections. The incidence of NSI is high in India, yet the surveillance remains suboptimal. The studt aims to determine the proportion of HCWs who sustained NSI in Govt. Medical College, Ernakulam, has been in operation for over one year to identify factors associated with NSI among the study population and to assess preventive and post-exposure practices among HCWs. This cross-sectional study was conducted from May to July 2018 at Govt., including doctors, house surgeons, nurses, nursing students, lab technicians, and last-grade workers working at Govt. medical college, Ernakulam. 349 participants were included in the study with the convenient sampling method and data were collected by structured questionnaire. Statistical analysis was conducted with SPSS software. Most participants were aged between 21 and 40 (65.5%), and 75.5% of the study population were females. Out of 495 respondents, the majority (28.7%) were nursing students, followed by house surgeons (23.8%), technicians/paramedical students (16.65%), doctors (15.5%), attenders (8.9%) and nurses (6.6%). NSI lifetime prevalence was 51.9%, and NSI over the past year was 38.1%. Of these, 43.6% reported multiple NSIs in the past 1 year. Out of 9697 HCWs, 58 (0.52%; 95% CI, 0.40%-0.66%) tested positive and the incidence rate was 598.5 per 1,000 HCWs. Most NSIs occurred in emergency settings (44.98%) and within wards, particularly in Medicine and Surgery (43.1%). Factors Associated with NSI: Healthcare workers aged 21–40 had the highest NSI incidence (p=0.00). Males were more affected. House surgeons, nursing students, and technicians were at higher risk. NSIs occurred during blood withdrawal, sharps disposal, and fluid tapping. Needle stick injuries is a significant occupational hazard in HCWs. Increased risk of NSI was significantly associated with younger age, male gender, and certain job roles. Before implementing this practice, it is important to acknowledge that there is a gap in availability of PPE (personal protective equipment) and standardized protocols, reporting systems, and proper training.

Assess The Accuracy Of Predictive Scores TRISS, NISS, And APACHE II In Predicting Mortality Among Trauma Patients In Tertiary Care Hospital In South India.

AIM: To evaluate and compare the efficacy of TRISS, NISS, and APACHE II scoring systems in predicting mortality among trauma patients. Obejctives: To assess the accuracy of the TRISS, NISS, and APACHE II scores in predicting mortality among trauma patients.To identify different trauma subgroups based on injury mechanism with Status of Patient Survivor.Methodology: Study Design: A retrospective cohort observational study (based on data availability) to evaluate and compare the predictive efficacy of TRISS, NISS, and APACHE II scoring systems among the trauma patient’s mortality. Study Area: Conducted at the Tertiary Care Centre in south India, SRIHER, Chennai. Sample Size:70 Samples doing has a pilot study. Study Population: Patients who admitted with aged 18 years and above within 24 hours of the traumatic event or traumatic injuries, regardless of the mechanism (blunt, penetrating, or others). Result: The study analysed the demographic, trauma scores, and mechanisms of injury data for 70 patients to assess their association with survival outcomes. Age showed no significant association with survival status (p = 0.98), suggesting it does not significantly contribute to trauma score prediction in this cohort. Gender was found to be significantly associated with survival (p = 0.05), with males showing a higher survival rate compared to females. Trauma Scores: The NISS score did not show a significant association with survival (p = 0.91), indicating it is not a reliable predictor in this context. The TRISS score demonstrated borderline statistical significance (p = 0.05), suggesting it has better predictive capabilities compared to the other scoring systems. The APACHE II score showed a trend toward significance (p = 0.06), but it did not meet the threshold for statistical significance. Among the trauma scoring systems, the TRISS score outperformed the NISS and APACHE II scores in predicting mortality, as indicated by the ROC curve analysis. Mechanism of Injury: The mechanism of injury showed a trend toward statistical significance (p = 0.07). Blunt trauma was associated with the only non-survivor in the study, while penetrating and other injury types were linked exclusively to survivors. Conclusion: The TRISS score was the most reliable tool for predicting survival outcomes among trauma patients in this study, with borderline significance. Gender and mechanisms of injury showed potential associations with survival status, while age, NISS, and APACHE II scores were not strong predictors in this sample. Future studies with larger samples may help clarify these trends and improve predictive accuracy for trauma care.

Absolute Eosinophil Counts as a Prognostic Marker in Patients with Sepsis.

Sepsis is a leading cause of mortality and morbidity in critically ill patients. It is necessary to have markers of severity that are easily accessible and useful to guide treatment in a timely manner. Eosinophil count could be a potential biomarker in sepsis, and it is routinely checked in clinical practice. To assess absolute eosinophil count (AEC) as prognostic marker in patients with sepsis. This observational study was conducted in a tertiary care hospital in South India. A total of 100 patients admitted with sepsis were included. AEC and Sequential Organ Failure Assessment (SOFA) score were calculated at admission and after 72 h. AEC was correlated with the SOFA score. These patients were clinically followed up during their hospital stay. A receiver operating characteristic curve was developed to determine the optimum AEC cutoff point for predicting mortality. Decreasing trend of AEC during the course of hospital stay (after 72 h) of admission was found to have a strong negative correlation with SOFA score. AEC cutoff <50 cells/mm 3 after 72 h of admission was associated with increased mortality. Low AEC after 72 h of admission and decreasing trend of AEC were associated with increased risk of requirement of ionotropic support, dialysis, ventilator, and mortality. A decline in AEC after 72 h of admission was linked to increased mortality. Therefore, eosinophil count can be used as a cost-effective marker for assessing severity and prognosis in patients with sepsis.

The Potential Effect on the Number of Computerized Tomography Pulmonary Angiography if a Clinical Probability-Adjusted D-dimer Is Added to an Age-Adjusted D-dimer.

Introduction Computerized tomography pulmonary angiography (CTPA) is the gold standard test for diagnosing pulmonary embolism (PE); however, owing to its high cost, contrast dye toxicity, and radiation exposure, it is necessary to ensure that CTPA is not performed unnecessarily. European Society of Cardiology (ESC) guidelines recommend the use of pretest clinical assessment tools and D-dimer levels to stratify patients according to risk, thereby determining the need for CTPA. However, such a broad classification incorporates a large population, where cases of CTPA could have been avoided. In this retrospective observational study, we established a new cohort within the moderate risk group, using a D-dimer threshold of 1000 ng/dL, and thereby aimed to identify its impact in identifying the number of cases of CTPA and to identify the number of cases of PE missed. Materials and methods This observational retrospective study was conducted over 24 months in the emergency medicine department of a tertiary care hospital in south India. Our study comprised of evaluation of electronic medical records of patients based on the inclusion and exclusion criteria. An overall 182 samples (n=182) were recruited, past medical records were evaluated, and classified patients were classified according to the new stratification criteria based on the Wells score, pulmonary embolism rule-out criteria (PERC), and D-dimer levels. The study outcomes of the number of CTPA cases avoided and PE cases missed out were analyzed. Results Assuming all samples (n=182) fell into the low moderate risk (LMR) category (Wells score<2 and PERC positive, or Wells score 2-4), 95 cases (n=95, 95/182) had D-dimer<1000 ng/dL, among which PE was absent in 93 patients (n=93, 97.89%) and present in 2 patients (n=2, 2.10%). The remaining 87 (n=87, 87/182) had D-dimer≥1000 ng/dL where all cases had PE (n=87, 100%). Assuming the samples (n=182) fell into the high moderate risk (HMR) category (Wells score 4.5-6), 21 cases (n=21, 21/182) had D-dimer< age-adjusted D-dimer (AADD) among which, PE was absent in 20 patients (n=20, 95.23 %) and present in 1 patient (n=1, 4.76%). The remaining 161 (n=161, 161/182) had D-dimer≥AADD, whereas all cases had PE (n=161, 100%). The false negative rates were 2.1% in LMR and 4.8% in HMR, while the reduction in CTPA procedures amounted to 95 scans in LMR and 21 scans in HMR. Conclusions We identified that establishing a higher threshold of D-dimer (1000 ng/dL) was effective in determining the need for CTPA and potentially reducing the number of CTPAs performed in suspected cases of PE.

Species Distribution and Antifungal Susceptibility Patterns of Candida Isolates: A Cross-Sectional Study From a Tertiary Care Hospital in South India.

Background The increasing prevalence of Candida infections and emerging antifungal resistance presents a significant challenge in tertiary healthcare settings. The epidemiological landscape of candidiasis is evolving, with non-albicans Candida species gaining prominence. This cross-sectional study aimed to investigate the distribution patterns of Candida species isolated from various clinical specimens at Srinivasan Medical College and Hospital,Samayapuram, India with particular emphasis on emerging non-albicans species that demonstrate varying virulence and antifungal susceptibility profiles. Methodology The study employed a hospital-based cross-sectional design conducted over six months from October 2023 to March 2024. A sample size of 97 clinical specimens was processed using standardized microbiological procedures, including potassium hydroxide (KOH) mount, Gram staining, and culture on Sabouraud's dextrose agar. Species identification utilized the Germ Tube Test, CHROMagar, and corn-meal agar techniques. Antifungal susceptibility testing was performed via disk diffusion method following Clinical and Laboratory Standards Institute (CLSI) guidelines for fluconazole, voriconazole, itraconazole, and amphotericin B. Statistical analysis employed StatisticalPackage for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 25.0, Armonk,NY), utilizing descriptive statistics, chi-square tests, and multivariate logistic regression. Results The study population demonstrated a mean age of 47.9 years, comprising 52 female and 45 male patients. Among clinical specimens, urinary samples constituted 51 specimens (52.6%), followed by high vaginal swabs with 23 specimens (23.7%), and sputum with 15 specimens (15.5%). Microbiological analysis revealed 45 isolates of Candidaalbicans (46.4%), while non-albicans species included 25 isolates of C. tropicalis (25.8%), 20 of C. krusei (20.6%), and 7 of C. glabrata (7.2%). Diabetes mellitus emerged as the predominant risk factor, affecting 38 patients (39.2%). Antifungal susceptibility testing demonstrated complete sensitivity to amphotericin B and voriconazole across all isolates, while 32 isolates showed resistance to itraconazole (33.0%). Fluconazole resistance patterns revealed 19 isolates with acquired resistance (19.6%) and 20 isolates with intrinsic resistance (20.6%). Conclusion The study reveals a significant prevalence of non-albicans Candida species and concerning levels of antifungal resistance, particularly to azoles. These findings emphasize the critical importance of species identification and antifungal susceptibility testing in guiding therapeutic decisions for Candida infections.

The mediating role of BMI in alcohol-linked liver enzyme elevation among adults at a tertiary care hospital in South India.

Excessive alcohol consumption is a major risk factor for liver disease, with significant variations in its impact across populations. BMI has been identified as a potential mediator in alcohol-related liver damage. This study aimed to examine the association between alcohol consumption and liver function and to explore the mediating role of BMI in a population from India, where both are rising public health concerns. A cross-sectional study was conducted using data from adult participants. Liver function was assessed using serum levels of gamma-glutamyl transferase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP). Alcohol consumption was self-reported, and BMI was calculated AST from height and weight measurements. Multiple linear regression models were used to evaluate the relationship between alcohol consumption and liver enzymes while adjusting for BMI as a mediator. Statistical significance was set at P < 0.05. The results indicated that higher alcohol consumption was significantly associated with elevated levels of GGT, ALT, and AST. BMI was found to mediate this relationship, with individuals having higher BMI showing a greater increase in liver enzyme levels in response to alcohol consumption. However, no significant association was observed for ALP. BMI also independently correlated with higher levels of GGT, ALT, and AST. This study highlights the mediating role of BMI in alcohol-induced liver dysfunction in the Indian population. Public health interventions focusing on both reducing alcohol intake and managing obesity may help mitigate the risk of liver disease in this high-risk population.

Predictors and Patterns of Adherence to Mood Stabilizers in Patients with Bipolar Affective Disorder in a Tertiary Care Hospital in South India – A Retrospective Study

Predictors and Patterns of Adherence to Mood Stabilizers in Patients with Bipolar Affective Disorder in a Tertiary Care Hospital in South India – A Retrospective Study

Clinical, Bacteriological And Radiological Profile Of Patients With Community Acquired Pneumonia In A Tertiary Care Hospital In South India

BACKGROUND: Pneumonia is one of the most common infections encountered in the clinical practice. Despite being the cause of significant mortality and morbidity, pneumonia is often misdiagnosed and mistreated. Pneumonia is defined as inflammation and consolidation of lung tissue due to an infectious agent. Pneumonia that develops outside the hospital is considered community acquired pneumonia (CAP).OBJECTIVE: To study the clinical, radiological, and bacteriological profile of patients with community- acquired pneumonia To evaluate CURB- 65 scoring system in community acquired pneumonia in tertiary care hospital.MATERIAL AND METHOD: This study was done in DEPARTMENT OF RESPIRATORY MEDICINE, TAGORE MEDICAL COLLEGE AND HOSPITAL, CHENNAI, TAMILNADU. The period of data collection was from January 2023 to December 2023. Eighty one patients were included in the study. A detailed history and examination, chest x-ray, routine laboratory investigation and sputum culture was done for all the patients diagnosed with community acquired pneumonia. CURB65 scoring system were applied to all the patients included in this study to assess the severity and prognosis.RESULTS: In the study it was observed that most of the patients were among 56 to 65 years of age group. The disease occurrence was more common in males. In the present study all the patients were symptomatic. The most common presenting symptom was cough and fever, followed by breathlessness(40. 7%), chest pain (22.2%) and confusion ( 3.7 %). Fever was equally distributed among both the age group. But cough and breathlessness was more among the older age group. The most common risk factor was smoking (43.2%) and alcohol intake (40 .7 %). The co-morbidities diabetes ( 29. 6%) and COPD (24.7 %) were seen predominantly in these patients. Streptococcus pneumonia( 38. 3%) was the most common etiological agent identified through sputum culture followed by gram negative organism (klebsiella and pseudomonas). Radiologically, the lower lobe was more commonly involved followed by middle lobe. There was no correlation between the causative agent and radiological appearance. The rate of ICU admission was 14%. Two patients in our study had died. CURB 65 was applied to all the patients and CURB 65 proved to be a good prognostic indicator for assessing the severity of community acquired pneumonia.

Potentially inappropriate medications in geriatric patients attending a tertiary care hospital in South India: an observational cross-sectional study

Potentially inappropriate medications in geriatric patients attending a tertiary care hospital in South India: an observational cross-sectional study

Impact of Noncommunicable Diseases and Heat Stress on Estimated Glomerular Filtration Rate in Security Officers at a Tertiary Care Hospital in South India.

The job profile of security officers in tropical countries involves prolonged standing in hot conditions causing heat stress as well as complications of sedentary lifestyle. The objectives of this study were to estimate the prevalence of noncommunicable diseases and heat stress in security officers and analyze factors affecting heat stress and estimated glomerular filtration rate (eGFR). This was an observational cross-sectional study conducted among security personnel working at a tertiary care hospital in South India during the hottest months of March to May 2020. Screening camps were conducted during which anthropometric measurements were taken and blood was collected for hemoglobin, creatinine, and fasting glucose estimation. Urine dipstick analysis for glucose, protein, pH, and red and white blood cells were done on early morning voided sample. Heat stress was assessed by a validated 18-item questionnaire called heat strain score index (HSSI). A structured questionnaire was prepared for surveillance of risk factors of noncommunicable diseases. A total of 678 security officers were screened. Majority (659/678, 97.2%) were men and mean age of the cohort was 45.4 ± 9.2 years. Fifty-two percent (355/678) of participants were engaged in outdoor work for a median duration of 6 (IQR, 0-8) hours/day. Prevalence of obesity, diabetes, hypertension, and chronic kidney disease (CKD) were 70.9, 25.5, 15.9 and 1.3 percentage, respectively. Half of the cohort (324/678) had definite heat stress and 0.9% (6/678) developed CKD of undetermined etiology. Heat stress was higher in those working outdoors and longer employment duration and lower in those with abdominal obesity. eGFR was lower in older officers, smokers, hypertensives, and those with longer employment duration, but was unaffected by HSSI scores. Kidney function was unaffected by high levels of heat stress experienced by security personnel working at a tertiary hospital in South India. Future studies are needed to understand the pathomechanisms of differential impacts of heat stress on kidney function of agricultural various worker categories.

Knowledge, Awareness and Prevalence of HPV Vaccine Hesitancy Among Parents of Adolescents from A Tertiary Care Hospital in South India

Knowledge, Awareness and Prevalence of HPV Vaccine Hesitancy Among Parents of Adolescents from A Tertiary Care Hospital in South India

P-1770. Antimicrobial Stewardship: Usage of AWaRe Classification for justification of antibiotic therapy in a tertiary care hospital in South India

Abstract Background Antibiotic resistance, a consequence of the overuse and inappropriate use of antibiotics, poses a significant global health threat, endangering our ability to effectively treat bacterial infection. Utilizing the WHO,s categorization of antibiotics into Access, Watch, and Reserve (AWaRe) for justification provides a structured approach for assessing antimicrobial use, thereby facilitating the identification of areas for improvement and the implementation of effective antimicrobial stewardship programs (AMS). Methods This Prospective Observational study was conducted in a Tertiary care hospital in South India in the month of APRIL 2024 using a tool containing patient’s demographic data, drug chart , indications, culture reports and justification column. Results Out of 1046 patients 246 patient were receiving antibiotics in which the study revealed that a majority of antibiotics fell into the WATCH (63.4%), followed by ACCESS (33.3%) and RESERVE (3.25%) categories. Among the antibiotics prescribed, Ceftriaxone (28.1%), Cefuroxime (24.8%) and Piperacillin-Tazobactam (22.4%) were most frequently used. Conversely, Fosfomycin, Tigecycline, and Linezolid were prescribed less frequently, each constituting less than 1% of prescriptions. Analysis showed that 164 patients (66.6%) received antibiotics without justification, while 84 patients (33.4%) received justified therapy. Regarding patient referral, 26.3% were referred with an ID reference, while the majority (74.6%) were not. Indications for antibiotic use varied, with empirical treatment being the most common (30.5%), followed by prophylaxis (48.9%), and definitive treatment (16.3%). A smaller percentage of cases transitioned from empirical to definitive treatment (6.2%). Conclusion In summary, the majority of prescriptions fell under the WATCH category (63.4%), with common antibiotics like Ceftriaxone and Cefuroxime being frequently prescribed. A significant portion (66.6%) of prescriptions lacked justification, highlighting the need for improved antimicrobial stewardship. The low rate of infectious disease referrals suggests potential gaps in consultation. Targeted interventions are necessary to rationalize prescribing practices and address the threat of antimicrobial resistance. Disclosures All Authors: No reported disclosures

P-1715. Antibiotic Stewardship based on the usage of Non- FDA Approved Fixed Dose Combination of Antibiotics in a Secondary Care Hospital South India

Abstract Background In developing countries, the widespread use of non-FDA (Food and Drug Administration) approved fixed-dose combinations of antibiotics in secondary care hospitals is a concern. Despite cautions from infectious disease specialists, comprehensive studies on this practice are lacking. Our research aims to investigate indications for prescribing these combinations in a South Indian secondary care hospital and develop stewardship strategies to reduce the use of it.TABLE 1:Indication for the Usage of non FDA Approved Fixed Combination of Antibiotics Methods The study conducted was a Prospective observational study at a secondary care hospital in South India over a 4-month period from December 2023 to March 2024. Data collection utilized a validated audit tool capturing details of non-FDA approved fixed dose antibiotic combinations prescribed to patients. Statistical analysis was conducted using MS Excel, employing simple descriptive statistics. Results CIPROFLOXACIN (500mg) + TINIDAZOLE (600mg) and CEFEXIME (200mg) + OFLOXACIN (200mg) are commonly prescribed for various conditions such as acute gastroenteritis, ear pain, and other ailments like fissures, cysts, and vaginal white discharge. However, these combinations lack FDA approval and randomized controlled trials (RCTs) to support their efficacy in treating conditions like otitis media and loose stools. The addition of antiparasitic agents in these combinations lacks evidence of effectiveness. Therefore, caution is advised in their prescription until further scientific validation is available. Conclusion In conclusion, our antibiotic stewardship efforts led to the removal of CIPROFLOXACIN (500mg) + TINIDAZOLE (600mg) and CEFEXIME (200mg) + OFLOXACIN (200mg) from our hospital formulary. Physicians were informed that these combinations lack scientific rationale for treating specific conditions. This action aligns with evidence-based prescribing practices to optimize patient care and combat antimicrobial resistance. Disclosures All Authors: No reported disclosures

P-2148. Prospective Study on Microbiological Profile of Fungal Isolates and its Antibiogram in a Tertiary care hospital in South India

Abstract Background Fungal infections are increasingly recognized as significant causes of morbidity and mortality, particularly in immunocompromised individuals. Despite their importance, there is limited data on the microbiological profile and antimicrobial resistance patterns of fungal isolates in South India. This prospective study aims to fill this gap by characterizing fungal isolates and determining their antibiograms in a tertiary care hospital, providing crucial insights for clinical management and infection control strategies. Methods A Prospective Observational Study was done under the guidance of an Infectious diseases Specialist by collecting the culture positive fungal isolates from the Microbiology department for the 1 year duration of April 2023 to March 2024. Data including patient age, gender, specimen, type of fungus isolated, its sensitivity pattern, average time required for identification of the species and requirement of ICU admission were analyzed. The three classes of antifungals including polyenes, azoles and echinocandins were included. Data was entered and analyzed using Microsoft excel. Results A total of n=62 fungal isolates were isolated. The average age of the patients was 49 years with a higher prevalence in male (n=42) compared to females (n=20). Fungal species have been isolated more commonly from blood samples followed by urine samples, tissues, body fluids. In all the cases tested, Azoles, Polyenes and Echinocandins were susceptible in 57%, 76% and 80% of the cases respectively. Average time taken for identification of the subspecies was 124 hrs (∼ 5 days). Candida auris was the most common isolate found, which developed complete resistance to azoles, partially to polyenes, while echinocandin has been found to be a reliable drug of choice. The spectrum and efficacy of Echinocandins were higher compared to azoles and polyenes. Conclusion Candida auris was found as the most resistant species and echinocandins have been found as a reliable drug of choice compared to Azoles and Polyenes antifungals. This study highlights the need for rapid diagnostic procedures for rapid identification of the species grown in the culture, thereby enabling rational antifungal therapy. As long as the reporting time delays, initiation of right antifungal therapy also delays. Disclosures All Authors: No reported disclosures

P-1767. Understanding Antibiotic Prescribing Practices by utilizing WHO's AWaRe Criteria in a tertiary care hospital in South India: A Prospective Observational study

Abstract Background Antibiotic resistance is a significant threat globally and the inappropriate use of antibiotics leads to subsequent rise in the antimicrobial resistance causing challenge in antimicrobial stewardship programs [AMS]. Assessment of Antimicrobial use by using World health organization [WHO] categorization of Antibiotics into ACCESS, WATCH, RESERVE [AWaRe]. Methods The prospective Observational study was conducted in a tertiary care hospital in the period of one month APRIL [01.04.24 -30.04.24] using a tool containing patient’s demographic data, AWaRe classification, their indications, culture reports and prescribing practices in hospitalized patients Results out of 1236 hospitalized patients 246 patient receive antibiotics. The results of the collected data in the following table ANTIBIOTIC CATEGORY- ACCESS – (33.3%)WATCH – (63.4 %)RESERVE – (3.25%)DoxycyclineMetronidazole6.9%2.1%CeftriaxoneCefuroximePiperacillin - TazobactumCefoperazone – SulbactumMeropenem28.1%24.8%22.4%13.8%7.3%FosfomycinTigecyclineLinezolid0.81%0.4%0.4%ID REFERENCEYes26.3%No74.6%INDICATIONSEmpirical30.5%Definitive16.3%Prophylaxis48.9%Empirical to Definitive6 Conclusion The data indicates a predominance use of antibiotics in the "Watch" category, with Ceftriaxone (28.1%), Cefuroxime (24.8%), and Piperacillin-Tazobactam (22.4%) being the most commonly used antibiotics and most of the antibiotics are given Empirically (30.5%) . A quarter of antibiotics are referenced in Infectious Disease. This highlights the importance of careful antibiotic stewardship to combat antimicrobial resistance and ensure effective treatment. Disclosures All Authors: No reported disclosures

P-1716. Assessing Appropriateness of Cephalosporins Prescription in a Tertiary Care Hospital in South India

Abstract Background Cephalosporins plays a vital role in empirical therapy. Unfortunately the misuse &amp; underuse of 3rd Generation Cephalosporins (3GCs) has triggered a concerning rise in ESBL-producing Enterobacterales, with resistance rates as high as 80-85% in India. If this ongoing misuse continues, it poses a serious threat to the efficacy of these vital antibiotics. This cross-sectional study aims to evaluate the appropriateness and utilization of Cephalosporins in a tertiary care hospital in South India.Table 1:Factors for the initiation of Cephalosporins Methods In April 2024, a cross-sectional study was conducted by Pharm D interns assisted with Infectious Disease Specialists. Patients admitted as IP who received Cephalosporins until discharge are included. Patients receiving other than Cephalosporins are excluded from the study. Therapy appropriateness was determined using the Sanford Antimicrobial Guide 2022. Simple statistics are done in Excel for analysis.Table 2:Assessment of the initiated Cephalosporins Results Of 1376 patients, 428 (31.1%) patients received antimicrobial therapy of that Cephalosporins were prescribed to 226 patients (52.8%) for various indications. The most commonly prescribed was Ceftriaxone 139 (61.5%) prescriptions, followed by Cefuroxime 67 (29.6%), Cefixime 5 (2.2%), Cefazolin 5 (2.2%) &amp; others 10 (4.4%). Reasons for initiating cephalosporins and analysis are given in Table 1 &amp; Table 2. 3GCs are the most frequently used empirical antibiotic. A significant proportion (37.6%) of cephalosporin prescriptions lacked clinical infections. Empirical therapy continued beyond the 5th day 5.8 ± days following negative cultures, Duration of surgical prophylaxis exceeded than the recommended guidelines. Conclusion From the findings, Ceftriaxone dominated 61% of prescriptions for various indications, with one-third administered inappropriately via parenteral till discharge, mean duration 5.8 ± days. 37.6 % of the 3GC administered have been inappropriate also which has added additional costs to the patient. A knowledge gap among clinicians in discontinuation should be addressed by educational interventions with clinical pharmacists actively engaging to de-escalate cephalosporins. This single-centric study suggests the need for RCTs providing alternatives to cephalosporins for infections to prevent the risk of increasing ESBL resistance in India. Disclosures All Authors: No reported disclosures

P-297. Prospective Study on Microbiological Profile of Nosocomial Infections due to Gram negative lactose non-fermentative Bacteria in a Tertiary Care Hospital in South India

Abstract Background Non-fermentative gram-negative bacteria (NFGNB) infections that are acquired in hospitals have particularly concerning characteristics; identifying these features can aid in prevention and improve the standard of care provided within hospital premises. This study aims to find out the nosocomial infections caused by NFGNB, its sensitivity pattern, length of culture reporting time, and patients with ICU stay. Methods A prospective observational study was conducted in a tertiary care hospital located in southern India during the 4 months of January-April 2024. Data were taken from the Department of Microbiology regarding the prevalence of NFGNB isolates from different culture samples and their sensitivity pattern. The number of MDR isolates throughout the four months, their susceptibility pattern, and the duration of culture reporting time for all NFGNB isolates were examined. Descriptive analysis was used to look at patient demographics, inpatient department, and ICU admission. Statistical analysis was done by Microsoft Excel. Results Total 72(18.6%) samples were recorded as NFGNB from 386 culture positive samples isolated from the Department of Microbiology. The most common isolate was Acinetobacter spp (38.8%) followed by Pseudomonas spp (27.7%). The mean of our study participants was found to be 55 years, with a male: female ratio 2:1. The General Medicine department showed maximum isolates i.e, 25% followed by Hepatology department i.e, 16.6%. Maximum NFGNB isolates are from Urine sample (33.3%) followed by Blood sample (27.8%). The mean time of culture reporting for NFGNB was 72 hours. Out of 72 NFGNB samples, 28(38.8%) were Multi-drug resistant isolates and 29(40.2%) required ICU admission. Conclusion NFGNB function as nosocomial pathogens, their startling resistance is a concern to epidemiology and medical care. These isolated pathogens have been manually reported for a considerable amount of time. Rapid culture identification methods would assist identify resistant diseases early and improve patient outcomes in low- and middle-income countries. Future studies should focus on implementation of approaches to reduce the incidence and resistance of nosocomial infections in LMICs. Disclosures All Authors: No reported disclosures

P-1366. Outcome of 10 Patients with Colistin-Resistant Gram-negative isolates in a Tertiary Care Hospital in South India

Abstract Background The emergence of colistin-resistant gram-negative isolates poses a significant challenge in the management of infections, particularly in tertiary care settings. This study aims to investigate the clinical outcomes of 10 patients with colistin-resistant gram-negative isolates in a South Indian tertiary care hospital. Understanding the impact of these resistant strains on patient outcomes is crucial for guiding treatment strategies and improving patient care in the face of increasing antimicrobial resistance. Methods This study conducted between January 2023-April 2024 at a tertiary hospital in India. We reviewed patients’ clinical profile, outcome, and antibiotics that were used for treatment. Results Ten colistin-resistant isolates were reported over 16 months. Respiratory was the most common source of the isolate, followed by blood and urine samples. Klebsiella pneumoniae constituted 50%, Acinetobacter baumannii 30%, Pseudomonas aeruginosa 20% of all isolates. Susceptibility of these isolates to other drugs were Amikacin 70%, tigecycline 58%, and chloramphenicol 25%. Antibiotics that were used for treatment combinations among the following antimicrobials as shown in Table 1.Table 1:Patient profile, antibiotic combination used, and outcomeS.NOSAMPLEANTIBIOTICS USED FOR TREATMENTOUTCOME1RespiratoryColistin +Tigecycline + ChloramphenicolDeath2RespiratoryMeropenem + ColistinDeath3RespiratoryCo-trimoxazole + TigecyclineDischarge4BloodTigecycline + ChloramphenicolDeath5PusAmikacin + ColistinDischarge6UrineChloramphenicol + ImipenemDischarge7RespiratoryColistin + TigecyclineDeath8RespiratoryAmikacin + ColistinDischarge9Wound SwabFosfomycin + ColistinDeath10RespiratoryMeropenem + ColistinDeath Conclusion Colistin resistance is becoming more common in Gram-negative bacteria, particularly K. pneumoniae, in Indian hospitals. Among patients infected with colistin-resistant gram-negative isolates, the mortality rate is 60%, while 40% are discharged. Amikacin, tigecycline, and chloramphenicol could be considered for combination therapy. Disclosures All Authors: No reported disclosures