Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
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Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2010 | Month : October | Volume : 4 | Issue : 5 | Page : 3109 - 3112

Microbiological Profile Of Nosocomial Infection In The Intensive Care Unit

SHALINI S, KRANTHI K, GOPALKRISHNA BHAT K*

*Department of Microbiology, Kasturba Medical College Mangalore-575001, Manipal University

Correspondence Address :
Dr. Gopalkrishna Bhat K, Associate Professor, Dept. of Microbiology, Kasturba Medical College, Mangalore (A constituent college of Manipal University)
E mail: gopalkrishna.bhat@manipal.edu

Abstract


Introduction: Nosocomial infections (NI) are those acquired in hospital settings. Each nosocomial infection adds 5-10 days to the affected patients’ stay in the hospital and leads to extra expenditure, thus overburdening the already strained health economy. The rate of nosocomial infections ranges from 2.8% to 34.6% in various studies.
Materials and Methods: We conducted this study to estimate the rate of nosocomial infections in the Intensive care unit (ICU) of a tertiary care hospital from coastal Karnataka, South India. The patients who developed infections after 48 hours of admission to the ICU were included in the study. The specific site related investigations included blood cultures and cultures of CVP or intravenous catheter tips, urine and indwelling catheter tips, endotracheal tube tips, suction catheter tips and endotracheal secretions. 97 suspected cases of nosocomial infections were studied prospectively, which were identified as per the guidelines laid down by CDC.
Observations: The rate of nosocomial infections was 27. 4%. The rates of the urinary, respiratory and the intravascular catheter related infections were 55.52%, 35.78% and 11.52%, respectively. Klebsiellapneumoniae and Staphylococcus aureus were the most common isolates with maximum susceptibility to imipenem and vancomycin respectively. Environmental sampling and healthcare personnel screening showed the presence of these organisms as the local flora in our hospitals.
Conclusion: Infections in the ICU patients are important problems. Adherence to infection prevention protocols and the proper monitoring and the judicious use of antibiotics are important in preventing such infections.

Keywords

Intensive care unit, nosocomial infection, nosocomial pathogen, drug resistance.

Introduction
Nosocomial infections (NI) are responsible for morbidity and mortality in hospitalized patients. They also increase the cost of treatment and prolong hospitalization. The Centre for Disease Control and Prevention (CDC) defines the intensive care unit associated infections as those that occur after 48 hours of ICU admissions or within 48 hours after the transfer of the patients from the ICU (1).The rate of NIs varies from 2.8% to 34.6% among hospitalized patients (2).The rate of NIs in the ICU is rising, mainly because of the increasing use of invasive procedures which are performed in the ICU. The therapeutic interventions which are associated with infectious complications include indwelling catheters, sophisticated life support, intravenous fluid therapy, prosthetic devices, immunosuppressive therapy, changes in the population at risk and the use of broad spectrum antibiotics leading to a spectrum of multidrug resistant pathogens, which contributed to the evolution of the problem of nosocomial infections (3). We conducted this study to estimate the rate of nosocomial infections in the ICU in a teaching hospital, the risk factors associated with Nis and to detect the nosocomial bacteria and their antibiotic susceptibility patterns.

Material and Methods


Materials and Methods
This study was conducted over a period of 18 months in the ICU of a tertiary care hospital from South India. (495 beds with 10 beds for medical ICU). The infections were considered to be intensive care unit associated, if they occurred within 48 hours of admission to the ICU. The following signs and symptoms were considered
1. Fever ≥ 380C leukocytes ≥10,000/cu.mm
2. New infiltrates on chest x-ray, persistent tracheal aspirates or secretions
3. Turbid urine, suprapubic tenderness, dysuria and burning micturition were included in the study.
The known risk factors like the duration of ICU stay, mechanical ventilation and catheterization, the use of broad spectrum antibiotics and immunosuppressive drugs and the extremes of age and pre existing diseases were recorded.

The specific site related investigations included blood cultures and the cultures of intravenous catheter tips, urine and indwelling catheter tips, endotracheal tube tips, suction catheter tips and endotracheal secretions. The bacterial profiles and antimicrobial susceptibility were studied. The blood cultures and the sensitivity of the patients with suspected catheter sepsis were performed by a Semi automated Bac T /Alert system. The cultures of intravenous catheter tips (peripheral and central) were performed by the semi quantitative method of Maki et al (4) and bacterial growth with 15 or more colonies were considered as positive.

Purulent secretions from endotracheal tubes with a gram stain showing one or more types of bacteria and more than 25 neutrophils per low power field were selected for culture and growth. CFUs Âł107 were considered as significant (5).

Urine samples were collected from the catheters and were cultured by a semi quantitative method by using a calibrated 4 mm diameter loop. The growth of bacteria in counts ³105 CFU/ml was considered as significant (6). The susceptibility of the organisms to various antibiotics was tested by using a modified Kirby – Bauer disk diffusion method and the results were interpreted as per the CLSI guidelines. Methicillin resistance in S.aureus was detected by using the agar screen method (Mueller-Hinton agar supplemented with 4% NaCl and Oxacillin 6µg/ ml) (7).

Environmental sampling was done on a monthly basis from floors, walls, taps, disinfectants, ventilator tubings, suction pumps, oxygen catheters and from the swabs from the anterior nares of the doctors and nurses.

Results

During the 18 month study period, a total of 355 patients were admitted to the ICU, of which 27.4% (97/355) had clinically suspected nosocomial infections. A total of 324 samples were analyzed, which included 97 intravenous catheter tips and blood cultures each, 67 urine samples, 8 Foley’s catheter tips, 49 ET aspirates and 6 ET tips. Significant growth was observed in 154 samples (47.5%) (Table/Fig 1).
Among the catheter related infections, UTI was the most common infection (55.52%), followed by Ventilator associated pulmonary infection (35.78%) and IV Catheter related infection (11.52%). Three patients had both pneumonia and probable catheter related bacteraemia.

51 patients had some sort of altered immune status (HIV positive - 6, prolonged steroids - 3, Diabetes mellitus -21, Chronic obstructive lung diseases- 9 , autoimmune diseases- 6 and broad spectrum antibiotics-5), which was statistically significant (P ≤ 0.05) . 85. 65% of the patients developed nosocomial infections after 96 hours of stay in the ICU, thus proving that the longer the stay in ICU, the higher the risk of NIs (P ≤ 0.05). Klebsiella pneumoniae was the most common pathogen (38.41%), followed by Staphylococcus aureus (23.37%) (Table/Fig 2).
We attempted to correlate the organisms which were isolated, with the antibiotic sensitivity pattern, so as to formulate antibiotic protocols. K. pneumoniae was most sensitive to Imipenem and Amikacin. 41% of S.aureus isolates were methicillin resistant S. aureus (MRSA) and these strains were found to be sensitive to Vancomycin. (Table/Fig 3) K. pneumoniae had the maximum sensitivity to Imipenem and Amikacin and Pseudomonas aeruginosa had the maximum sensitivity to Imipenem and Ceftazidime. (Table/Fig 4).Exogenous sources from the environment: out of the 120 samples, we isolated 60 organisms (50%). S.aureus was the most commonest organism (28), followed by K. pneumoniae (10), P.aeruginosa (10) Acinetobacter spp (6) S. epidermidis (4) and Enterococus spp (2)

Discussion

Health care – acquired infections have been associated with substantial morbidity,mortality and increased health care costs. An integrated infection control program can reduce the incidence of infection by as much as 30% and reduce the health care costs.

The high rate of nosocomial infections observed in the present study could be due to different clinical profiles of our patients and the absence of a powerful hospital acquired infection control program.

K. pneumoniae and P. aeruginosa were the commonest causes of respiratory infections and urinary tract infections. These findings were comparable to the observations of previous workers (8). The environmental sampling of the ICU showed the predominance of K.pneumoniae and P. aeruginosa strains.
Catheter colonization and catheter related bacteraemia rates vary widely. The catheter colonization rate was found to vary from 5% to 61% and the catheter related bacteraemia rate was found to vary from 2% to 43% (9). In the present study, the rates of catheter colonization and catheter related bacteraemia were 52. 57% and 11.52% respectively, which were rather high. A previous study carried out at AIIMS, Delhi, showed a 17.27% rate of catheter related sepsis (10). The high rate of IV catheter sepsis observed by us may be due to the multipurpose use of a single lumen catheter with a three way connection and the lack of a specialized IV catheter care team. The commonest organisms which were found to be colonizing the catheter and causing bacteraemia were S.aureus (43.54%) and Candida spp. (24.19%). These results are consistent with the findings of a previous study (11). S.aureus colonizes the anterior nares of healthcare personnel and such carriers are important sources of infections. The present study showed that 25.45% of the healthcare personnel are carriers of MRSA. In the current study, K.pneumoniae and S.aureus (41% MRSA) were the predominant isolates. Studies showed that the nosocomial pathogens were probably unique to each ICU (8). The standard of the practices followed in the ICUs could have contributed to the nature of the flora and the infection rate. There was an alarming increased incidence of NIs caused by multi drug resistant gram negative bacilli and MRSA in our study, which was consistent with a previous study (8).

The present study on the microbiological profiles of the nosocomial infections showed that the rate of NIs is high, even though it was within the reported range. The risk of the development of NIs was directly related to the duration of ICU stay and the duration of the use of the indwelling catheters/tubes. The prolonged use of indwelling devices need careful prophylactic standards of microbiological monitoring. The empirical and the indiscriminate use of antibiotics should be avoided in order to curtail the emergence and the spread of drug resistance among nosocomial pathogens. This study gives an insight into the incidence of NIs and helps in instituting various interventional strategies to prevent these infections.

References

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1. Akash Deep, R. Ghildiyal, S. Kandian , N. Shinkre. Clinical and Microbiological Profile of Nosocomial infections in the Pediatric intensive care Unit. Indian Pediatr 2004;41:1238- 1246.
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2. Rosenthal VD, Maki DG, Salomao R, Moreno CA, Mehta Y,et al. Device – Associated Nosocomial Infections in 55 Intensive care units of 8 Developing Countries. Ann Intern Med. 2006;145:582-591
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Tullu MS, Deshmukh CT, Baveja SM; Bacterial profile antimicrobial susceptibility pattern in catheter related nosocomial infections. J Postgrad Med Sciences 1998;44:7-13
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4. Maki DG, Weize CE, Sarafin HW. A semiquantitative culture method for identifying intravenous catheter related infection. N. Engl. J. Med. 1977;296:1305-1309
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5. Albert S, Kirchner J, Thomas H , Behne M, Schur J, Brade V et al. Role of quantitative cultures and microscopic examinations of endotracheal aspirates in the diagnosis of pulmonary infections in ventilated patients. J Hosp Infect 1997;37:25-37.
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Koneman EW, Allen SD, Janda WM, Schreckenberger PC, Winn, Jr. WC.Color atlas and textbook of diagnostic microbiology 5th ed. Lippincot, Philadelphia, 1997, PP139-140.
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Isenberg HD. Essential procedures for Clinical Microbiology ASM Press. Washington DC,1998,pp232-234.
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Supaletchimi Gopal Katherason, Lin Naing, Kamaruddin Jaalam, Asma Ismail. Baseline assessment of intensive care – acquired nosocomial infection surveillance in three adult intensive care units in Malaysia. J Infect Developing Countriesa 2008;2:364-368.
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Shukla NK, Das DK, Deo SV, Raina V. An analysis of long-term venous access catheters in cancer patients:experience from a tertiary care centre in India. J Postgrad Med 2002;48:21-4.
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Sachdev A, Gupta D, Soni A,Chugh K. Central Venous Catheter Colonisation and related Bacteremia in Pediatric Intensive Care Unit. Indian Pediatrics 2002:39:752 -760.
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Bouza E, Burillo A, Monoz P. Catheter – related infections: diagnosis and treatment. Clin Microbiol Infect 2002; 8: 265-74

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