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Aug 2018

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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)
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.
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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.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : DD01 - DD03 Full Version

Ochrobactrum intermedium Bacteraemia in COVID-19 Positive Patients: Case Report of Rare Co-infection from Northern India

Published: May 1, 2022 | DOI:
Tasneem Siddiqui, Rafat Shamim, Sangram Singhpatel, Chinmoy Sahu, Mitra Kar

1. Senior Resident, Department of Microbiology, SGPGIMS, Lucknow, Uttar Pradesh, India. 2. Assistant Professor, Department of Anaesthesiology, SGPGIMS, Lucknow, Uttar Pradesh, India. 3. Assistant Professor, Department of Microbiology, SGPGIMS, Lucknow, Uttar Pradesh, India. 4. Associate Professor, Department of Microbiology, SGPGIMS, Lucknow, Uttar Pradesh, India. 5. Senior Resident, Department of Microbiology, SGPGIMS, Lucknow, Uttar Pradesh, India.

Correspondence Address :
Dr. Chinmoy Sahu,
Associate Professor, Department of Microbiology, SGPGIMS, Lucknow, Uttar Pradesh, India.


Ochrobactrum intermedium (O. intermedium) is a novel emerging gram negative bacillus infecting immunocompromised hosts. It is known for its multidrug resistance and to distinguish it from other species of Ochrobactrum genus by conventional methods, is often difficult. Here, authors report two unusual and interesting cases of bacterial infection due to O. intermedium in a 28-year-old female and 46-year-old male having Coronavirus Disease-2019 (COVID-19) infection. Rapid identification by Matrix Assisted Laser Desorption/Ionisation-Time Of Flight (MALDI-TOF) mass spectrometry and patient’s treatment guided by antibiotic sensitivity yielded in favourable outcome. Present report describes clinical and microbiological characteristics of this rare pathogen and also highlights the need of automated methods for proper identification of such opportunistic pathogens and their unique antibiotic susceptibility profiles.


Antibiotic sensitivity, Bacillus, Coronavirus disease 2019

Case Report

Case 1

A 28-year-old female with type 2 diabetes presented with low grade fever, cough with productive and exertional breathlessness for four days and a positive Reverse Transcription Polymerase Chain Reaction (RT-PCR) for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and was admitted in the isolation ward of the centre. X-ray chest and High-Resolution Computed Tomography (HRCT) (Table/Fig 1) (patient-1) thorax was done which showed evidence of COVID-19 pneumonia with severity scoring of 11/25, so the patient was started on oxygen supplementation (16 L/Min) by non rebreathing mask along with antibiotics, remedesivir and injectable dexamethasone. Due to worsening of sugar control (fasting >250 mg/dL) with deterioration of sensorium and breathlessness, the patient had to be intubated subsequently. She was found having Diabetic Ketoacidosis (DKA) when history revealed and insulin infusion and fluids were started. The patient developed signs of sepsis on the 10th day, hence, paired blood culture were sent for microbiological sudy in BACTEC bottles (aerobic and anaerobic). The blood culture bottles flagged positive after 24 hours of incubation and gram negative bacilli was seen with direct gram stain which was then subcultured on blood and MacConkey agar plates (Table/Fig 2). Non lactose fermenting colonies grew on culture which were catalase and oxidase positive and were identified as Ochrobactrum intermedium by MALDI-TOF mass spectrometry. Antibiotic Susceptibility Testing (AST) of the isolate performed by VITEK 2 system (Biomerieux, France) showed it to be susceptible to ciprofloxacin, levofloxacin, cotrimoxazole, aminoglycosides, minocycline and carbapenems but was resistant to penicillin, cephalosporins and colistin (Table/Fig 3). Repeat blood cultures also isolated O. intermedium with similar antibiogram. She was treated with amikacin and meropenem for next 14 days following and her repeat blood cultures became sterile and patient was then discharged in stable condition. On 7th day of follow-up in outpatient department, patient was healthy with controlled blood sugar levels.

Case 2

A 46-year-old male presented with the complaints of low grade fever, cough with productive sputum and exertional breathlessness for 15 days with a positive RT-PCR for SARS-CoV-2. He was admitted in the isolation ward of the centre. His SpO2 (oxygen saturation) was around 95% so he was started on medications like azithromycin, paracetamol and antihistaminic. In spite of the ongoing treatment, his symptoms worsened over the next two days. Routine blood investigations revealed: Haemoglobin (11 g/dL), blood sugar (HbA1c=6.2%, prediabetic), lymphopenia (600 cells/μL), and raised C-reactive protein (CRP=10 mg/dL) and procalcitonin levels (>2 mg/dL). Radiological workup was planned on the same day and a HRCT revealed ground-glass opacities on both the lung fields (Table/Fig 1), patient-2). The patient was diagnosed as a case of COVID-19 pneumonia. Steroids and low molecular weight heparin was added to the treatment regimen with regular sugar monitoring. Over the next four days, the patient clinically deteriorated and the SpO2

(oxygen saturation) dropped to 85% with room air, so, the patient was subsequently started on oxygen with nasal cannula. Various biomarkers including CRP (96 mg/dL), lactate dehydrogenase (LDH=360 U/L), D-dimers (>1), and ferritin levels (1224 ng/mL) were increased significantly. On the 12th day, the patient started to show signs of sepsis and hence, blood culture was sent to the microbiology laboratory in a pair of BACTEC bottles. Microbiological identification and AST were done similar to case 1 (Table/Fig 3). Final identification was O. intermedium with similar AST as case 1. Repeat blood cultures showed growth of O. intermedium with similar antibiogram. After treatment with amikacin and imipenem for 10 days, repeat blood cultures became sterile. The patient was discharged in stable condition. On 8th day of follow-up visit in outpatient department, the patient was healthy and maintaining SpO2 (oxygen saturation) of around 98%.


Ochrobactrum spp. is a gram negative, non lactose fermenting, aerobic bacilli belonging to the Brucellaceae family (1). Other than genus Ochrobactrum, mainly three species, have been isolated and identified from the respiratory and blood samples (O. anthropi, O. intermedium, and O. pseudointermedium). O. intermedium is a novel emerging opportunistic nosocomial pathogen which is often difficult to differentiate from other Ochrobactrum spp. by conventional methods and has been rarely reported in the literature (2). Its treatment is challenging as it is notorious for its multidrug resistance (3).

The COVID-19 pandemic has led to the emergence of bacterial co-infections in these hospitalised patients as these patients were on immunosuppressive agents like steroids. As per report from Washington DC, United States this bacterial co-infection rate was 4.8% (4). Lansbury L et al., in their meta-analysis, reported a bacterial co-infection rate of around 6.8% in hospitalised COVID-19 cases (5). Gram-negative bacilli found in the majority in these co-infection groups (4),(5). However, there are very few case reports of O. intermedium bacteraemia in literature (3). First case of O. intermedium liver abscess associated with bacteraemia was reported by Mo¨ller LV et al., in 1999 in pateint with post liver transplantation who was successfully treated with imipenem and aminoglycosides (6). Later nine more cases have been reported worldwide till date (3). Infections by O. intermedium in immunocompromised cases give rise to

liver abscess, infective endocarditis and prostatic abscess (3). However, there were two cases reporting that O. intermedium caused endophthalmitis and pelvic abscess in immunocompetent hosts (3). Of the nine cases, eight patients were male and five patients had bacteraemia, two of whom were related with catheters (3). This was the first case report of bacteraemia by O. intermedium in COVID-19 pneumonia patient. The isolation of these isolates could be because both patients had COVID-19 pneumonia for which they were receiving steroids and first patient had uncontrolled diabetes and second patient was in a prediabetic stage so chance of bacterial co-infection was high in index patients. Biochemicals that are commonly used, are not able to differentiate O. intermedium from other Ochrobactrum species but it can be accurately identified by molecular methods such as 16S Recombinant Deoxyribose Nucleic Acid (rDNA) gene sequencing, MALDI-TOF mass spectrometry and recA-PCR Restriction Fragment Length Polymorphism (RFLP). Although 16S rDNA gene sequencing is considered as the gold standard method for speciation but have high cost and lack of availability. MALDI-TOF is used alternatively to gene sequencing exhibiting reliable tool in identification of isolates (7),(8),(9). In preset study, isolates were promptly identified with the MALDI-TOF MS. It is resistant to multiple families of antibiotics such as ß-lactum including penicillins, cephalosporins, and sometimes carbapenems, hence treatment is challenging but maximum isolates of O. intermedium are susceptible to carbapenems, aminoglycosides, trimethoprim-sulfamethoxazole and fluoroquinolones [6,8,10-12]. In present study, both isolates were susceptible to fluoroquinolones, cotrimoxazole, aminoglycosides, minocycline and carbapenems but was resistant to penicillin, cephalosporins and colistin. As per AST, both the patients were treated successfully with carbapenem and aminoglycosides.

Informed consent was obtained from both the patient regarding the publication of images and clinical information in the journal.


Here, the first case of bacteraemia by O. intermedium in COVID-19 pneumonia patients were reported. MALDI-TOF mass spectrometry could be helpful in rapid identification of O. intermedium. Rapid diagnosis with timely management is a necessary to clear infection caused by this multidrug resistant pathogen.


Mudshingkar SS, Chore AC, Palewar MS, Doha VB, Kigali AS. Ochrobactrum anthropi: An unusual pathogen: Are we missing them. Indian J Med Microbiol 2013;31:306-08. [crossref] [PubMed]
Wu W, Jiang Y, Zhou W, Liu X, Kuang L. The first case of Ochrobactrum intermedium bacteremia in a pediatric patient with malignant tumor. BMC Infect Dis. 2021;21(1):1252. [crossref] [PubMed]
Aujoulat F, Romano-Bertrand S, Masnou A, Marchandin H, Jumas-Bilak E. Niches, population structure and genome reduction in Ochrobactrum intermedium: Clues to technology-driven emergence of pathogens. PLoS ONE. 2014;9(1):e83376. [crossref] [PubMed]
Arentz M, Yim E, Klaff L, Lokhandwala S, Riedo FX, Chong M, et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. JAMA. 2020;323(16):1612-14. [crossref] [PubMed]
Lansbury L, Lim B, Baskaran V, Lim WS. Co-infections in people with COVID-19: A systematic review and meta-analysis. J Infect. 2020;81(2):266-75. [crossref] [PubMed]
Möller LV, Arends JP, Harmsen HJ, Talens A, Terpstra P, Slooff MJ. Ochrobactrum intermedium infection after liver transplantation. J Clin Microbiol. 1999;37:241-44. [crossref] [PubMed]
Rodriguez-Villodres A, Cuevas Palomino A, Gomez Gomez MJ. Usefulness of MALDI-TOF mass spectrometry in infections by infrequent microorganisms such as Ochrobactrum intermedium. Med Clin (Barc). 2016;147:277-78. [crossref] [PubMed]
Ryan MP, Pembroke JT. The genus Ochrobactrum as major opportunistic pathogens. Microorganisms. 2020;8:1797. [crossref] [PubMed]
Kampfer P, Citron DM, Goldstein EJC, Scholz HC. Difficulty in the identification and differentiation of clinically relevant Ochrobactrum species. J Med Microbiol. 2007;56:1571-73. [crossref] [PubMed]
Appelbaum PC, Campbell DB. Pancreatic abscess associated with Achromobacter group Vd biovar 1. J Clin Microbiol. 1980;12:282-83. [crossref] [PubMed]
Cieslak TJ, Drabick CJ, Robb ML. Pyogenic infections due to Ochrobactrum anthropi. Clin Infect Dis. 1996;22:845-47. [crossref] [PubMed]
Kern WV, Oethinger M, Kaufhold A, Rozdzinski E, Marre R. Ochrobactrum anthropi bacteremia: Report of four cases and short review. Infection. 1993;21:306-10. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/55370.16388

Date of Submission: Jan 31, 2022
Date of Peer Review: Feb 22, 2022
Date of Acceptance: Mar 30, 2022
Date of Publishing: May 01, 2022

• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

• Plagiarism X-checker: Feb 05, 2022
• Manual Googling: Mar 29, 2022
• iThenticate Software: Apr 29, 2022 (18%)

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