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On Sep 2018




Prof. Somashekhar Nimbalkar

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Prof. Somashekhar Nimbalkar
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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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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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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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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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Professor and Head
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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,
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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
Anuradha

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
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Case report
Year : 2023 | Month : June | Volume : 17 | Issue : 6 | Page : DR01 - DR04 Full Version

Obstructive Uropathy Caused by Chryseobacterium indologenes : A Case Series from University Hospital, Uttar Pradesh, India


Published: June 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/62482.18085
Akanksha Dubey, Mitra Kar, Tasneem Siddiqui, Chinmoy Sahu

1. Senior Resident, Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. 2. Senior Resident, Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. 3. Senior Resident, Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India. 4. Additional Professor, Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

Correspondence Address :
Dr. Chinmoy Sahu,
Additional Professor, Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, 2nd Floor, C-Block, Lucknow, Uttar Pradesh, India.
E-mail: csahu78@rediffmail.com

Abstract

Chryseobacterium spp., is non motile, non fermenter, Gram Negative Bacillus (GNB) showing enzymatic activity of catalase, oxidase, and indole production. Chryseobacterium spp. are found widely in the soil and aquatic milieu. It is also capable of surviving in chlorinated water, which can be attributed to the spread of infection in hospital settings hosting profusely immunosuppressed individuals. Newer diagnostic modalities like Matrix-Assisted Laser Desorption Ionisation-Time Of Flight-Mass Spectrometry (MALDI-TOF-MS) and Vitek-2 facilitate early identification and treatment can alleviate the infections caused by them. Present series discusses three cases of Chryseobacterium indologenes (C. indologenes) Urinary Tract Infection (UTI) Case 1- was a 61-year-old hypertensive and diabetic male patient diagnosed with renal failure with pyelonephritis. Case 2- was a female patient of 64-year-old with left upper ureteric calculus. Case 3- was a 31-year-old male patient having left mid ureteric calculus. All the patients were catheterised with a urinary catheter and developed UTI by C. indologenes. C. indologenes infection in UTI patients is uncommon but these cases of complicated UTIs demonstrate C. indologenes as a potential cause of UTI in hospitalised patients using invasive equipment like urinary catheters. As the organism was Multidrug-Resistant (MDR), appropriate antibiotic treatment and accurate identification can alleviate infection by this organism.

Keywords

Gram negative bacillus, Immunosuppressed individuals, Multidrug resistance, Urinary catheterisation, Urinary tract infection

Chryseobacterium indologenes comes under the genus Chryseobacterium (it was previously categorised as Flavobacterium CDC group IIb). It is a non motile and non fermenting bacterium, showing enzymatic activity of catalase, oxidase, and indole production (1). This organism is widely distributed on plants, soil, and water but human infections are very rare (1). The organism can colonise water supplies because of its ability to survive in chlorine-treated waters; thus the hospital water supply can act as the reservoir for these infections (2). Although generally found in soil, plants, and water bodies it does not exist as a commensal on human body (3).

Liquid medium supports the growth of the microorganism, so it can grow well in hospital settings, particularly from sinks, feeding tubes, vials, indwelling vascular catheters, and equipment that are in contact with fluids, water, and even liquid disinfectants which act as a supporting niche for the growth of C. indologenes (4). Human diseases are uncommon with C. indologenes. Immunocompromised patients are at a higher risk rather than immunocompetent individuals for C. indologenes infections. Hospital stay for longer duration with indwelling devices, and antibiotics therapy for prolonged durations is also risk factors that can contribute to its infection (5).

As Chryseobacterium is a rare pathogen that can cause infection, very few cases have been reported of urine infections caused by Chryseobacterium spp. Here, three cases are reported who had obstructive uropathy admitted to the hospital, as during the stay they developed complicated UTIs caused by C. indologenes.

Case Report

Case 1

A 61-year-old male patient, follow-up case of advanced renal failure with type 2 diabetes mellitus and systemic hypertension presented to the medicine outpatient department with chief complaints of high-grade fever and chills, vomiting, and progressive leg swelling for two months and diagnosed as an advanced renal failure with acute pyelonephritis. He had a previous history of admission and haemodialysis in the hospital seven days earlier, his blood investigations reported haemoglobin of 8.4 mg/dL, Total Leukocyte Count (TLC) 17400 cells/ cubic mm with 90% polymorphs and 10% lymphocytes, serum creatinine 8.36 mg/dL, uric acid 8.6 mg/dL.

Urine routine microscopy showed 11-12 pus cells/HPF and a few RBC/high power fields with bacteriuria. A urine sample was sent to the bacteriology section, Department of Microbiology, for culture and sensitivity. The sample was inoculated on Blood agar and MacConkey agar and subjected to overnight incubation at 37ºC.After complete incubation, colonies observed only on blood agar were dark yellow in colour, 1-2 mm in diameter and non haemolytic, (Table/Fig 1). From the blood agar colony, a Gram-stained smear was prepared which showed gram-negative bacilli (Table/Fig 2). After performing the motility and biochemical characteristics test, the following results were observed: non motile bacilli, catalase-positive, oxidase-positive, and indole were produced in tryptophan broth, urease was not produced and citrate not utilised. Finally, for confirmation and identification of bacteria, the flexirubin type of pigment was confirmed by adding 1 drop of 10% KOH solution to colonies giving a red to pink colour (Table/Fig 3) and MALDI-TOF-MS were performed and the organism was identified as C. indologenes by both routine method and proteomics. Antibiotic Sensitivity Test (AST) was performed by the Kirby-Bauer disc diffusion method on Muller-Hinton Agar (MHA) according to the CLSI guidelines (6) and the organism was sensitive to doxycycline, minocycline, cotrimoxazole, levofloxacin and it was resistant to piperacillintazobactam, and ciprofloxacin. Based on the culture and sensitivity report, patient was given intravenous (i.v.) levofloxacin.

The patient was earlier administered i.v. meropenem by the clinician, but was started on i.v. levofloxacin after antibiotic susceptibility testing and the same continued for five days. His fever subsided within two days, sugar was controlled with insulin according to a sliding scale. His urine output was 2.5 liters/day and after 5 days of i.v. treatment with levofloxacin, he was discharged on oral levofloxacin 400 mg BD. After 14 days, the patient presented to the nephrology outpatient department for routine follow-up and due to persisting high creatinine levels of 7.4 mg/dL was advised to undergo Continuous Ambulatory Peritoneal Dialysis (CAPD).

Case 2

A 64-year-old female patient was admitted to the Department of Emergency medicine with a chief complaint of bilateral flank pain for the past six months, which was associated with nausea but not associated with any lower urinary tract symptoms, haematuria, turbiduria, or urinary retention. In the course of her hospital stay, she was diagnosed with Pelvic Ureteric Junction (PUJ) calculus with left upper ureteric calculus on ultrasound of the kidney and urinary bladder region (Table/Fig 4). Bilateral Percutaneous Nephrostomy (PCN) insertion was done under interventional radiology on day of admission. The daily output was from the right PCN 1400 mL and the left PCN 800 mL; bilateral PCN culture sensitivity was done and it was sterile.

But after seven days of admission, the patient developed a high-grade fever with decreased output from the right PCN and his TLC was 18800 cells/mm3 with increased polymorphs. On examination, there was a right, the PCN per catheter leak. PCN urine sample was sent to the bacteriology section, Department of Microbiology and was inoculated in routine culture media. A Gram-stained smear was prepared from the colonies on blood agar which were 1-2 mm in diameter accompanied by production of yellow to orange pigmentation on blood agar and were gram-negative bacilli; further motility test was performed to observe non motile bacterium and routine biochemical identification was performed along with MALDI-TOF-MS and the organism was identified as C. indologenes both routine method and proteomics. Using AST and Kirby-Bauer disc diffusion method, the organism was sensitive to doxycycline, minocycline, cotrimoxazole, levofloxacin, and ciprofloxacin, while it was resistant to piperacillin, tazobactam, and cefoperazone-sulbactam. Based on the AST results, i.v. ciprofloxacin 400 mg was prescribed every 12 hours for five days and the patient improved symptomatically after this particular treatment. Interventional radiology was used to reposition the right nephrostomy tube. Urine output increased after repositioning of the PCN. On repeat, bilateral PCN culture and sensitivity, urine was sterile. She underwent antegrade urolithotripsy and left mini Percutaneous Nephrolithotomy (PCNL) under general anaesthesia after 15 days of PCN insertion. Bilateral PCN was clamped on the 4th postoperative day and bilateral PCN removed on the 7th day postsurgery. The patient was afebrile and discharged in a stable condition with advice to follow-up in seven days. After 21 days, the patient came back to the urology outpatient department for a routine check-up and his urine output was 3 L/day along with no pain in the flanks with no sign of infection. It was observed on routine blood investigations and urine culture results were also sterile.

Case 3

A 31-year-old male patient presented to our hospital with chief complaints of bilateral flank pain, dysuria, vomiting, and haematuria for the last 15 days. The patient had a history of a renal stone disease diagnosed two years back and was on homeopathic treatment. On evaluation by ultrasound of the kidney and urinary bladder region, the patient had bilateral renal stone disease with left hydroureteronephrosis, left mid-ureteric calculi with multiple bilateral cysts (Table/Fig 5) along with anaemia and advanced renal failure. On examination he was afebrile with a pulse rate of 98/minutes and blood pressure 160/100 mmHg. Laboratory investigations revealed haemoglobin as 8.2 mg/dL, total lymphocyte count 13,500 cells/mm3, blood urea 45 mg/dL and serum creatinine elevated level of 4.7 mg/dL. The patient developed fever chills and rigors and back pain after four days of admission. Urine routine microscopy showed 11-12 pus cells/HPF and a few RBC under high power magnification, with bacteriuria. A urine sample was sent to the bacteriology section, Department of Microbiology, for culture and sensitivity. Routine processing of the sample was performed. The microorganism was subjected to routine biochemicals and MALDI-TOF-MS for identification. Finally, the organism was identified as C. indologenes by both methods. The isolate was sensitive to doxycycline, minocycline, and cotrimoxazole, and levofloxacin and resistant to ciprofloxacin and piperacillin-tazobactam. Based on AST report patient was given i.v. levofloxacin 400 mg eight hourly for five days. Double J stenting was done on the left-side to relieve urinary obstruction and the patient recovered after this treatment. On the repeat, urine sample was collected, microscopy and culture were performed. On microscopic examination, 2-3 pus cells/HPF and urine culture showed no growth. His condition improved subsequently, with adequate urine output and he was discharged on oral levofloxacin 400 mg BD and advised to follow-up after 15 days, to the outpatient department. After one month of DJ stenting, patient came to the outpatient department for follow-up and was advised to do another urine culture which showed no significant growth of microorganisms.

Discussion

The genus Chryseobacterium consists of six species and those that are most commonly isolated from clinical samples include: C odoratum, C. multivorum, while C. meningosepticum, C. indologenes, and C. gleum, and C. breve comes under Group IIb Chryseobacterium spp. (7). The organism can survive in the liquid medium, so through contaminated medical devices, this organism can survive in the patients’ microflora and it may cause infections, fluids which are used in devices such as incubators for newborns, intubation tubes, respirators, humidifiers, syringes, ice chests, has been documented (8). In a study conducted by Bonten MJ et al., a tracheal aspirate sample showed growth of C. indologenes in a ventilator-bound patient (9). In 1996, Hsueh PR et al., studied the prevalence of other Chryseobacterium spp., among hospital-acquired infections, which is more common than C. meningosepticum (Elizabethkingia meningoseptica) (2). Other reported infections include bacteraemia, pneumonia, and meningitis (10). There are a very few cases reported from urine and (Table/Fig 6) shows all cases of C. indologenes UTI reported in the literature (11),(12),(13),(14),(15),(16),(17).

Three cases have been reported by Palewar MS et al., in patients with obstructive uropathy complicated UTIs developed which were caused by C. indologenes (18). The clinical and demographic details of the cases included in present study are discussed in (Table/Fig 7). The diagnostic studies performed on each case during the procedures these patients underwent in the course of the hospital stay is shown in (Table/Fig 8). Many outbreaks of hospital-acquired infections can be attributed to MDR pathogens such as Acinetobacter baumannii, Klebsiella pneumoniae, Escherichia coli, and, Chryseobacterium spp., and the unregulated use of drugs of last resort like colistin and tigecycline (19).

Because of empirical therapy to Gram negative pathogens, there is antimicrobial resistance in this pathogen and it is intrinsically resistant to a variety of antibiotics like aminoglycosides, first-generation cephalosporins, aminopenicillins, aztreonam, carbapenems, and cephalosporins (19). There are additional problems to resolve results of susceptibility testing for Chryseobacterium may differ when different methods are used, and one more problem is that results from Disk Diffusion (DD) methods are not reliable (3). Infection control practices, although highly spoken of, are scarcely practiced in the Indian set-up, which becomes necessary as all the cases in literature previously suffering from, UTI gave a history of urinary catheterisation (11),(14),(15). Of the three cases discussed in present case series, patients from cases 2 and 3 were managed with PCN and DJ-stenting, respectively, which could have been a reason for nosocomial colonisation of C. indologenes. Care bundles, strict handwashing and stringent infection control can prevent the nosocomial spread of infections caused by this rare pathogen.

With respect to the three cases discussed in present case series, urinary drainage of all patients was performed using a urinary catheter, with the length of catheterisation exceeding a week. The presence of indwelling catheters can be attributed to Chryseobacterium UTI as described in a study by Chang YC et al., (5). What differentiates it from a colonisation include the characteristic clinical features and diagnostic parameters that were suggestive of infection. All cases included in present study are excerpts of hospital acquired infection caused by C. indologenes, rarely encountered. Although the source of infection cannot be recognised, but acquisition of MDR by these rare pathogens could lead to outbreaks of nosocomial infections in the respective wards. Infection control is imperative in cases of hospital acquired UTI involving strict adherence to hand hygiene protocols and routine cleaning of the patient stations along with periodic change and cleaning of objects used by patients.

Conclusion

C. indologenes infection in UTI patients is uncommon but these cases of complicated UTIs show that C. indologenes is a leading cause of UTI in hospitalised patients. Thus signifies the role of C. indologenes in infections associated with indwelling urinary catheter. This MDR organism can be identified by MALDI-TOF-MS, administration of appropriate antibiotic treatment and following stringent infection control methods can alleviate spread of infection by this organism in susceptible patients.

References

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DOI and Others

DOI: 10.7860/JCDR/2023/62482.18085

Date of Submission: Jan 03, 2023
Date of Peer Review: Feb 08, 2023
Date of Acceptance: Apr 05, 2023
Date of Publishing: Jun 01, 2023

AUTHOR DECLARATION:
• 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. No

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 04, 2023
• Manual Googling: Feb 15, 2023
• iThenticate Software: Mar 25, 2023 (13%)

ETYMOLOGY: Author Origin

EMENDATIONS: 6

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