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Team:IIT Roorkee/Integrated HP

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Integrated Human Practices

Dr. Nand Kishore Joshi

Dr. NandKishore Joshi
Dr. Nand Kishore Joshi
ICU specialist (COVID-19 Centre)
in Jaipur Rajasthan
DESCRIPTION:

Provided insights on the situation of AMR infections inside the ICU during the COVID-19 and also helped us get acquainted with the main barriers and challenges in combating or de-accelerating the problem of Antibiotic Resistance.


The inspiration: of choosing A. baumannii

Whenever a person is admitted to an ICU and put on any open tube system like Cannula (a central line put in veins to deliver drugs), Catheter, Ventilators; there are significant chances of developing infections, out of which 40-60% are MDR. The leading pathogens currently are: A.baumannii, Pseudomonas, Klebsiella, E.coli. For A. baumannii infections or colonisers, colistin, polymyxin and ampicillin are frequently administered.


Antibiotics continue to be overused in the Indian Hospitals

He explained that the following principles should be considered when antibiotics are administered:

  • Rationalised
  • Dose Adequate
  • Timely De-escalation
  • Specific
  • Dose Duration

Inside the ICUs, the chances of cross infections are extremely high and in India the prime reason for infection spread and propagation is poor hand hygiene and irrational prescription.


COVID-19 Complications:

The COVID-19 patients are admitted to hospitals/ICUs only in the cases when they have some comorbidities like immunocompromised, diabetes, renal infection etc. Such conditions already increase their chances of infections by opportunistic bacteria. After an attack by the virus, our body releases inflammatory mediators to treat the virus but this results in a cytokine storm which attacks our own body and causes multi organ failure.

Currently, severe covid cases are treated by Tocilizumap, Steroids, Dexamethasone, Hydrocortisone etc. These are IL-6 antagonists and suppress the immune response for COVID regulation. But due to these drugs, the person becomes more susceptible to deadly bacterial infections which are mostly XDR/MDR inside the ICU.

We understood how complex and sensitive the situation is and the pandemic brought this issue in the forefront. The drug-resistant bacteria have been generated and continue to grow due to our irresponsible antibiotic usage.








Dr. Rajesh Kulkarni

Interviewee Name
Dr. Rajesh Kulkarni
Dept.of Pediatrics B.J. Govt.
Medical College, Pune Maharashtra,
India
DESCRIPTION:

Research Profile on Ventilator-Associated Pneumonia in Children Admitted to Pediatric Intensive Care Unit of a Tertiary Care Center in India.


Team iGEM IIT Roorkee is working on Hospital-acquired infections (HAIs) inspired from the current situation of hospitals due to the spread of coronavirus. The hospitals are much more crowded than before which increases the susceptibility of disease transmission in patients. Analyzing the condition and to gain more knowledge on HAIs, our team decided to have a detailed discussion with Dr. Rajesh Kulkarni - a pediatrics specialist. During the interview, Dr. Kulkarni enlightened us about Ventilator-Associated Pneumonia (VAP), a considerable contributor to HAIs. He says VAP continues to be a significant threat to patients who are admitted for mechanical ventilation into the critical care unit, emphasizing the urgent need for infection control measures.


Limited literature is available on VAP in children, mainly in India. Hence, our team aims to determine the incidence, clinical laboratory, radiological and microbiological profile, risk factors, and outcomes of ventilator-associated pneumonia in pediatric patients. He also tells us about his research study on Ventilator-Associated Pneumonia in Children. According to his research, early VAP incidence is 27.6%, while late VAP is 75%. The primary risk factor for the incidence of VAP in this study was the duration of ventilation. Dr. Kulkarni describes the most common VAP pathogen as Acinetobacter species bacteria. Tracheostomized children have a higher incidence of VAP but have higher recovery rates. At the same time, he also suggests POC (Point-of-care) test kit, early diagnosis method, and human practices by making more people aware of Ventilator-Associated Pneumonia in the hospital and among the country's population would be the best strategies to take up the challenges associated with hospital-acquired infections.


This interview proved to be a breakthrough point for our team. We got the right direction to work in and develop antimicrobial proteins as an attempt to cure the disease.




Research Paper

Profile of Ventilator Associated Pneumonia in Children Admitted to Pediatric Intensive Care Unit of a Tertiary Care Center in India

(Asha PT, Kulkarni R., Kinikar A., Rajput U., Valvi C., Dawre R.)








Dr. Anand Raman Tiwari

Interviewee Name
Dr. Anand Raman Tiwari
Intern
GMC Amritsar
DESCRIPTION:

Being an Intern, Dr. Anand Raman Tiwari during his clinical postings in all departments from Internal Medicine, Surgery, Pediatrics, NICU to ICU etc., has witnessed HAI in hospital, our team decided to interview Dr. Anand to gain insights on Antimicrobial Resistance as a health issue


Dr. Anand told us that physicians generally observe that the patients suffering from HAIs have a bacterial presence in their bodies. One of the reasons is that the majority of the Indian population prefers going to government hospitals instead of private ones due to financial instabilities, but unfortunately, government hospitals in India lack proper sanitation and hygiene. In fact, in government hospitals there are times when antiseptic conditions are not well maintained because of the huge influx of patients. Most of the patients prefer self medication or medicines as advised by local quacks, so by the time a rural patient reaches government hospital, he has developed AMR. Every year WHO runs a campaign of Antimicrobial Awareness Week which aims to increase awareness of global antimicrobial resistance as it (AMR) is creating ‘superbugs’ that makes treating basic infections difficult (and in some cases impossible) and surgery risky. It’s a high time that we need to educate the general public so they don’t fall prey to Quacks and Self-Medication.


Dr. Anand Tiwari also enlightened us on how Indian doctors have made a policy to ease their work. They prescribe antibiotics for every infection without considering the consequences or even diagnosing it properly. For instance, doctors prescribe amoxiclav, and sometimes, people even self medicate themselves without knowing the consequences. Working on the situation, Dr. Tiwari suggested that we look into the governance of AMR in hospitals due to its greater extent in mortality rate.




Message

Being a developing country, the Indian administration should get more involved in society to promote awareness and understanding of Antimicrobial Resistance. The need of the hour is a greater responsibility of the general public towards Healthcare.








Clemedi

Interviewee Name
Dr. Prajwal
Chief Security Officer, Clemedi
Interviewee Name
Dr. Sebastian Dümcke
Chief Executive Officer, Clemedi


Clemedi provides complete information about diagnosis and treatment of diseases to clinicians. It renders comprehensive information more quickly, leading to faster, targeted therapy, thus creating value. It will massively reduce the cost of infectious diseases to patients, families, carers, and society. It will revolutionize diagnostics and ultimately facilitate the end of antibiotic misuse.


We aimed to study the protein mechanisms and use machine learning in our project. We decided to meet with Clemedi, where they develop in vitro diagnostic tests for infectious diseases, by uniting two novel technologies - Next Gen Sequencing and Machine learning.



The interview with Clemedi held in two phases:

1. The first phase focused on designing the protein. Dr. Prajwal suggested us to combine our designed protein with the FC (Fragment, crystallizable) part of the antibody. The FC part is the fragment crystallization tail part of the antibody, and it interacts with the FC surface receptors. So it will have a sort of dual killing effect. The FC chains will then direct the immune cells to clear the protein after it's killed. It will lead to much better efficacy of our drug. Dr. Prajwal told us that due to less available data and literature on A. baumannii, Machine Learning would be challenging to work with. Also, he mentioned that a considerably huge protein like ours could not be modeled easily, let alone extracting MD Simulations. The team worked on the suggestions and scheduled a second meeting to discuss the progress.


2. In our second phase of the meeting, we conceptualized a therapy for the post-antibiotic world and proposed a paradigm shift aimed at developing narrow-spectrum therapeutics. We also got to draw a visual representation of our Pyomancer designer proteins using different Bioinformatics tools. We gained knowledge about modeling, machine learning, and the possible target research group like hospitalized patients. This undoubtedly helped us build upon our project.