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  • Overview
  • Services
  • Doctors
  • International Collaborations
  • Publications
  • Trainings Offered

Overview

The landscape of infectious diseases has been progressively getting complicated over the years. This is because of a multitude of reasons – emerging (new) infectious diseases (like COVID, Zika, Nipah etc.), growing population of immune-suppressed people (due to illness – diabetes or rheumatological diseases, drugs – like steroids and treatments like transplants), rising rates of antimicrobial resistance resulting in difficult to treat bacterial/fungal infections and the exceedingly complex surgical care provided in the hospitals. Even the age old infections like Tuberculosis has evolved as a challenging problem with drug resistance, extra-pulmonary TB and complications from TB and TB therapy.

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The landscape of infectious diseases has been progressively getting complicated over the years. This is because of a multitude of reasons – emerging (new) infectious diseases (like COVID, Zika, Nipah etc.), growing population of immune-suppressed people (due to illness – diabetes or rheumatological diseases, drugs – like steroids and treatments like transplants), rising rates of antimicrobial resistance resulting in difficult to treat bacterial/fungal infections and the exceedingly complex surgical care provided in the hospitals. Even the age old infections like Tuberculosis has evolved as a challenging problem with drug resistance, extra-pulmonary TB and complications from TB and TB therapy.

To navigate this complex landscape, we have unique group of physician-led multidisciplinary team with experience and additional training in handling the different aspects of a wide range of infectious diseases related diagnosis including latest molecular techniques, in-depth knowledge in application of pharmacokinetics/dynamics of antimicrobial therapy (appropriate use of antimicrobials) and the clinical acumen to define and treat as per global evidence based clinical pathways for the infectious syndromes; along with implementation of the infection prevention requirements.

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Services

The ID Department at Aster Medcity is competent in evaluation of a multitude of infectious problems including evaluation of undiagnosed/prolonged fever, complex/multi-system infections, drug resistant infections, sepsis. We adopt a “multi-disciplinary” approach to the syndromic evaluation & management – taking support from senior Physicians, Rheumatologists, Haematologists, Surgeons, Pulmonary Medicine specialists, Cardiologists, Neurologists and Critical Care Experts – to rapidly evaluate the problem, evolve a most cost-effective care plan that will offer the best chance for a comprehensive diagnosis and successful treatment.

We have the support and backup of a “state of art” Microbiology Lab which is capable of routine Microbiological diagnostics, advanced/rapid molecular diagnosis (for specific diseases like pneumonias, brain infections – Meningitis/Encephalitis, and Sepsis – blood stream infection) wherein the possible bacteria/fungus/virus is identified within couple of hours itself so that the effective treatment can be initiated and ineffective therapy discontinued immediately. For common infections like TB and COVID-19 also, we have rapid diagnostics. We also use the best in class microbiological identification systems like MALDI-TOF for accurate identification of the bug that could modify the treatment options.

Out-Patient Services

(Including HIV and second opinion services) – 6 days a week (10 am – 3 pm)

In-Patient Services (including HIV and critical care)

All aspects of management of Infectious diseases in patients admitted under the I.D department as well support the various other departments in the hospital in handling ID and IPC related aspects.

The department offers a spectrum of unique services in management of fever of unknown origin (FUO) including those caused by rare as well as emerging new pathogens, management of multi-drug resistant pathogens through use of the latest molecular diagnostics as well as new (approved) drugs, and also actively support critical care units for management of Sepsis

Adult and Travel related Vaccination (including COVID-19 vaccination)

6 days a week (10 am – 3 pm) – Expanding the spectrum of preventive efforts against infectious diseases by offering the increasing range of effective and approved vaccines to adults including routine recommended influenza vaccine as well as catering to immunization needs of special population such as in pregnancy and in those with compromised immune system.

Also cater to those who are seeking vaccination as a part of meeting mandatory travel requirements to different countries for jobs, training or leisure

Out-Patient Parenteral Antimicrobial Therapy (OPAT)

There are few infectious syndromes that need long term intra-venous antibiotic therapy – like bone & joint infection, infections of the heart valves etc. In today's AMR era, often for routine infections like urinary tract infections, oral antibiotics are no longer viable. In these scenarios, the ID Department develops and coordinates a process where in the intra-venous antibiotic therapy is delivered at the home of the patient. This is through initiation of the long term peripherally inserted central line (PICC) for the patient, choosing the best drug options, coordination of the nurse driven drug administration and safe upkeep of the PICC line.

Antimicrobial Stewardship Program

Supported by Department of Clinical Microbiology and Clinical Pharmacy)

Every patient admitted with Aster Medcity who has been prescribed an antibiotic under the “restricted/watch” category (by World Health Organization) and every patient who has a positive microbiology culture result is reviewed by a clinical ID, clinical Microbiologist and clinical pharmacist at bedside to ensure that the disease, the culture results and the antimicrobial therapy are all aligned and optimised for best outcomes. This is done in close discussion and approval from the primary admitting doctors (“handshake model”) and is also followed by appropriate infection prevention recommendations (integrated model). This input from the AMS team ensures that each patient receives the right antimicrobial, in the right dose/dosing. We also monitor for any adverse effects of antimicrobials in these patients by follow up visits – thus ensuring the concept of patient safety goals.

Doctors

Dr. Anup R Warrier

Senior Consultant-Infectious Diseases
Infectious Anupwarrier

Dr. Arun Wilson

Senior Specialist
Infectious Arunwilson

International Collaborations

  • Collaboration with CDC, USA as a part of CDC AMR Challenge 2018-2019
  • Radboud University for Antimicrobial Stewardship Program (2021)
  • Recognised as European Centre for Collaboration (ECC) by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) for training of overseas students in AMS (2020-21)

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Publications

  • Rathish B, Wilson A, Warrier A, Pillay R, Thomas J. Aspergillus fumigatus meningitis in an immunocompetent young woman. Indian J Pathol Microbiol 2020; 63:488-90.
  • Warrier, A., & Wilson, A. (2020). A Single Case Outbreak of Nipah Encephalitis from India in May–June 2019. Infection Control & Hospital Epidemiology, 41(S1), S104-S104. doi:10.1017/ice.2020.607
  • Warrier, A., & Wilson, A. (2020). Phylogenetic Analysis of Candida auris Isolates from Clinical Samples of Surgical Intensive Care Units. Infection Control & Hospital Epidemiology, 41(S1), S349-S350.
  • Cyril G, Rathish B, Wilson A, et al. (October 28, 2020) A Case of Diphtheria and Infectious Mononucleosis Co-Infection in a Partially Vaccinated Boy. Cureus 12(10): e11227. doi:10.7759/cureus.11227
  • Warrier, A., & Merin, A. (2020). Reducing Sternal Site Surgical Site Infections by Postdischarge Follow-Up Using WhatsApp. Infection Control & Hospital Epidemiology, 41(S1), S369-S369. doi:10.1017/ice.2020.996

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  • Rathish B, Wilson A, Warrier A, Pillay R, Thomas J. Aspergillus fumigatus meningitis in an immunocompetent young woman. Indian J Pathol Microbiol 2020; 63:488-90.
  • Warrier, A., & Wilson, A. (2020). A Single Case Outbreak of Nipah Encephalitis from India in May–June 2019. Infection Control & Hospital Epidemiology, 41(S1), S104-S104. doi:10.1017/ice.2020.607
  • Warrier, A., & Wilson, A. (2020). Phylogenetic Analysis of Candida auris Isolates from Clinical Samples of Surgical Intensive Care Units. Infection Control & Hospital Epidemiology, 41(S1), S349-S350.
  • Cyril G, Rathish B, Wilson A, et al. (October 28, 2020) A Case of Diphtheria and Infectious Mononucleosis Co-Infection in a Partially Vaccinated Boy. Cureus 12(10): e11227. doi:10.7759/cureus.11227
  • Warrier, A., & Merin, A. (2020). Reducing Sternal Site Surgical Site Infections by Postdischarge Follow-Up Using WhatsApp. Infection Control & Hospital Epidemiology, 41(S1), S369-S369. doi:10.1017/ice.2020.996
  • Warrier, A., & Bernadit, S. (2020). Impact of Leadership Walk-Arounds and Feedback from Senior Management to Reduce CLABSI Rates. Infection Control & Hospital Epidemiology, 41(S1), S261-S261.
  • Kancharu, F.K., Viswam, V., Sreeram, P. et al. Mucormycosis of Neck a Rare Presentation. Indian J Otolaryngol Head Neck Surg (2020).
  • Rathish B, Zito P. Nocardia. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020 July
  • Pillay R, Rathish B, Wilson A, Philips GM, Warrier A. Quality Improvement project on adherence to antibiotic policy in acute admissions from a tertiary care hospital in South India. Clinical Medicine. Accepted for publication. October 2020.
  • Hassan S, Rathish B, Mukthar F. An unusual case of hyperpigmented maculopapular rash with unmasking of lepromatous leprosy after steroid cessation. Am J Trop Med Hyg. 2020;103(4):1353
  • Rathish B, Wilson A, Warrier A, Babu R, Ahamaddunny R, Joy S. Nocardia farcinica ventriculitis and meningitis in an immunocompromised man with Crohn’s disease. Med Mal infect. Accepted for publication, Nov 2020.
  • Azeez F, George A, Rathish B, Philips G, Joy S. Aeromonas hydrophila causing Endogenous Endophtalmitis: A rare manifestation. JRCPE. Accepted for publication. October 2020.
  • Rathish, Balram and Wilson, Arun, The Wilson-Rathish Index (WRI): A Simple Index to Facilitate Decision Making on Containment Measures in COVID-19 (April 28, 2020). Available at SSRN: https://ssrn.com/abstract=3587... or http://dx.doi.org/10.2139/ssrn.3587553
  • Ahammadunny R, Rathish B, Abraham M, Wilson A, Warrier A. A case of Levamisole induced Multifocal inflammatory leukoencephalopathy and secondary Nocardia veterana brain abscess. Annals of Indian Academy of Neurology. Accepted for publication. July 2020.
  • Pillay R, Mukthar F, Pillay VV, Rathish B. Little Known Dangers of an Exotic Poisonous Fruit: Lessons from Two Cases of Konjac Ingestion. Cureus. 12(12): e11972.
  • Wilson A, Warrier A, & Rathish B. (2020). Contact tracing: a lesson from the Nipah virus in the time of COVID-19. Tropical Doctor, 50(3), 174–175.
  • Rathish B, Wilson A, Warrier A, et al. (February 02, 2021) Clinical Outcomes in Carbapenem-Resistant Enterobacteriaceae Infections Treated With Ceftazidime-Avibactam: A Single-Center Observational Study. Cureus 13(2): e13081. doi:10.7759/cureus.13081
  • Rathish B, Mohammed S M, Ullal K, et al. (February 06, 2021) Tropical Aquatic Skin and Soft Tissue Infections: A Series of Three Cases. Cureus 13(2): e13170. doi:10.7759/cureus.13170
  • Rathish B, Wilson A, Joy S. A comparison of COVID-19 secondary attack rate in household and close contacts compared to current risk stratification guidelines of the Kerala government. Tropical Doctor. March 2021. doi:10.1177/00494755211002012
  • Rathish B, Pillay R, Wilson A, Pillay VV. Comprehensive Review Of Bioterrorism. 2021 Apr 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 34033376.
  • Raheem A, Rathish B, Charles D, et al. (May 18, 2021) Pneumococcal Bacteremia and Cryptococcal Meningitis Dual Infection in a Patient With Multiple Myeloma. Cureus 13(5): e15089. doi:10.7759/cureus.15089
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Trainings Offered

  • Infectious Diseases Fellowship Program (Institutional) – 2 year clinical ID training program for post-MD (Medicine and Microbiology)
  • Residency Program for Clinical Pharmacists (degree awarded by the JSS University, Mysore)

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