BACKGROUND:Effective surgical site infections (SSIs) surveillance improves patient outcomes and ensuring evidence-based prevention strategies. However, data generated by surveillance programs is hindered by data of patients lost to follow-up (LTFU), which introduces bias. AIM:This study was conducted to evaluate and reduce LTFU rates among lower-segment cesarean section (LSCS) patients enrolled in SSI surveillance. METHODS:This prospective observational study analyzed 5,057 LSCS surgeries (962 elective and 4,095 emergent) from February 2021 to December 2021 (baseline phase) and December 2022 to September 2024 (intervention phase). Women who underwent LSCS procedures were enrolled in an SSI surveillance program, with follow-up data collected through structured protocols. Targeted interventions, including enhanced communication methods, expanded contact information collection, and patient engagement, were implemented to address identified barriers. Chi-square tests and regression was assessed between the occurrence of LTFUs, demographics, and procedure types FINDINGS: LTFU rate in the baseline phase was 10.9% (125/1152), with key reasons including incorrect data (0.88%), network/issues (1.4%), non-communicative behavior of patients (1.2%) and patient related logistics (0.5%) (e.g. poverty). After interventions, the LTFU rate decreased to 2.2% (85/3905) in the intervention phase (P<0.05, OR=5.470, 95% CI 4.117-7.267). CONCLUSION:This study highlights the multifactorial nature of LTFU during SSI surveillance, influenced by individual, systemic and environmental factors. Targeted interventions, such as improved communication strategies, tailored patient engagement, leveraging technology and robust data collection protocols, significantly enhanced follow-up rates. These findings provide actionable insights to optimize SSI surveillance and mitigate LTFU-related challenges in healthcare settings.
Streptococcus suis is a zoonotic pathogen frequently reported in China and Vietnam, and is frequently under recognized in India. A 52 year old woman presented with fever, headache, vomiting and altered sensorium. CSF analysis was suggestive of acute bacterial meningitis. Blood cultures grew Streptococcus suis which was detected by MALDI-TOF. Effective management depends on timely detection of pathogen.
INTRODUCTION:Antimicrobial resistance due to bloodstream infections (BSIs) in low and middle-income countries remains unclear. Characterising the resistant patterns is crucial for limiting the spread of resistance and improving treatment strategies. This study aims to evaluate the antimicrobial resistance profile and co-existence of genes in organisms causing BSI. MATERIAL & METHODS:This is a 5-year retrospective cohort study conducted in an Indian tertiary care hospital. The blood samples collected from BSI patients were cultured in BacT/ALERT blood culture bottles. Pathogens were identified using MALDI-TOF, and antimicrobial susceptibility profiling was done using the automated VITEK-II system. The presence of antimicrobial-resistant genes was identified using PCR. The statistical analysis was done using SetupStata17. RESULTS:A total of 296 isolates were obtained from 281 patients having BSIs. Klebsiella pneumoniae (115/296, 38.8%), Acinetobacter baumannii (51/296, 17.2%), Escherichia coli (34/296, 11.4%) and Pseudomonas aeruginosa (14/296, 4.76%) were the most commonly isolated Gram-negative bacilli (GNB) (214/296, 72.29%). A higher frequency of MDR 149/214 (69.6%) was observed in overall GNBs. The highest percentage (>70%) of resistance was observed for K. pneumoniae and A. baumannii to most cephalosporins, carbapenems, and fluoroquinolones. The prevalence of ESBL producers was observed in 168/214 (78.5%) isolates, whereas the Carbapenemase gene was observed in 176/214 (82.2%) isolates, where bla-NDM (144/214, 67.2%) was the most predominant gene. A lower proportion of AmpC producers (117/214; 54.6%) was observed out of all three β-lactamases classes studied. The co-occurrence of ESBL genes was observed in 95.4% (168/176) carbapenemase producers. CONCLUSION:The high prevalence and co-occurrence of bla-NDM, ESBLs, and carbapenemase indicate an evolving resistance pattern across ICU and ward settings. Strengthening infection prevention, integrated surveillance, and antimicrobial stewardship is essential to limit the emergence and transmission of resistant GNBs and support timely, appropriate clinical management.
Pseudomonas fluorescens, an environmental rhizobacterium, is a rare cause of human wound infection. We describe two patients: a 73-year-old man with a 6-month diabetic foot ulcer, and a 30-year-old woman with a 2-month foot ulcer, whose wound swabs yielded multidrug-resistant P. fluorescens in pure culture. Identification relied on standard phenotypic methods, including pyoverdine fluorescence on King's B medium; molecular confirmation was not performed. Both isolates were meropenem-susceptible. Both patients received targeted intravenous meropenem with debridement and wound care, improving clinically, with culture-confirmed clearance in one. Susceptibility-guided therapy is essential given this organism's intrinsic resistance.
Respiratory syncytial virus (RSV) is the foremost viral cause of acute lower respiratory infections (ALRIs) in children under five years of age, yet surveillance data from rural India remain conspicuously scarce. This cross-sectional study simultaneously characterised RSV seroprevalence and active molecular infection in two non-overlapping paediatric cohorts from Karad, Maharashtra, India (September 2021-August 2023). In Cohort 1 (serological study, n = 290; ≥246 required by a prior calculation), RSV-specific immunoglobulin M (IgM) antibodies were detected in 182 children (62.8%) by enzyme-linked immunosorbent assay (ELISA; indirect format with rheumatoid factor pre-absorption), with the highest positivity in the 2-3-year age group. This rate is interpreted as an indicator of high community-level RSV exposure rather than a precise incidence estimate, given the known limitations of single-timepoint IgM testing in previously exposed children. In Cohort 2 (molecular study, n = 283; ≥233 required), RSV-B was detected by real-time reverse transcription polymerase chain reaction (RT-PCR) in 7 of 283 (2.47%) symptomatic children presenting with acute respiratory infection (ARI) or severe ARI (SARI); no RSV-A was identified. The low detection rate is consistent with pandemic-era suppression of respiratory virus transmission. All seven RSV-B strains belonged to the GB5 genotype and formed a phylogenetically distinct local sub-cluster within global GB5 (82% bootstrap support), carrying shared amino acid substitutions in glycoprotein G (A74V, I252T, 165del) and fusion protein F (F12I, S190N, S211N, S389P), numbered relative to the GISAID reference sequence EPI_ISL_1653999 (F precursor). Substitutions S190N and S211N map to the apex region of prefusion F at or adjacent to antigenic site Ø-the primary binding epitope for nirsevimab-though their functional impact on neutralisation was not assessed in vitro and requires dedicated experimental evaluation. A novel predicted N-linked glycosylation site at position F180 was identified in one strain (KIMS-102/2022), with potential but unconfirmed implications for local immune evasion. RSV-B illness was predominantly mild. These findings provide the first combined serological and molecular RSV dataset from rural Maharashtra and underscore the need for region-specific surveillance as RSV prophylactics become available in India.
BACKGROUND:Cutibacterium acnes is a slow-growing anaerobic gram-positive bacillus increasingly recognised as a cause of delayed, indolent post-surgical infections, particularly in the context of implants or bone flaps. Diagnosis is often challenging due to its slow growth and tendency to be dismissed as a contaminant. CASE PRESENTATION:We describe a case of C. acnes osteitis involving a cranial bone flap in a patient who underwent craniotomy and tumour decompression for a high-grade glioma. The postoperative course was initially uneventful; however, several weeks later the patient developed low-grade pyrexia and purulent wound discharge. Anaerobic culture of bone material yielded pure growth of C. acnes identified by MALDI-TOF MS (VITEK® MS). Antimicrobial susceptibility testing demonstrated resistance to penicillin and metronidazole, with susceptibility to multiple other agents. The patient responded favourably to targeted antimicrobial therapy with no recurrence on follow-up. CONCLUSION:C. acnes represents an important but under-recognised cause of delayed post-craniotomy infection. Prolonged anaerobic incubation, modern proteomic identification techniques, and careful clinicomicrobiological correlation are essential for accurate diagnosis. Combined surgical and antimicrobial management results in excellent outcomes.
BACKGROUND:Diarrhoeagenic Escherichia coli (DEC) is a leading bacterial cause of acute diarrhoea in children. DEC is characterised by diverse virulence factors that contribute to its pathogenicity. Cytolethal Distending Toxin (CDT), an E. coli genotoxin that induces DNA damage and cell-cycle arrest, remains poorly characterised in paediatric diarrhoeal disease. This study assessed DEC prevalence, antimicrobial resistance, and CDT production among children with diarrhoea and healthy controls. METHODS:A prospective case-control study was conducted from November 2022 to October 2023, including 250 diarrhoeal cases and 250 age-matched healthy controls aged 0-14 years at tertiary care hospitals in North India. Organisms were isolated by culture, and presumptive E. coli isolates were confirmed using standard biochemical tests and Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS). Polymerase chain reaction (PCR) was used to detect the cdtB gene and other DEC virulence genes. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method as per CLSI guidelines. RESULTS:Overall DEC prevalence was 14% in cases and 6.4% in controls (p = 0.006; OR = 2.38). Enteroaggregative E. coli (EAEC) was the most common pathotype, followed by enteropathogenic E. coli (EPEC) and enterotoxigenic E. coli (ETEC). Among the 35 DEC isolates from diarrhoeal cases, high antimicrobial resistance (AMR) was observed to nalidixic acid (74.3%), followed by cotrimoxazole (48.6%) and ciprofloxacin (45.7%), and 54.3% were multidrug-resistant. The cdtB gene was detected in 1.6% of cases and 0.4% of controls, predominantly in children aged 1-<5 years, with two isolates co-harbouring eae. CONCLUSION:The high prevalence of antimicrobial resistance among DEC highlights the need for strengthened AMR surveillance and antimicrobial stewardship. Although the prevalence of CDT-producing E. coli was low, their predominance among diarrhoeal cases highlights the need for larger multicentric studies to determine their clinical and epidemiological significance.
Pasteurella multocida is a zoonotic Gram-negative coccobacillus commonly associated with animal bites and capable of causing invasive disease. We retrospectively analysed five culture-confirmed P. multocida infections at a tertiary care centre in South India between 2018 and 2024. Clinical presentations included cellulitis, abscess, diabetic foot osteomyelitis, preseptal cellulitis, and necrotizing fasciitis. Animal exposure was documented in three patients, while two had no identifiable exposure. All patients received appropriate antimicrobial therapy and achieved favourable outcomes. This series highlights the diverse clinical spectrum of P. multocida infection, the importance of early microbiological diagnosis and culture-directed therapy, even without recognized animal exposure.
BACKGROUND:Pediatric melioidosis is an under-recognised but potentially severe infection caused by Burkholderia pseudomallei. Evidence is largely fragmented across case reports and small series, limiting understanding of disease patterns, severity, and outcomes in children. METHODS:A scoping review was conducted in accordance with PRISMA-ScR 2020 guidelines. PubMed and Google Scholar were searched up to December 2025 for studies reporting culture-confirmed melioidosis in children (≤18 years). Case reports, case series, and observational studies were included. Given the heterogeneity of available data, findings were synthesised narratively with emphasis on clinical patterns and outcome determinants. RESULTS:A total of 140 studies comprising 1058 pediatric cases were included. Most cases were reported after 2000 and originated from Southeast Asia and northern Australia. Pediatric melioidosis demonstrated a broad clinical spectrum, ranging from localized infections (predominantly parotid, lymphatic, and skin involvement) to severe disseminated disease with bacteraemia and pneumonia. Overall mortality was 22.4% (229/1024). Mortality was markedly lower in localized melioidosis (0.7%; 4/557) than in disseminated disease (46.2%; 226/489) and was highest in neonatal (56.0%) and neurologic melioidosis (51.7%). Diagnostic delay ranged from 1 to 420 days and was frequently associated with severe and fatal outcomes, suggesting progression from initially localized infection to disseminated disease. CONCLUSIONS:Pediatric melioidosis follows a phenotype-severity continuum, with outcomes strongly influenced by disease pattern and timeliness of diagnosis. Early recognition of localized disease and prompt microbiological confirmation are critical to preventing progression and reducing mortality. This review provides a consolidated framework for understanding pediatric melioidosis and highlights key priorities for clinical practice and future research.
AmpC β-lactamases are less commonly reported and are one of the major contributors to third-generation cephalosporin resistance within hospital settings. Emergence of new variants of this beta-lactamase complicates laboratory detection and treatment options. In the current investigation, we report the presence of blaCMY-225, a new type of class C beta-lactamase from a teaching hospital in northeast India.
Nocardia mainly affects immunocompromised individuals. We report a case of immunocompetent male, with neurological complaints for the past eight months. Contrast-enhanced MRI (CE-MRI) revealed space-occupying lesion with frontal lobe abscess. The patient underwent craniotomy, and pus was sent for microbiological diagnosis. Direct KOH-calcofluor white mount, and modified Ziehl-Neelsen (ZN) staining demonstrated thin, branching filamentous structures suggestive of Nocardia spp. Nocardia brasiliensis was confirmed through 16S rRNA sequencing. The patient received targeted antimicrobial therapy. Direct fluorescent microscopy is an important initial investigation in the diagnostic workup. Early diagnosis and appropriate management is key to favorable clinical outcomes in cerebral nocardiosis.
We present the case of a 53-year-old male with chronic diarrhoea, abdominal pain, vomiting, and significant weight loss over six months. Initial evaluation revealed acute kidney injury, metabolic acidosis, and lymphadenopathy. Stool examination identified Cystoisospora belli immature oocysts, and Human Immunodeficiency Virus serology was reactive. The patient responded well to cotrimoxazole therapy, with no episodes of diarrhoea by the sixth day after initiation of treatment, underscoring the importance of considering opportunistic parasitic infections in immunocompromised individuals.
INTRODUCTION:The upper respiratory tract harbours diverse microbial flora that contribute to homeostasis and immunity but may occasionally become pathogenic. The upper respiratory tract acts as a point of entry for various pathogenic bacteria, which can have local or systemic manifestations. Many non-pathogenic Corynebacterium species exist as commensals, but a few species can produce toxins and can have systemic manifestations. Identifying such pathogenic Corynebacterium at the earliest is a diagnostic challenge faced by microbiological laboratories. To shorten diagnostic turnaround time, study adopted primary inoculation on selective Tinsdale medium and Loeffler's Serum Slope (LSS) for rapid growth. As Tinsdale medium is known to produce standout colony characteristics for rapid identification, we exploited the ability of Tinsdale medium to form characteristic grey to black colonies of Corynebacterium genus. METHODS:In this cross-sectional study, 50 throat swab specimens collected from patients presenting with clinical features suggestive of diphtheria were cultured on Tinsdale medium and Loeffler's Serum Slope. Grey to black-pigmented colonies were identified using conventional microbiological methods and the VITEK 2 Compact system. RESULTS:Of the 50 specimens processed, 35 (70.0%) yielded colonies with grey-black pigmentation on Tinsdale medium; none of these isolates was finally identified as Corynebacterium. Out of the organisms identified by conventional methods as well as by VITEK, Enterococcus faecalis was the most prevalent organism (25.7%), followed by Lactobacillus acidophilus (14.3%) and Streptococcus mitis (14.2%) and Lactobacillus gasseri (11.4%). The remaining isolates comprised Actinomyces naeslundii, Clostridium spp., Candida albicans, Schaalia odontolytica, and Pseudopropionibacterium propionicum. CONCLUSION:Black colonies on Tinsdale medium were not specific for Corynebacterium, as several other organisms produced similar colonies. These findings reinforce the need for confirmatory identification methods, as no Corynebacterium species were isolated from the throat swab specimens processed in this study.
Corynebacterium striatum, a non-diphtherial Gram-positive bacillus traditionally considered a skin commensal, is increasingly recognised as an opportunistic pathogen in device-associated infections. We report a polymicrobial prosthetic joint infection in a 73-year-old woman with prior bilateral total knee replacement. C. striatum was repeatedly isolated from synovial fluid and deep tissue samples with Pseudomonas aeruginosa and identified by MALDI-TOF mass spectrometry. The isolate was susceptible to glycopeptides and linezolid. The patient received intravenous teicoplanin and revision surgery, highlighting the clinical significance of repeated isolation from deep specimens.
