Background Ventilator-associated pneumonia (VAP) resulted from Carbapenem-Resistant Acinetobacter baumannii (CRAB) poses serious treatment challenges. Our objective was to assess two triple medication combinations for VAP caused by CRAB. Methods This prospective observational research was performed in the critical care unit of an academic medical center from January 2024 to March 2025. Two hundred adult patients with culture-proven CRAB-VAP were enrolled and treated with either minocycline-polymyxin-sulbactam or meropenem-polymyxin-sulbactam. Various outcomes assessed were clinical recovery, 7 and 28-day mortality, microbiological eradication, duration of ICU and hospital stay. Results The clinical recovery rates were comparable in both groups (54% minocycline vs. 47% meropenem, p = 0.322). The microbiological eradication rate was similar (39%) at day 28 in both groups. Patients treated with the minocycline regimen had significantly shorter ICU stay (16 vs. 18 days, p = 0.003) and hospital stays (24 vs. 28 days, p < 0.001) than the meropenem group. There was no significant difference between 7-day mortality (21% vs. 32%, p = 0.078) or 28-day mortality (46% vs. 53%, p = 0.322). Conclusion Minocycline-based triple therapy was comparable to meropenem-based therapy in treating CRAB-VAP, with potential advantages in reducing duration of ICU and hospital stay. Minocycline may be a suitable alternative for CRAB-VAP in resource-limited settings.
Background Indian antimicrobial resistance (AMR) surveillance rarely uses contemporary global frameworks, and Saurashtra is under-represented in the national evidence base. We applied the WHO Bacterial Priority Pathogens List (BPPL) 2024 and the WHO AWaRe (Access–Watch–Reserve) classification to institutional surveillance data, with national and global benchmarking. Methods Cross-sectional analysis of 2195 non-duplicate clinical bacterial isolates (May–October 2024) at a government tertiary care teaching hospital. Susceptibility testing followed CLSI M100-S33 (Kirby–Bauer disk diffusion); multi-drug resistance (MDR) followed Magiorakos criteria. Isolates were assigned to BPPL 2024 tiers by resistant phenotype, and agent-level resistance was grouped by AWaRe 2023 category. MDR correlates were explored by multivariable logistic regression. The isolate was the unit of analysis; proportions describe cultured isolates, not infections or patients. Results Isolates meeting Critical-priority phenotypes numbered 1192 (54.3% of the isolate pool): third-generation cephalosporin-resistant Enterobacterales (n = 1086; 49.5%; ceftriaxone resistance 78% in E. coli and 61% in K. pneumoniae) and carbapenem-resistant Acinetobacter baumannii (n = 106; 4.8%). High-priority phenotypes accounted for at most 228 isolates (10.4%). Within the Access group, Enterobacterales resistance was high to ampicillin (89.7% in E. coli) and amoxicillin/clavulanic acid (77–83%) but lower to gentamicin (22–33%); Watch-group fluoroquinolone resistance was 47–73%. Meropenem resistance in E. coli (1%) and K. pneumoniae (7%) was markedly lower than ICMR AMRSN 2023 national estimates (40% and 54%). MDR was present in 58.6% of isolates and was independently associated with ICU admission, age >60 years, tracheal-aspirate specimens, and surgical-department admission. Conclusions Reading isolate-level surveillance data through the BPPL 2024 and AWaRe frameworks adds a priority- and stewardship-oriented layer to the conventional antibiogram. These proportions describe cultured isolates, not the frequency of resistant infection in patients. The low Enterobacterales carbapenem resistance relative to national benchmarks warrants multi-center, consumption-linked confirmation.
INTRODUCTION Helicobacter pylori, a gram-negative, spiral bacterium primarily associated with gastric disorders such as peptic ulcer disease and gastric carcinoma, has been implicated in hepatobiliary diseases including cholelithiasis and gallbladder carcinoma. AIM To detect Helicobacter pylori in bile samples of patients with gallbladder diseases undergoing ERCP and to evaluate its association with clinical diagnosis. MATERIALS AND METHODS This observational cross-sectional study was conducted in the Departments of Microbiology and Gastroenterology at a Tertiary care hospital in Central India, from September 2023 to June 2025. Eighty-four patients with gallbladder and biliary diseases undergoing Endoscopic Retrograde Cholangiopancreatography were included. Bile samples were subjected to Rapid Urease Test (RUT), Modified Giemsa staining, culture, and real-time PCR targeting the vacA gene of H.pylori. Statistical analysis was performed using SPSS version 26.0, with p-value <0.05 considered significant. RESULTS Among 84 patients, 46/84 (54.76%) were females. Cholelithiasis was the most common diagnosis [63/84 (75.00%)]. RUT was positive in 56/84 (66.67%) samples, while Modified Giemsa staining demonstrated curved or spiral bacilli suggestive of Helicobacter species in 31/84 (36.90%) samples and PCR was positive in 28/84 (33.33%) samples. Modified Giemsa staining demonstrated curved or spiral bacilli suggestive of Helicobacter species in 22/28 (78.57%) PCR-positive cases, whereas RUT was positive in 24/28 (85.71%) PCR-positive cases. PCR positivity was 28.57% in cholelithiasis cases and 42.86% in gallbladder carcinoma cases, while Modified Giemsa positivity was 33.33% and 57.14% in cholelithiasis cases and gallbladder carcinoma cases, respectively. No H. pylori isolates were recovered by culture methods. Escherichia coli was the predominant biliary isolate in 17/59(28.81%) culture-positive samples. CONCLUSION Helicobacter pylori was detected in bile samples of Gallbladder and biliary disease patients. Modified Giemsa staining showed a stronger association with PCR, whereas RUT showed higher positivity among PCR positive samples. PCR remains a more species-specific molecular method for the detection of H.pylori.
Non-typhoidal Salmonella urinary tract infections (UTIs) are rare and may be linked to immunosuppression, chronic illnesses, or structural urinary tract abnormalities. Salmonella enterica serovar Kentucky (ST198) is a globally disseminated lineage associated with fluoroquinolone resistance and the acquisition of additional antimicrobial resistance (AMR) determinants. This is the first Indian case report of a rare UTI caused by Salmonella Kentucky ST198, resistant to both fluoroquinolones and extended-spectrum cephalosporins. This report emphasises the value of whole-genome sequencing (WGS) for serovar-level characterisation and resistance-gene discovery in uncommon Salmonella isolates, as well as the importance of off-label azithromycin use for treating UTI for a favourable outcome.
Despite India's progress toward measles elimination, serological data from isolated communities such as Lakshadweep remain limited. We conducted a community based cross-sectional serosurvey in selected wards of Kavaratti in September 2022. Of 368 samples collected, 299 participants with complete demographic data were analyzed. Measles-specific IgG was measured by commercial ELISA, and age- and sex-related patterns were assessed. IgG levels correlated positively with age, and serological status differed significantly across age groups (p < 0.001). Median levels were higher in females, but not significantly (p = 0.190). Negative or equivocal results clustered among younger participants, supporting surveillance.
