BACKGROUND:Antimicrobial resistance among Acinetobacter baumannii and Klebsiella pneumoniae has significantly increased which has reduced available treatment options. Omadacycline, a novel tetracycline, has shown in vitro activity against multidrug-resistant pathogens; however, in vitro susceptibility of Omadacycline has not been previously studied against the extensively drug-resistant (XDR) isolates in Indian setting. METHODS:This prospective observational study evaluated the in vitro activity of Omadacycline against extensively drug-resistant (XDR) A. baumannii and K. pneumoniae isolates obtained from bloodstream infections and bacterial meningitis. Minimum inhibitory concentrations (MICs) of Omadacycline were determined using broth microdilution method. MIC50 and MIC90 values were calculated, and results were also compared with Tigecycline. RESULTS:Overall, 30.58% of isolates demonstrated MIC values ≤ 2 μg/mL. Omadacycline exhibited better in vitro activity against A. baumannii than K. pneumoniae. Lower MICs were observed in bloodstream isolates than meningitis isolates. Comparative analysis with Tigecycline showed no statistically significant difference in vitro susceptibility. CONCLUSION:Omadacycline demonstrated favorable in vitro activity against XDR A. baumannii, particularly bloodstream isolates, with lower activity against K. pneumoniae. No statistically significant difference in vitro susceptibility was observed compared with Tigecycline. These findings support further evaluation of Omadacycline as a potential therapeutic option and further clinical and pharmacokinetic studies are required to define the role in management of XDR infections in Indian setting.

Background:The increasing prevalence of antimicrobial resistance (AMR) has created an urgent need for alternative therapeutic strategies. Acinetobacter baumannii, a major cause of hospital-acquired infections, has been classified by the World Health Organization as a critical priority pathogen due to its high levels of multi-drug resistance. Bacteriophage therapy has re-emerged as a potential approach to combat infections caused by multidrug-resistant organisms. Methods:Fifty multidrug-resistant (MDR) A. baumannii clinical isolates were collected. Bacteriophages were isolated from hospital sewage using standard enrichment protocols and screened for lytic activity against these isolates using spot and plaque assays. Morphological characterization of purified phages was performed using transmission electron microscopy. Results:Three bacteriophages - vB_AbaS_SRNAIIMS002, vB_AbaS_SRNAIIMS008, and vB_AbaP_SRNAIIMS010 - were isolated and demonstrated lytic activity against MDR A. baumannii. Plaque assays revealed clear central zones with surrounding halos, indicating active bacterial lysis. Host range testing showed that two phages exhibited activity against multiple clinical isolates, whereas one displayed a narrow host range. Transmission electron microscopy revealed that two phages belonged to the family Siphoviridae, whereas one was morphologically consistent with the family Podoviridae. Conclusions:This study reports the isolation and characterization of three bacteriophages active against MDR A. baumannii. These findings highlight the feasibility of isolating lytic phages from environmental sources and support further investigation of bacteriophage therapy as a complementary strategy to address infections caused by multidrug-resistant pathogens.

Background Pancreatic pseudocysts are known sequelae of acute and chronic pancreatitis and are typically sterile. Superinfection is not uncommon, but isolation of Streptococcus pneumoniae is exceedingly rare. Case Presentation We report a 32-year-old immunocompetent male with a background of chronic alcohol-related pancreatitis presenting with worsening abdominal pain and early satiety. Imaging revealed a large pseudocyst. Laparoscopic transgastric cystogastrostomy with cholecystectomy was performed, and culture of aspirated cyst fluid yielded Streptococcus pneumoniae. The patient recovered uneventfully on targeted antibiotic therapy. Conclusion This case illustrates the importance of microbiological evaluation of pseudocyst fluid and highlights an unusual presentation of S. pneumoniae superinfection in a pancreatic pseudocyst.

INTRODUCTION:Stenotrophomonas maltophilia is an emerging nosocomial pathogen associated with severe infections in critically ill patients and limited therapeutic options due to intrinsic antimicrobial resistance. Indian data describing its clinical spectrum, resistance patterns, and outcomes remain scarce. METHODS:A retrospective observational study was conducted at a tertiary care center in northern India between January 2021-June 2022. Adult patients (≥18 years) with culture-confirmed S. maltophilia infection were included. Only hospital-acquired infections were included. Data on demographics, comorbidities, clinical severity (SOFA, APACHE II), prior antibiotic exposure, and ICU parameters were collected. Microbiological details (source, susceptibility per CLSI guidelines), treatment regimens, resistance profiles, and clinical outcomes (14-day cure, oxygen/vasopressor requirement, mortality) were analyzed. RESULTS:Among 53 patients with Stenotrophomonas maltophilia isolates, 38 (71.7%) had true infections. Median age was 33.5 years (IQR 26-51.5); 68.4% were male. Bloodstream infection was most common (73.7%), followed by hospital/ventilator-associated pneumonia (26.3%). Diabetes (31.6%) and chronic kidney disease (23.7%) were the main comorbidities. Prior carbapenem (63.2%) and glycopeptide (42.1%) use was frequent. Susceptibility remained high to minocycline (86.8%), levofloxacin (86.8%), and cotrimoxazole (84.2%). Pneumonia, higher SOFA scores, vasopressor use, and minocycline resistance were associated with poor outcomes, with a mortality rate of 52.6%. CONCLUSION:S. maltophilia infections in critically ill patients carry a high mortality despite susceptibility to standard agents. Early recognition, optimal antimicrobial choice, and supportive care are crucial for improving outcomes.

Burn injuries are a major cause of morbidity and mortality in low- and middle-income countries, with infections and antimicrobial resistance posing significant challenges. Carbapenem-resistant Gram-negative bacteria are particularly concerning in burn intensive care units. The aim of the study was to evaluate bacteriological profile, and antimicrobial susceptibility patterns of burn ICU patients, and identify risk factors associated with carbapenem resistance, invasive infections, and in-hospital mortality. This retrospective, single-center study included all patients admitted to a 30-bed burns ICU in north India between January and December 2024, whose clinical sample was received for microbiological investigations. Data on demographics, clinical parameters, and microbiological findings were extracted from hospital records and analyzed using chi-square, Fisher's exact, Mann-Whitney U tests, and multivariable logistic regression. Out of 246 patients included, the mean age was 29.1 ± 20.4 years and mean total body surface area (TBSA)% was 39.0% ± 19.9%. Overall mortality was 42.3%. A total of 1586 samples yielded 1057 pathogens, predominantly Gram-negative bacteria (Pseudomonas aeruginosa 36.1%, Acinetobacter baumannii 22.3%, and Klebsiella pneumoniae 18.8%). Carbapenem resistance was observed in 85.3% of patients and was significantly associated with higher TBSA% (P < .001), longer hospital stays (P = .022), and mortality (P < .001). Invasion was present in 27.6% and was significantly associated with both carbapenem resistance and mortality. Multivariable logistic regression identified TBSA% (odds ratio [OR]: 1.07, P < .001) and invasion (OR: 4.14, P = .001) as independent predictors of mortality. Carbapenem resistance and invasive infections are highly prevalent in burn ICU patients, underscoring the urgent need for robust infection control, regular antibiogram surveillance, and targeted antimicrobial stewardship in burn care settings.

Purpose This study aimed to investigate the distribution of diarrheagenic Escherichia coli (DEC) pathotypes, virulence profiles, hybrid strains, and antimicrobial resistance (AMR) in children across secondary (CRHSP Ballabgarh) and tertiary (AIIMS, New Delhi) healthcare settings in North India. Methods Fecal specimens from 270 children (≤ 12 years) with acute diarrhea were prospectively collected between September 2024 and June 2025. Following Escherichia coli (E. coli) identification via MALDI-TOF MS, PCR targeted eleven virulence genes to assign pathotypes. Antimicrobial susceptibility was determined using the VITEK-2 Compact system following CLSI 2023 guidelines. Results Out of 200 E. coli isolates in our study, 93 (46.5%) were confirmed as DEC, comprising 73 classical pathotypes and 20 hybrid strains (10%). DAEC and EAEC were the most prevalent pathotypes, followed by ETEC, EPEC and EIEC. Hybrid strains, most frequently ETEC/DAEC, were predominantly found in the secondary healthcare settings. High resistance rates were observed for β-lactam antibiotics, including ceftriaxone (63.3%–100%), whereas carbapenems, colistin, and tigecycline remained highly effective. Clinically, ETEC was associated with watery diarrhea and EIEC with bloody stools. Conclusion DEC, specifically DAEC and EAEC, is a major contributor to pediatric diarrhea in North India. The presence of diverse hybrid pathotypes and high AMR levels highlights the critical need for integrated molecular surveillance and robust antimicrobial stewardship across varying healthcare levels.

OBJECTIVE:This study determines the prevalence and genomic characterisation of uropathogens causing community-acquired urinary tract infections. MATERIALS AND METHODS:This is a first multicentric cross-sectional community study conducted across different regions of India, in patients aged >1.5 y suspected with urinary tract infection. Uropathogens causing significant bacteriuria were identified, and susceptibility testing was performed. Whole-genome sequencing was done to characterise antimicrobial resistance genes, virulence genes, and sequence types (ST). The effect of age and gender on significant bacteriuria was assessed by Multivariable random-effects logistic regression. RESULTS:Significant bacteriuria was seen in 11.8% (711/6009) of the specimens, out of which 63% (448/711) were Escherichia coli, and 15.7% (112/711) were Klebsiella pneumoniae. The prevalence of extended-spectrum beta-lactamase positive, multidrug-resistant and carbapenem resistant E. coli was 65.4% (293/448), 64.5% (289/448) and 9.8% (44/448); among K. pneumoniae isolates, similar resistance was seen in 56.2% (63/112), 39.2% (44/112), and 9.8% (11/112), respectively. Genomic analysis showed high-risk clones of E. coli (ST131, ST1193) and K. pneumoniae (ST15, ST16, and ST231) carrying multiple plasmids with blaCTX-M-15, blaOXA-232, blaNDM-5, and blaNDM-7 genes. CONCLUSIONS:This study revealed a wider presence of drug-resistant high-risk clones of uropathogens in community settings of India. A multifaceted approach through routine antimicrobial resistance surveillance, judicious choice of empiric antibiotics in a community setting, is deemed necessary. Whole-genome sequencing analysis of extended-spectrum beta-lactamase-producing E. coli isolates revealed a predominance of ST131 lineage (25%), while ST1193 strains carried IncFIA and ColKP3 plasmids associated with blaCTX-M-15 and blaTEM-1B. ST231 K. pneumoniae isolates harboured blaOXA-32 gene along with ColKP3 plasmid.

Corynebacterium species are increasingly recognized as opportunistic pathogens in immunocompromised hosts. We report three cases of culture-confirmed Corynebacterium infections in cancer patients undergoing radiation therapy at a tertiary care centre. Two patients developed Corynebacterium striatum skin and soft tissue infections and one had Corynebacterium matruchotii vaginal infection. All cases presented with foul-smelling discharge and delayed wound healing in previously irradiated tissues. Identification was performed using MALDI-TOF MS (Bruker Biotyper®) and standard microbiological methods. Direct Gram stain of all specimens revealed gram-positive, pleomorphic rod-shaped bacilli. Antimicrobial susceptibility testing confirmed susceptibility to linezolid in all isolates, and culture-guided therapy with linezolid resulted in rapid clinical improvement. These cases highlight the importance of recognizing Corynebacterium species as true pathogens rather than contaminants in immunocompromised cancer patients.

The aim for the present study was to determine the clinico-microbiological profile and antimicrobial susceptibility patterns of organisms isolated from bile aspirates during endoscopic retrograde cholangiopancreatography (ERCP) in patients with acute cholangitis. In this prospective, observational, single-center study, bile aspirates and blood from consecutive patients undergoing ERCP for acute cholangitis were collected for culture. Demographic, outcome, and microbiological data were collected. Multivariate logistic regression was used to identify factors associated with adverse outcomes. Bile aspirates from 117 patients were collected; 95 (81.2%) yielded positive culture results, and 101 isolates were identified. Gram-negative organisms were the most frequently isolated, with Escherichia coli (E. coli; 50.5%), Pseudomonas spp. (21.8%), and Klebsiella spp. (15.8%), being the most common. Extended-spectrum beta-lactamase production and carbapenem resistance were observed in 79.1% and 29.2% of Gram-negative isolates, respectively. Among 64/117 (54.7%) concurrent blood cultures, 11 (17.2%) were positive. A biliary endoscopic sphincterotomy had been conducted previously in 43 cases (36.8%) and was associated with a higher frequency of E. coli and carbapenem-resistant Klebsiella pneumoniae (CRKP). Multivariate analysis revealed that male sex (odds ratio [OR]: 4.2; P = 0.05) and malignant biliary obstruction (OR: 8.1; P = 0.005) were independently associated with worse outcomes. Bile cultures frequently yield multidrug-resistant organisms in acute cholangitis. A previous biliary sphincterotomy increases the risk of drug-resistant infections, particularly CRKP. These findings highlight the importance of local microbiological surveillance and individualized empirical therapy.

Typhoid fever, a systemic febrile illness caused by Salmonella Typhi (S. Typhi) has a complex history of ongoing adaptation and progressive build-up of resistance to commonly used antibiotics. All the culture positive enteric fever cases during 2017–2024 presenting to our hospital were included in the study. Antimicrobial susceptibility was done against amoxicillin, chloramphenicol, cotrimoxazole, ciprofloxacin, levofloxacin, ofloxacin, pefloxacin, ceftriaxone and azithromycin as per corresponding CLSI guidelines for each year. The organism identification and antimicrobial susceptibility was done by standard protocol. WGS was carried out for molecular characterization of XDR isolate with paired-end 2 x 150 bp reads on Illumina MiSeq (Illumina, USA) employing v2 and v3 chemistry. Total isolation of blood culture positive typhoidal Salmonella was 596 during the study period (2017-2024). Out of which Salmonella Paratyphi A was 117 followed by 479 Salmonella Typhi. Pre-COVID 19 - Fluoroquinolones (CIP, LEV, OFL) show notable non susceptibility which is 14–20% followed by 74–89% intermediate susceptibility and exhibiting only 2–6% susceptibility. While ceftriaxone and cefixime showed complete susceptibility, azithromycin resistance was observed in 2% isolates. Resistance to chloramphenicol, cotrimoxazole and ampicillin (MDR) was recorded in 2-3% isolates. Post-COVID 19- Fluoroquinolones (CIP, LEV, OFL) shows increase in non-susceptibility which is 28–52% followed by 69–44% intermediate susceptibility and exhibiting only 3–4% susceptibility. The increase in typhoidal cases suggests a surge in typhoid cases, possibly due to compromised public health systems during and after the pandemic and a shift in its seasonality, is likely to be influenced by environmental and systemic factors. Further epidemiological studies are required for better understanding. The identified XDR strain represents a novel lineage distinct from known XDR isolates in Pakistan. Arrival of XDR S. Typhi in Indian subcontinent serves as a warning. The question now is the timeframe for its potential spread to other regions of India. All Authors: No reported disclosures

Diarrheagenic Escherichia coli (DEC) is one of the major causes of diarrhea in pediatric patients. Differentiating the commensal Escherichia coli from the pathogenic types requires molecular techniques making it difficult to diagnose. This study was done to find out the rate of DEC infection and to analyze the resistance profiles in children below 10 years of age. Out of 115 fecal specimens tested, DEC was detected in 12.17%. Multi-drug resistance was present in 28.5% of DEC isolates, while trimethoprim-sulfamethoxazole exhibited the highest efficacy at 64.2%. These results show the necessity of DEC surveillance and rigorous antibiotic stewardship in pediatric populations.

Introduction Human Immunodeficiency Virus, the retrovirus that causes Acquired Immune Deficiency Syndrome, is a major global public health threat. This chronic viral infection diminishes the immune system by attacking CD4 cells. The principal treatment is antiretroviral medication (ART), which significantly increases the life expectancy of HIV patients. However, ART does not address psychological issues, including depression, anxiety, and stress. Psychosocial factors are known to influence HIV disease progression through activation of stress-related biological pathways, including the hypothalamic-pituitary-adrenal (HPA) axis, inflammatory cytokine responses, and monoamine neurotransmitter dysregulation. Mind-body practices such as yoga may modulate these pathways by reducing physiological stress, improving emotional regulation, and enhancing overall well-being. The current trial aims to assess the effectiveness of yoga as an adjunct therapy on psychological parameters (depression, anxiety, and stress), quality of life, and medication adherence of people living with HIV on antiretroviral therapy at a tertiary care hospital in AIIMS, New Delhi, India.Materials and methods This study is a two-arm, parallel-group, open-label, blinded-endpoint, single-center, randomized controlled trial investigating the effects of a yoga therapy as an adjunct therapy in people living with HIV (PLHIV). Participants (n = 192) will be randomized to either 12 weeks of a Yoga therapy program (n = 96) or an Active control group, i.e., a prescribed brisk walk (n = 96). Both groups will receive standard treatment. The primary outcome is anxiety and depression scores (HADS-A and HADS-D), and the secondary outcomes are Stress (PSS), quality of life (WHOQOL-HIV BREF and SF-36 QoL), and medication adherence.Discussion The findings of this RCT will help shed light on yoga intervention to address the psychosocial dimensions of HIV. If shown to be effective, yoga as an adjunct intervention may promote a transition in HIV care from a predominantly biomedical framework to a holistic, patient-centered approach encompassing mental health and overall well-being. The study is approved by Institute Research Board Ethics (AIIMSA2969/03.01.2025, RP-46/25, OP-16/02.05.25, OP-18/05.12.2025) and is registered at Clinicaltrials.gov (CTRI/2025/03/081645). CTRI Link- https://www.ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MTIyNjUx&Enc=&userName=HIV,%20Yoga

Implant-associated infections (IAIs) are an important complication after orthopaedic surgery and Coagulase-negative staphylococci (CoNS) are a common cause of such infections. We report a case of a chronic IAI caused by Staphylococcus xylosus, after internal fixation of a femoral neck fracture. The diagnosis was established by culture of the implant sonication fluid, and supportive histopathological findings. The patient was treated successfully with oral linezolid and rifampicin. This case adds to a growing literature implicating S. xylosus as a human pathogen, and highlights the importance of implant sonication to identify the causative organism and establish a diagnosis of an IAI.

BACKGROUND:Carbapenem-resistant Enterobacterales (CRE) represent a major therapeutic challenge, particularly in high-resistance settings where metallo-β-lactamases and aminoglycoside resistance mechanisms may coexist. Plazomicin, a next-generation aminoglycoside designed to evade many aminoglycoside-modifying enzymes, may retain activity against selected CRE isolates; however, its utility in Indian settings remains uncertain. OBJECTIVES:To evaluate the in vitro susceptibility of CRE isolates to plazomicin and compare its activity with conventional aminoglycosides, including amikacin, gentamicin, and netilmicin, with species-wise and phenotypic subgroup analysis. METHODS:This laboratory-based cross-sectional study included 106 non-duplicate CRE isolates from a tertiary care centre in North India. Isolates were analysed by specimen source, species distribution, plazomicin susceptibility, comparative aminoglycoside susceptibility, ceftazidime-avibactam (CZA) susceptibility, and ceftazidime-avibactam and aztreonam synergy testing. Statistical comparison of aminoglycoside susceptibility was performed, including paired analysis for Klebsiella pneumoniae using McNemar's exact test. RESULTS:Among 106 CRE isolates, most were from respiratory specimens 60/106; 56.6%), followed by blood (23/106; 21.7%). Overall, plazomicin susceptibility was 41.5% (44/106), higher than gentamicin (26.4%), amikacin (19.8%), and netilmicin (18.9%), with a statistically significant overall difference (χ2 = 17.80, df = 3, p = 0.00048). Species-wise susceptibility was highest among Escherichia coli (16/27; 59.3%) and lower among Klebsiella pneumoniae (28/76; 36.8%). In K. pneumoniae, paired analysis showed significantly greater susceptibility to plazomicin (36.8%) than gentamicin (19.7%), amikacin (13.2%) and netilmicin (10.5%) with significantly higher paired susceptibility (McNemar exact p < 0.001 for all comparisons). Among ceftazidime-avibactam (CZA) resistant, Aztreonam (AT) synergy-negative E. coli, 6/9 (66.7%) remained plazomicin-susceptible. CONCLUSION:Plazomicin demonstrated significantly greater in vitro activity than conventional aminoglycosides against CRE, but overall susceptibility remained limited. Its role in high-resistance Indian settings should be selective and guided by phenotypic susceptibility testing rather than empirical use.

Sphingomonas paucimobilis is a non-fermenting, Gram-negative bacterium, an emerging pathogen. It is associated with various clinical presentations, both healthcare-associated as well as community-acquired infections, especially in immunocompromised patients. On account of its rarity, it is seldom identified and reported by Microbiology laboratories. We report an unusual case of S. paucimobilis urinary tract infection (UTI) where a clinically significant pure isolate of non-lactose fermenting (NLF) was isolated from a patient with renal dysfunction. However, advanced automated systems such as Matrix-assisted laser desorption/ionisation time of flight mass spectroscopy (MALDI-TOF MS) failed to accurately identify the organism, prompting the use of biochemical tests, through which S. paucimobilis was ultimately identified. In the absence of standardised guidelines, antimicrobial susceptibility-guided, tailor-made treatment is warranted with prompt initiation for favourable outcomes in such cases. This case highlights the diagnostic challenges associated with such rare organisms and the importance of conventional microbiological techniques in the identification of these emerging pathogens.

Latent viral reservoirs remain a major barrier to curing HIV-1, with the long-terminal repeat (LTR) and Tat playing crucial roles in regulating viral transcription. Subtype-specific transcription factor binding site (TFBS) variations within the LTR significantly influence latency and reservoir stability. In earlier work, we identified HIV-1C LTR variants with duplicated TFBS motifs, including NF-κB, AP1, RBEIII, and TCF-1α/LEF-1. Using five cell models, including Jurkat and primary CD4⁺ T cells, we compared canonical R-LTR and variant R2-LTR strains. Across sub-genomic reporters, single-round infections, and full-length viral vectors, we found that the balance between RBEIII and NF-κB motifs governs stability of latency. The ‘two-viruses-one-cell’ system that normalized confounding environmental factors further revealed that latency is primarily controlled by intrinsic transcriptional circuits rather than external stimuli. In longitudinal studies of HIV-1⁺ individuals from acute and chronic infection phases, we observed dominant R strains during early infection and the spontaneous emergence of R2 strains in nearly half of chronic-phase subjects, a process accelerated by ART. Upon CD4⁺ T cell activation, R strains preferentially rebounded, while R2 strains showed strong resistance to reversal, even in subjects harbouring a co-infection. Together, these findings establish the clinical significance of LTR variation in latency regulation and identify the R2 phenotype as a critical determinant of reservoir persistence. These results underscore the importance of addressing reservoir heterogeneity in cure strategies, particularly in HIV-1C-prevalent regions. ### Competing Interest Statement The authors have declared no competing interest. * TFBS : Transcription factor binding site HIV-1C : HIV-1 subtype C LTR : Long Terminal Repeats C-LTR : HIV-1C LTR NGS : Next-generation sequencing RT-PCR : Reverse transcription polymerase chain reaction MTRC : Master transcription regulatory circuit TFC : Transcription factor complex PBMC : Peripheral Blood Mononuclear Cell TILDA : Tat/Rev Induced Limiting Dilution Assay gDNA : genomic DNA cDNA : complementary DNA pRNA : Plasma RNA LFU : Lost-to-Follow-Up PTC : Post-Treatment Control ART : Anti- Retroviral Therapy Department of Biotechnology, https://ror.org/03tjsyq23, BT/PR7359/MED/29/651/2012, BT/NETHERLANDS/RG/40/2015 United States Agency for International Development, AID-OAA-A-16-00032 Science and Engineering Research Board, https://ror.org/03ffdsr55, SPR/2021/000338-G Gennova Biopharmaceuticals Ltd., Corporate Social Responsibility Funds

This study aimed to evaluate the in vitro activity of sulbactam-durlobactam (SUL-DUR), a novel β-lactam/β-lactamase inhibitor combination, against carbapenem-resistant Acinetobacter baumannii (CRAB) clinical isolates from a tertiary care facility in north India. Special focus was placed on extensively drug-resistant (XDR) strains, a subgroup which is likely to be underrepresented in global surveillance.A total of 100 non-duplicate CRAB clinical isolates were included in the study. Isolates were obtained from various clinical specimens, primarily respiratory samples, and characterized using MALDI-TOF MS. Susceptibility testing for SUL-DUR was performed using both broth microdilution (BMD) and disk diffusion (DD) in accordance with CLSI M100, 35th edition guidelines. Quality control was ensured using A. baumannii NCTC 13304 strain. Descriptive analysis and categorical interpretations were employed to evaluate susceptibility patterns. Of the 100 CRAB isolates, 80

Acute bacterial meningitis (ABM) is a medical emergency that requires early diagnosis and prompt treatment. Understanding bacterial etiology and resistance patterns is critical for optimal management and reduction of mortality. Nucleic acid amplification tests, with high sensitivity and rapid results, are valuable for diagnosing ABM. This study aimed to identify the etiological agents of acute bacterial meningitis in children aged 1–59 months in India. 2004 CSF were collected from Children aged 1–59 months admitted to the ward/ ICU of seven study sites with probable meningitis between 2019 and 2023. The samples were subjected to conventional culture, 16s rRNA PCR, real-time Multiplex PCR for detecting S.pneumoniae, H.influenzae type b, N.meningitidis, and Quadraplex real-time Multiplex PCR to determine S.pneumoniae serotypes. A total of 2,004 cerebrospinal fluid (CSF) samples were analysed for ABM in children over a 51-month period. The majority of cases (61