Cefiderocol (FDC) shows promise against carbapenem resistance, with differing carbapenemase epidemiology across Southeast and East Asia, including India. This study evaluated the susceptibility of carbapenem-resistant Klebsiella pneumoniae (CRKP) and carbapenem-resistant Acinetobacter baumannii (CRAB) against FDC and assessed carbapenemase genetic influences on susceptibility. A total of 100 clinical isolates of CRAB and 100 clinical isolates of CRKP were studied. The minimum inhibitory concentration for FDC, ceftazidime-avibactam (CZA), aztreonam, polymyxins in CRKP, and polymyxins and minocycline in CRAB was determined by the broth microdilution method. Carbapenemases were detected using the ethylenediaminetetraacetic acid-modified carbapenem inactivation method in CRKP and the modified Hodge test for CRAB. The confirmation of carbapenemases (blaSME, blaNMC, blaGES, blaKPC, blaIMP, blaVIM, and blaNDM for all; blaOXA-48 in CRKP; and blaOXA-23 like blaOXA-24/40 and blaOXA-58 in CRAB) was performed by multiplex PCR. FDC resistance in CRKP and CRAB was 1% and 6%, respectively. CRKP isolates showed significant resistance to polymyxin B (31%), colistin (21%), aztreonam (34%), and CZA (41%; p < 0.05) as compared to FDC, while CRAB isolates exhibited higher FDC resistance (p < 0.05). Moreover, 96% of CRKP and 100% of CRAB were carbapenemase producers. For CRKP, blaOXA-48 + blaNDM combination and for CRAB, blaNDM was significantly associated with FDC resistance. The study revealed the presence of blaNDM as one of the causes for reduced susceptibility to FDC in these isolates.

Background and Aims: Traditional didactic lecture methods were previously dominant in medical education in India, where students tend to lose their concentration after 15–20 min of lectures. In the context of competency-based medical education, a teaching–learning method that includes pre- and posttests were hypothesized to have the potential to enhance the learning process and make difficult topics easier for students to understand. This method was implemented for phase 2 MBBS students at Rampurhat Government Medical College and Hospital in India. Materials and Methods: The study was conducted in the department of microbiology in October 2021, with 65 male and 33 female students who provided informed consent. All the students were allotted immunology topics and were asked to present seminars. The students were required to complete a pretest and posttest questionnaire covering key areas of immunology. The mean and standard deviation of the scores were calculated. Paired Student’s t -test was used to compare pre- and posttest scores, and P values were calculated using SPSS 20. A P < 0.05 was considered statistically significant. Results: The total number of correct responses on the posttest was significantly higher ( P < 0.05) than the number of responses on the pretest. Gender-specific posttest responses were also significant (for males, P < 0.001; for females, P < 0.001). Overall marks were improved on the posttest, and the mean scores among all the students showed significant improvement in their posttest scores compared to their pretest scores. Conclusions: Evaluating students using a pretest and posttest was found to be a practical and feasible tool for learning. The majority of students reported that this method of learning helped them engage in critical thinking and understand topics more systematically, which they believed would contribute to their success as competent Indian Medical Graduates.

Introduction: Pyoderma is a common health problem characterised by pyogenic infections of the skin and its appendages. Though easily treatable, the condition is known for its chronicity, recurrence and other complications. Therefore, timely recognition and prompt bacterial diagnosis with antimicrobial sensitivity is imperative for the effective management and treatment of pyoderma. It is a common bacterial skin infection accounting for nearly 25% of patients attending Dermatology Outpatient Department (OPD) in India and other tropical countries. Aim: To determine the incidence of pyoderma in relation to age, sex and socio-economic status, to isolate and identify the common aerobic microbial pathogens associated with pyoderma prevalent in the community and antibiotic susceptibility pattern. Materials and Methods: An institutional based cross-sectional observational study was conducted on 148 cases in Department of Microbiology, Rampurhat Government Medical College and Hospital, Burdwan, West Bengal, India, clinical features of suspected pyoderma for a period of 12 months from March 2021 to February 2022. Lesion swabs were collected and isolates were identified; antibiotic susceptibility testing was also performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines using antibiotic discs. Descriptive data was presented as count and percentages. Results: Out of 148 samples collected 144 (97.3%) were culture positive while, rest 04 (2.7%) were culture negative. Overcrowding and low socio-economic group were closely related with pyoderma patients. Primary pyoderma (72.2%) cases were detected more than the secondary (27.8%) cases. Impetigo contagiosa (54%) were detected more among the primary pyoderma patients. High numbers (66.7%) of pyoderma were detected among children (0 to 10 years). The culture positive samples were more in male patients (68.7%) than in female patients (31.3%) and mostly detected from OPD. Out of 144 isolates, 89 (61.8%) were Staphylococcus aureus, 23 (15.9%) isolates were Coagulase Negative Staphylococci (CoNS) and 04 (2.8%) were Streptococcus pyogens. Further 06 (4.2%) isolates of Pseudomonas aeruginosa, 10 (6.9%) isolates of Escherichia coli and 08 (5.5%) isolates of Klebsiella pneumonia were found. Conclusion: The present study results suggest that the era of antibiotics has ushered in an unprecedented predominance of Staphylococcal rather than Streptococcal infections and other gram negative infections for pyoderma cases. Increasing incidence of methicillin, quinolones and amikacin resistance in Staphylococci and other gram negative isolates have limited treatment options. For this, a single infection like pyoderma is challenging in all the healthcare facility.

Background: The ideal dosage, timing, and duration of corticosteroid therapy in covid-19 patients has not yet been determined, and it continues to remain a grey territory. Methods: A multi-centric retrospective cohort study was conducted among hypoxic COVID-19 patients divided into three groups based on the timing and initiation of corticosteroids concerning onset of symptoms- Group A(on or before day-6), Group B (day 7-9) and Group C (on or after day 10) with further subdivision into high dose and low-to-moderate dose steroid recipients. To estimate the primary outcome(mortality benefit), survival analysis was done using the Cox proportional-hazard model with a propensity score-based method. The secondary outcome was assessed by Kruskal-Wallis test and post-hoc Dunn test for any difference in predefined exposure variables. Findings: A total of 505 patients were included. Cox regression showed a higher risk of hospital death in high doses of corticosteroid recipients in both Group-A[HR=5·036, 95% CI 2·461-10·302, p-value <0·0001, N=114] and Group-B[HR=3·375, CI 1·91-5·94, p-value<0·0001, N=251]. The mortality rate in Group C was the lowest, 13·47%(N=141), and no significant statistical difference was found(P-value= > 0·05) between the two groups of steroid recipients. Kruskal-Wallis and posthoc Dunn testing among pre-defined exposure variables showed statistical significance for the N/L ratio. Interpretation: High dose of corticosteroid initiated early in the course of the disease would increase the overall mortality compared to a low-moderate dose. N/L ratio, a marker of the individual immune response, could be a significant predictor for determining the appropriate dosage of corticosteroid therapy.Funding: Self fundedDeclaration of Interest: This study is a non sponsored investigator-initiated academic study; all the researchers declare no conflict of interestEthical Approval: Permission was duly obtained from the Institutional Ethics Committees of the two institutes.

Introduction: Scrub typhus is a vector-borne zoonotic disease caused by Orientia tsutsugamushi, obligate intracellular gram negative bacteria. It is transmitted by the larval stage of mites (“chiggers”) in the family Trombiculidae. The disease is endemic in many parts of India and continues to be a public health problem. Aim: To study the clinical and demographic characteristics of the scrub typhus patients in a peripheral medical college of West Bengal, India. Materials and Methods: Present study was a retrospective study enrolling 66 confirmed positive cases with Enzyme Linked Immunosorbent Assay (ELISA) test during the period from 1st September 2021 to 31st December 2021 at Department of Microbiology, Rampurhat Government Medical College and Hospital, Rampurhat, West Bengal, India. Results: The clinical and demographic characteristics of the scrub typhus patients’ majority were below age of 15 years i.e. (72.7%), in which females (65.2%) were more compared to male (34%). Most of the study participants were from rural area (76.8%). Majority of study subjects presented with fever (94%), fever with chills (36.4%), cough (24.2%), altered sensorium (25.8%). Maximum cases 42 (63.6%) had occurred in the month of September followed by 11 (16.7%) in October, and November and 02 (3.0%) case reported in December 2021. About 15.3% study population had expired where as 84.7% survived. Conclusion: Current study shows that majority of the cases occurred in the month of September 2021 with female preponderance. Most of the residents were from rural areas with common clinical symptoms with fever with or without chills and breathlessness, headache, altered sensorium and skin lesions

Background: Corticosteroid dosing in COVID-19 cases associated with early-onset and late-onset hypoxia have not been separately explored.Methods: In this retrospective cohort study, we divided hypoxic COVID-19 cases into groups based on timing of initiation of corticosteroids relative to onset of symptoms; Group A ( <= 6th day), Group B (7th-9th day) and Group C ( >= 10th day), each group being sub-grouped into high and low-to-moderate dose corticosteroid recipients. Cox regression with propensity scoring was used to compare 28-day mortality between high and low-to-moderate dose recipients separately in Group A, Group B, Group C.Results: Among 505 patients included, propensity score matched Cox regression showed greater risk of all-cause mortality among high dose recipients in Group A [HR = 7.35, 95%CI 3.36-16.11, p-value < 0 center dot 01, N = 114] and Group B [HR = 3.17, 95%CI 1.65-6.07, p-value < 0 center dot 01, N = 251]. In Group C, mortality was lowest [12.8% (18/140)] with no significant difference between sub-groups [HR = 2.52, 95%CI 0.22-29.15, p-value = 0.459, N = 140]. KruskalWallis Test between Group A, Group B and Group C for six pre-defined exposure variables showed significant differences for Neutrophil:Lymphocyte Ratio (NLR).Conclusion: When steroids were initiated early (owing to an earlier onset of hypoxic symptoms), a high dose of corticosteroid was associated with greater overall 28-day mortality compared to a low-to-moderate dose. NLR, a marker for individual immune response, varied between treatment groups.

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic was declared by the World Health Organisation (WHO) on 11th March 2020 caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). As a preventive measure, valid information concerning the development of antibodies is being collected for assessing the progress towards herd immunity of COVID-19. Aim: To assess the level of Anti-SARS-CoV-2 IgG before and after vaccination by two doses of ChAdOx1 nCoV 19 vaccine in a rural Medical College of West Bengal. Materials and Methods: The present interventional cohort study was conducted in a rural Medical College and Hospital, West Bengal, India, from February 2021 to August 2021. Total 248 willing subjects were included for this interventional study from the same socio-economic and geographical distribution depending upon a vaccine population of a rural Medical College of West Bengal. To measure the anti-SARS-CoV-2 IgG antibody authors used Indian Council of Medical Research-National Institute of Virology (ICMRNIV) certified Anti-SARS-CoV-2 human IgG ELISA COVID KAVACH MERILISA kit and approved protocol by the ICMR. Results: The median age of study population was 39 years (range 25-64) with 97 (39.1%) females and 151 (60.9%) males. It was found that antibody response induced by two doses of vaccination was significantly high (t-value: 28.421, p<0.001) in the vaccinated population. Conclusion: Thus, present study suggests that vaccination may be critical to develop anti-SARS-CoV-2 IgG antibody. This would lead to a better understanding of the immunisation program and prevention of severe disease and deaths due to COVID-19.

Background: The incidence of diabetes mellitus (DM) throughout the world is increasing strikingly and is becoming a serious public health problem especially in the developing countries. Infections are important cause of death in diabetes and remain a very important cause of morbidity and mortality in people with diabetes. Most common type of diabetes in Indian population is type 2 DM. Most common infection associated with DM found to be urinary tract infections (UTI). Objective: The main objectives of this study were to isolate, identify and to determine antimicrobial susceptibility pattern of microbiological agents of UTI in type 2 DM patients and assess prognosis of these patients with prescribed antimicrobial treatment regimen. Results and Discussions: We conducted the study from December 2013 to December 2018 in the department of microbiology from the patients attending the outpatients department of a tertiary care hospital. In this study, total 774 non-repetitive patients’ samples were included but 14 samples were contaminated and lost from follow-up. Thus, available data for analysis were 760 samples. Total 254 samples showed significant growth (32.82%). Most common isolated pathogen was Escherichia coli. In our study, 17.82% patients were asymptomatic but culture positive. The asymptomatic patients with positive urine culture turn up with symptomatic UTI, often with complications. Conclusion: UTI with multidrug-resistant organism in outpatients has emerged; limiting the treatment options in the high-risk groups. The need for an antibiotic policy based on adequate and continuous monitoring of susceptibility patterns in the institutions is recommended.

Introduction: Carbapenemase producing enterobacteriaceae (CPE) isolates have now emerged worldwide. Resistance to carbapenems is mainly due to production of beta-lactamases inactivating carbapenems (carbapenemases) included in classes A, B, C, or D of the Ambler classification. In Enterobacteriaceae carbapenemase encoding genes are often located on plasmids that contribute to a rapid spread among clinically relevant gram negative bacteria. Rapid and reliable detection of carbapenemase production is needed for therapeutic and control reasons. Aims: To compare the different phenotypic methods of carbapenemase detection namely, the modified paper strip carba NP method, the CLSI Carba NP method, the carbapenem inactivation method, and for rapid detection of CPE. Materials and methods: A total of 200 CPE from urine, pus, and blood cultures sent to the Microbiology Laboratory, R.G. Kar Medical College and Hospital (RGKMCH), were tested for the modified paper strip carba NP method, the CLSI Carba NP method, and the carbapenem inactivation method. Results and analysis: Out of 200 isolates, 108 isolates of Klebsiella spp and 92 isolates of Escherichia coli were compared for carbapenemase production by various phenotypic methods. In total, 100(93%) isolates of Klebsiella spp and 88 (95%) isolates of Escherichia coli showed positive results by paper strip and carba NP methods. A total of 96 (89%) isolates of Klebsiella spp and 84 (91%) isolates of Escherichia coli showed positive results by CLSI carba NP method. A total of 104 (96%) isolates of Klebsiella spp and 92 (100%) isolates of Escherichia coli showed positive results by CIM method. Conclusion: Rapid and accurate detection of carbapenemase producers are important for preventing their spread in health care settings. Although genotypic tests remain the gold standard but cannot practically be conducted because they are highly expensive and results are limited by the targets. The different phenotypic methods used in this study were inexpensive, rapid, highly sensitive, and specific. The modified paper strip Carba NP method in this study is a simple and rapid method compared to those performed by the CLSI method.

Introduction: Healthcare associated infections(HAI) by multi-drug resistant organisms(MDRO) are major cause of mortality and morbidity having significant impact on quality of life and economic burden.HAI by carbapenem-resistant Pseudomonas aeruginosa (CRPsA) and Acinetobacter baumannii (CRAB) are emerging threat for their high antibiotic resistance and spread via mobile genetic elements.Objectives of this study were to detect prevalence of CRPsA and CRAB infections in a tertiary care hospital of Eastern India and to determine their antimicrobial resistance profile. Material and methods: This observational study was done inDepartment of Microbiology from January 2018-June 2019.From HAI patients, different clinical samples were collected.Culture and identification by standard conventional methods and antimicrobial susceptibility tests by modified Kirby-Bauer disc-diffusion method following CLSI guidelines were performed.CRPsA and CRAB cases were identified when isolates were resistant to ≥1 carbapenem, 10µg imipenem disc(zone diameter ≤15mm for P. aeruginosa or ≤18mm for A. baumanii) or meropenem disc (≤15mm for P. aeruginosa or ≤14mm for A. baumanii).Result: From 27,043 clinical samples, 1785(6.6%)Acinetobacter baumannii and 777(2.87%)Pseudomonas aeruginosa were isolated.CRAB and CRPsA prevalence were 74.17% and 62.29% respectively.Carbapenemresistance were further categorised into imipenem-resistantmeropenem-resistant (IRMR) (A.baumanii-63.19%,P. aeruginosa-51.61%), imipenem-resistant-meropenemsensitive (IRMS) (A.baumanii-10.48%,P. aeruginosa -9.13%), meropenem-resistant-imipenem-sensitive (MRIS) (A.baumanii -0.51%, P. aeruginosa -1.54%) phenotypes.Fourth category was imipenem-sensitive-meropenemsensitive (ISMS) (A.baumanii -25.82%,P. aeruginosa -37.71%).Carbapenem-resistant groups showed significantly high resistance for all antibiotics excepting colistin. Conclusion:Carbapenems are often used for treating MDRO.But high carbapenem-resistance in HAI is alarming, warranting judicious use of antibiotics.

INTRODUCTION: Primary breast abscesses occur both in the puerperal and nonpuerperal settings and affect women of all ages. Breast abscesses are a common complication of the postpartum period afflicting 9%–33% of all lactating women. Incision and drainage with postoperative antibiotic drugs has been suggested as the treatment of choice but data regarding the bacteriological profile and antibiotic susceptibility is lacking. AIMS AND OBJECTIVES: To find out the risk factors, bacteriological profile along with antibiotic susceptibility pattern of breast abscess cases. MATERIALS AND METHODS: A total of 136 breast abscess cases were studied over a period of 1 year to identify the risk factors and to isolate the organisms. RESULTS: Among 136 cases 88 (64.7%) were suffering from puerperal breast abscess whereas 48 (35.3%) patients suffered from nonpuerperal breast abscess. Staphylococcus aureus was the predominant pathogen, of which 57.35% showed methicillin resistance. Young age, primiparous, difficulty in lactation came out to be the most important risk factors for development of puerperal breast abscess whereas diabetes mellitus was the predominant risk factor for nonpuerperal breast abscess. DISCUSSION: This is the first study from India in recent past to evaluate the susceptibility patterns of bacterial isolates from breast abscesses as well as risk factors for development of breast abscesses which highlights probably the emergence of community-acquired methicillin-resistant S. aureus as a predominant pathogen of breast abscess cases.

Introduction: Fosfomycin trometamol is a phosphonic acid derivative, which acts primarily by interfering with bacterial peptidoglycan synthesis with broad spectrum of activity against agents causing urinary tract infections (UTIs) with good antibiofilm activity and limited reports of resistance. There are limited studies from India regarding the efficacy of the drug, so the study was conducted to determine the in vitro efficacy of fosfomycin. Materials and Methods: Two hundred and thirty nonrepetitive urinary isolates over a period of 4 months were included in the study. Antibiotic susceptibility and extended-spectrum β-lactamase (ESBL) detection following the Clinical and Laboratory Standards Institute guidelines were performed. Results: One hundred and seventy (73.91%) out of the 230 urinary isolates were sensitive to fosfomycin in our study with equivalent efficacy among outdoor and indoor patients. Among the Gram-positive isolates, 34 (60.71%) out of 56 isolates were sensitive to fosfomycin. Among the Gram-negative isolates, 136 (78.16%) out of 174 were sensitive to fosfomycin which was higher than other commonly used drugs for UTI. ESBL production did not affect the overall susceptibility to the drug. Conclusion: The convenience of a single-dose regimen, broad range of activity proven in vitro and in vivo, and minimal propensity for promoting resistant pathogens make fosfomycin an attractive regimen for the treatment of complicated and uncomplicated community- and hospital-acquired UTIs. This study also reveals an alarming finding of high level of resistance among Klebsiella spp., which could well turn out to be a limiting factor in the clinical usefulness of this drug, which warrants further clinical studies regarding the drug in India.

Background: Extended-spectrum beta-lactamase (ESBL)-producing strains are causing an increasing problem worldwide. Infection control is most effective when ESBL strains are detected by rapid, sensitive, and specific tests and an early implementation of appropriate antibiotic therapy is initiated. Recently, a rapid and cost-effective biochemical test for the detection of ESBL, the ESBL Nordmann/Dortet/Poirel (NDP) test, has been implemented. Aims: The aim of the study was to detect ESBL by a rapid NDP test. Settings and Design: The prospective study was conducted in the Department of Microbiology at a tertiary care hospital. Materials and Methods: A total of 208 isolates were subjected to the ESBL NDP test. Simultaneously, these isolates were also tested for ESBL production by double-disc synergy test (DDST) method. The ESBL NDP test was also used directly with spiked blood cultures inoculated with ESBL producers and non-ESBL producers. Statistical Analysis Used: Descriptive statistics such as mean and ratio are used for the interpretation of the study. Results: Using the ESBL NDP test, 80 of 208 (40%) of the tested isolates produced ESBL, among which Escherichia coli were 56 (70%) and Klebsiella pneumonia were 24 (30%) which showed positive result. Our results, done directly on clinical isolates as well as on spiked blood cultures inoculated with them, showed a perfect correlation between the ESBL NDP test and DDST in detecting ESBLs. Conclusion: This inexpensive ESBL NDP test might be implemented worldwide, especially in resource-limited settings of developing countries to optimize rapid choices of antibiotics for treating severe infections and avoidance of overuse of carbapenems.

Introduction:The emergence of colistin or tigecycline resistance as well as imipenem resistance in Acinetobacter baumannii poses a great therapeutic challenge. Increasing reports of polymyxin heteroresistance have suggested that rapid resistance to polymyxins can develop upon treatment with polymyxin B monotherapy, especially upon exposure to subtherapeutic polymyxin concentrations. To circumvent this phenomenon, experts have advocated that polymyxins should be used in combination with one or more antibiotics for the treatment of carbapenem resistant isolates. Aims & Objectives: The aim of this study is to assess the in vitro activity of different combinations of polymyxin B, rifampicin, meropenem and tigecycline against selected clinical isolates of A. baumannii . Materials & Methods: Twelve representative imipenem-resistant A.baumannii clinical isolates were included in present study. Minimal inhibitory concentration (MIC) was determined using agar dilution method according to Clinical and Laboratory Standards Institute (CLSI) guideline.Time-kill studies were performed on four antimicrobial agents and combinations of these agents according to a previously reported method. Results: Only polymyxin-B was consistently effective as a single agent against all 12 isolates, but showed bacterio-static activity when used singly. Among the combinations of 0.5 x MIC antimicrobial agents, the combination of polymyxin-B and tigecycline showed synergistic or bactericidal effects against 8 of the isolates. Antimicrobial combinations are effective for killing imipenem-resistant A. baumannii isolates, even if they are simultaneously resistant to either carbapenems or tigecycline. Discussion & Conclusions: The Time-kill assay method used in this study can be used for individualized treatment of patients suffering from critical infections caused by extremely drug resistant Acinetobacter isolates. The use of these lower MIC values obtained from synergy studies can be as a guide to determine effective individualized therapeutic doses can help to decrease the emergence of resistance and can also minimize the side effects associated with using a single agent at a higher dose.

Whereas previously only regarded as an innocuous commensal microorganism on the human skin, Staphylococcus epidermidis is nowadays seen as an important opportunistic pathogen. In particular, S. epidermidis represents the most common source of infections on indwelling medical devices such as peripheral or central intravenous catheters. Linezolid, the first approved oxazolidinone antibiotic, is a useful therapeutic option in the management of infections caused by multidrug-resistant Gram-positive bacteria. The previous administration of linezolid has been reported to be an independent predictor of linezolid resistance in coagulase-negative staphylococci (CoNS). Cases of patients developing infections with linezolid-resistant CoNS in the absence of prior exposure to linezolid have also been reported. The source of the resistant strain remains undetermined, but the clonal spread of CoNS has been reported to occur within hospitals, and therefore, the possibility of nosocomial transmission from patients colonized with linezolid-resistant CoNS following linezolid exposure needs to be entertained. Besides linezolid resistance, linezolid dependence has also been documented. All harboring linezolid-dependent linezolid-resistant S. epidermidis (LRSE) had prolonged linezolid treatment before yielding LRSE. This exposure also may have fostered the transition from resistance to dependence as suggested previously in vancomycin-dependent enterococci. Therefore, the high intrahospital linezolid consumption may favor not only LRSE selection but also their competitive survival. Should linezolid dependence prove common in highly LRSE isolates, it could explain their increasing clinical occurrence and the emergence of LRSE outbreaks. Our reports describe the first few cases of clinical failure of linezolid treatment due to LRSE in India.

Introduction: CLSI recommends that until laboratories can implement the revised carbapenem MIC interpretive criteria, the Carba NP test (or an alternative confirmatory test for carbapenemases) should be performed when isolates of Enterobacteriaceae are suspicious for carbapenemase production based on imipenem or meropenem MICs of 2–4 μg/mL or ertapenem MIC of 2 μg/mL. CLSI recommends that for isolates that are Carba NP positive, report all carbapenems as resistant, regardless of MIC. If the Carba NP test is negative, interpret the carbapenem MICs using CLSI interpretive criteria as listed in Table 2A in M100-S20 (January 2010). Aim and objectives : To compare different phenotypic methods of carabapenemase detection namely, the CNPtdirect, the Blue-Carba test, the Carbapenem Inactivation Method in comparison to the Modified Hodge test. Material and Methods: The CNPt-direct, the Blue-Carba test, the Carbapenem Inactivation Method in comparison to the Modified Hodge test were performed to detect Carbapenemase production. Results and Analysis: 70 isolates of Klebsiella spp., 26 isolates of E.coli, 52 Pseudomonas spp. and 56 Acinetobacter spp. were compared for carbapenamase production by the various phenotypic methods as described before. Among all the phenotypic tests, the least detection rate for carbapenamase production in comparison with MHT was for the BCT. The rest of the tests showed good correlation with MHT results. Discussion: CNPt-direct and BCT could also be used to quickly identify carbapenem-resistant isolates from critically ill patients, despite their limitation to detect OXA expressing isolates, while the CIM can be used routinely for detection in other clinical isolates in resource limited settings. -------------------------------------------------------------------------------------------------------------------------------------Date of Submission: 1512-2017 Date of acceptance: 22-2-2017 --------------------------------------------------------------------------------------------------------------------------------------

Introduction-Chemical substances with antiseptic, disinfectant, and/or preservative activity have been defined as biocides. Chlorhexidine (CHX) is a biguanide compound, widely used in a clinical practice as a skin and mucous membrane antiseptic and disinfectant. However, bacterial resistance to CHX has been detected but there is a lack of simple method for routine testing of CHX susceptibility. Increasing frequency of hospital infection leads to overuse and pressure of biocides, similarly to antibiotics. The linkage between bacterial resistance and the use of biocides has been suggested. ObjectiveDetection of decreased CHX susceptibility of clinical isolates from different wards in association with drug resistance pattern of these isolates. Materials And Methods: The clinical isolates were isolated from various clinical samples obtained from wards and ICU. The MIC of chlorhexidine digluconate for all clinical isolates was determined as per CLSI guideline and antibiotic resistance pattern was noted. ResultsAmong 235 isolates 47 showed MIC of >256 g/ml and these isolates showed statistically significant (P value  0.05) association between decreased susceptibility to CHX and resistance to sulfamethoxazoletrimethoprim, cephalosporin, carbapenem, aminoglycoside, penicillin with  lactamase inhibitors group of antibiotics. Thirty one isolates with MIC > 512 mg/L showed statistically significant (P value  0.05) association between decreased susceptibility to CHX and resistance to Sulfamethoxazole-trimethoprim, carbapenems and aminoglycoside group of antibiotics ConclusionThis study raises an important question whether the indiscriminate use of CHX in hospital settings might select the multi-drug resistant organisms to be the predominant flora in the hands of health care providers which in turn might be transmitted to the patient. Especially in view of the fact that biocides when used on the unclean and wet surfaces might itself promote the development of CHX resistance. Thus this study highlights the point that CHX resistance might itself trigger antibiotic resistance.

Introduction: Infection of the prosthesis remains one of the most devastating complications of arthroplasty surgery. Identification of the likely cause of early-onset PJI is particularly important given that these infections are more frequently treated with a debridement procedure where the implant is not removed. Aim and objectives: To identify the microbiological aetiology of prosthetic joint infections and to identify the antimicrobial susceptibility pattern in order to propose the treatment guidelines of PJI based on the duration of onset of symptoms. Material and methods: Synovial fluid collected preoperatively, periprosthetic tissue and the removed prosthesis were processed following standard laboratory protocols set up by the Mayo Clinic. Results:The primary gram stain from culture positive samples was positive in 81/111 (72.97%) samples. Gram negative bacteria constituted majority of the isolates (57/75) (76%) identified from early onset of infection of which Acinetobacter baumannii was the commonest and was significantly associated with early onset infection, while MRSA was associated significantly with delayed onset infection and CONS was significantly associated with late onset infection. Discussion: This study highlights the importance of gram negative pathogens (76%) in early onset of infection, which showed a high incidence of resistance to β lactam and β lactam inhibitor combinations which might be due to the high incidence of ESBL in both community and hospital acquired infections. Multi-drug resistance among the isolates advocates the case for reconsideration of existing protocols for surgeries involving prosthesis which might potentially decrease the incidence of PJIs and reduce patient morbidity and mortality. Treatment modalities can be determined based upon the database generated in individual institutions

Background:Quinolone resistance in Enterobacteriaceae usually results from mutations in genes carried by chromosomally encoded type II topoisomerases, efflux pumps, or porin-related proteins.Since 1998, plasmid-mediated quinolone resistances (PMQR) have been described.Recently, a new mechanism of transferable quinolone resistance was reported: enzymatic inactivation of certain quinolones.AAC(6′)-Ib-cr is a variant of AAC(6′)-Ib which encodes an aminoglycoside acetyltransferase that confers reduced susceptibility to ciprofloxacin or norfloxacin.. PMQR determinants are often combined with extended-spectrum beta-lactamases (ESBLs) leading to organisms possessing multi drug resistance. Aims & Objectives: To study the incidence of AAC(6′)-Ib-cr expression in Enterobacteriacae isolates by phenotypic method and to find any correlation between the genetic expression of AAC(6′)-Ib-cr along with ESBL production. Materials and methods:The 430 clinical Enterobacteriaceae isolates exhibiting ciprofloxacin and norfloxacin resistance were included in this study.They were grown in Luria-Bertani Broth ( LB broth) containing norfloxacin (8 µg/ml), with intermittent shaking for 18 h at 35°C.Ten microliters of each culture medium was applied on the blank disk set on a Mueller-Hinton agar plate inoculated with E. coli ATCC 25922 and incubated for 18 h at 35°C.A significant decrease of a growth-inhibitory zone by ≥ 10 mm was considered as a positive test for the production of aac(6′)-Ib-cr, while aac(6′)-Ib-cr production was considered not to be produced in strains which did not show any reduction in the zone of inhibition. Results: The overall expression of the AAC(6′)-Ib-cr did not show much variation with almost half of the isolates from all the different samples showing AAC(6′)-Ib-cr production with blood isolates showing aproduction as high as 66.77%.).A significant association was noted with ESBL production and the simultaneous expression of AAC(6′)-Ib-cr in both E.coli (P value <0.0001) and K.pneumoniae isolates (P value = 0.0137 )which were the two most predominant isolates in the study.A significant association (P value 0.0442) was observed between aminoglycoside resistance and AAC(6')-Ib-cr expression in E.coli isolates only, while no significant association was observed (P value= 0.7763) in K. pneumonia isolates.Conclusion: AAC(6′)-Ib-cr, though being a recently described gene has high degree of expression in Enterobacteriaceae isolates, which not only confers resistance to fluroquinolones and aminoglycosides but also is coexpressed with ESBL genes, thus producing a scenario of multi drug resistant organisms, further increasing the burden on our limited armamentarium against these bacteria.

Introduction: Urinary tract infection (UTI) is a common bacterial infection in children and associated with significant morbidity. Recently, UTI has become more difficult to treat because of the appearance of multidrug resistance pathogens. Objectives: The main aim of this study was to evaluate the changing trends of etiology, and antibiotic susceptibility pattern of urinary isolates in children of 0-12 year age group attending our hospital. Materials and Methods: A total of 930 urine samples were analyzed from children aged 0-12 years complaining of fever with or without urinary symptoms attending pediatric out- or in-patient of a tertiary care hospital from March 2011 to September 2012. In children under 2 years, urine sample was collected in a sterile bag and in above 2 years freshly passed clean-catch mid-stream urine was collected. All specimens were subjected to urine culture and sensitivity tests. Results: Significant bacteriuria was detected in 24.95% of patients. The most common pathogens isolated were Escherichia coli (60.34%), Klebsiella pneumoniae (20.63%), and Enterococcus spp. (5.17%). Extended spectrum beta-lactamase (ESBL) detection rate was low (3.77%). Most of the pathogens were susceptible to amikacin, piperacillin-tazobactam, nitrofurantoin, and imipenem. E. coli which was the main isolate was found to be most susceptible to imipenem (94.28%), amikacin (88.57%), nitrofurantoin (81.43%) and piperacillin-tazobactam (74.29%). Conclusion: This study reveals that most of the urinary isolates in pediatric age group are multidrug resistant, although ESBL detection rate is low. This suggests regular monitoring and modification of empirical therapy, and it should be validated by culture report to prevent morbidity associated with this disease.