Background: Ventilator-associated pneumonia (VAP) is defined as pneumonia that develops in patients after 48 h of mechanical ventilation. Most common complications among stroke patients in Neurosurgery ICU are Ventilator associated pneumonia, Urinary tract infections, Venous thromboembolism, Pressure ulcers. This study aims to estimate the prevalence of VAP and to identify the bacterial pathogens causing early-onset and late-onset VAP and their antibiotic susceptibility profile. Materials and Methods: This was a prospective and longitudinal study carried out at Kalinga Institute of Medical Sciences, Bhubaneswar, India, from September 1, 2022 to May 31, 2024. This study included stroke patients admitted to the neurosurgery ICU who developed VAP. The demographic, clinical, and microbiological data were collected in the case report pro forma. VAP was diagnosed based on the clinical pulmonary infection score system. Microbiological processing of samples was done as per the India Council of Medical Research standard operating procedures. Results: In our study, the prevalence of VAP was 5.75% (47/817). Early-onset VAP was developed in 24 patients (51%) and late-onset VAP was seen in 23 patients (49%). The common pathogens isolated from the early-onset and late-onset VAP were Acinetobacter baumannii and Klebsiella pneumoniae. K. pneumoniae was most susceptible to tigecycline (100%), A. baumannii was most susceptible to minocycline (80%), both in early- and late-onset VAP. The mortality rate was higher in late-onset VAP 10 (43.47%). Conclusion: The prevalence of VAP is 5.75%. The pathogens isolated are Klebsiella pneumoniae and A. baumannii complex, and in late onset VAP, maximum were resistant to most of the commonly used antibiotics.

Background Carbapenem-resistant Acinetobacter baumannii (CRAB) causes severe infections in intensive care units (ICUs), with increased morbidity and mortality. The pathogen exhibits extensive antimicrobial resistance, substantially limiting available therapeutic options. Recently, the emergence of sulbactam-durlobactam, a novel β-lactam/β-lactamase inhibitor combination, has renewed interest as a potential treatment option. The study evaluates the clinical and microbiological profile of CRAB isolates, assesses the in vitro efficacy of sulbactam-durlobactam in these isolates, and analyzes key risk factors and clinical outcomes in patients developing CRAB infection. Methodology This cross-sectional study was conducted over a period of six months (July-December 2024) at a tertiary care hospital in Odisha. All clinical specimens were processed for bacterial identification and antimicrobial susceptibility testing using the VITEK-2 automated system (bioMérieux, Marcy-l'Étoile, France). A. baumannii isolates were characterized as CRAB and carbapenem-susceptible Acinetobacter baumannii (CSAB). CRAB susceptibility to sulbactam-durlobactam was tested by the Kirby-Bauer disc diffusion method, and results were interpreted based on the Clinical & Laboratory Standards Institute 2024 guidelines. Clinical and microbiological data were analyzed by applying appropriate statistical tests, with a p-value <0.05 considered statistically significant. Results Among 291 Acinetobacter spp. isolates, 275 (94.5%) were A. baumannii, and out of the 275 A. baumannii, 227 (82.5%) were carbapenem-resistant. Most of the CRAB-infected patients were ≥60 years old (93, 40.9%). All CRAB isolates were multidrug resistant. CRAB cases showed a significantly higher association with multiple comorbidities and risk factors, including hypertension (53.7%, 122/227), diabetes (31.1%, 72/227), malignancy (22.9%, 52/227), renal disease (33.4%, 76/227), surgery/invasive procedures/accident (33.9%, 77/227), lung disease (53.7%, 122/227), liver disease (31.2%, 71/227), bloodstream infection (57.2%, 130/227), and genitourinary infection (61.6%, 140/227) than CSAB cases. Mortality was 40% (91/227) in CRAB. The majority (98.6%, 224/227) of the CRAB isolates showed sensitivity to sulbactam-durlobactam. Conclusions Our study highlights the alarming rise of CRAB in a tertiary care setting in Odisha as an emerging ICU pathogen, particularly among elderly patients. The strong association with comorbidities, risk factors, and multidrug resistance underscores the need for continuous surveillance and targeted interventions. Sulbactam-durlobactam demonstrated promising activity, indicating its potential as an effective therapeutic option.

Aminoglycosides remain critically important broadspectrum antibiotics for treating serious infections caused by multidrug-resistant bacteria, despite their introduction over 80 years ago. This narrative review evaluates the contemporary role of aminoglycosides in antimicrobial therapy, emphasizing resistance mechanisms, clinical applications and emerging therapeutic strategies. Aminoglycosides exert concentration-dependent bactericidal activity by binding to the 30S ribosomal subunit and demonstrate synergistic effects when combined with cell wall-active agents, making them valuable for empirical treatment of severe Gram-negative and select Gram-positive infections. However, the global emergence of sophisticated resistance mechanisms including aminoglycoside-modifying enzymes (AMEs), reduced membrane permeability, efflux pump upregulation and critically, 16S ribosomal RNA methyltransferases conferring pan-aminoglycoside resistance poses significant clinical challenges. Additionally, nephrotoxicity and ototoxicity limit their therapeutic window. Next-generation aminoglycosides such as plazomicin offer improved activity against AMEs but remain vulnerable to 16S rRNA methyltransferases. Advanced molecular diagnostics, optimized extended-interval dosing strategies and novel combination therapies with adjuvant compounds represent promising approaches to overcome resistance and enhance safety. Continued antimicrobial stewardship and ongoing research are essential to preserve aminoglycoside efficacy in managing multidrug-resistant infections.

Background Pseudomonas aeruginosa, an important nosocomial bacterial pathogen, poses serious healthcare challenges, particularly in ICUs, leading to morbidity and mortality. Moreover, the emergence of multidrug-resistant (MDR), difficult-to-treat resistant (DTR), and extensive drug-resistant (XDR) isolates has resulted in very limited treatment options. Limited data are available on the antibiotic susceptibility patterns of P. aeruginosa in eastern India during the study period. This study aimed to generate insights into the resistance profile of P. aeruginosa over a five-year period. Materials and methods This retrospective study was conducted from 2021 to 2025 in a tertiary care hospital in Bhubaneswar, India. Samples from ICU patients, including respiratory samples, blood, pus, urine, tissue, and swabs, were cultured on appropriate media. Bacterial identification and antimicrobial susceptibility testing (AST) were performed using the VITEK 2 Compact system (bioMérieux, Marcy-l'Étoile, France). Results were interpreted according to the Clinical & Laboratory Standards Institute (CLSI) 2025 guidelines. All data, including occurrence, antibiogram, comorbidities, and patient predisposing factors, were retrieved from the hospital's laboratory information system. Results A total of 988 P. aeruginosa isolates were identified, representing a prevalence rate of 12.08% (988/8174). The highest occurrence was observed in adult ICUs (96.26%, 951/988), followed by pediatric ICUs (3.24%, 32/988) and neonatal ICUs (0.5%, 5/988). Prevalence was higher in males (67%, 659/988) than in females (33%, 329/988). Overall AST patterns revealed the highest susceptibility to amikacin (56%, 523/942), followed by cefepime (53%, 471/891). Resistance was highest for piperacillin/tazobactam (53%, 473/891), followed by imipenem (51%, 446/884) and meropenem (50%, 467/943). Trend analysis showed a decline in resistance to piperacillin/tazobactam, meropenem, imipenem, ciprofloxacin, and levofloxacin over the 2021-2025 period. Conclusions This study demonstrates the presence of MDR, non-MDR, DTR, and XDR strains of P. aeruginosa in ICUs, with periodic fluctuations in prevalence. This is concerning, as ICU patients are critically ill and infections caused by drug-resistant pathogens may have severe consequences. Continuous antimicrobial stewardship, strict infection control practices, and active surveillance are essential to prevent further escalation of resistance.

Introduction: Urinary tract infections are common in both hospital and community settings and impose a significant financial burden. Among Enterobacterales, Escherichia coli and Klebsiella pneumoniae are the leading uropathogens. The rise of carbapenem-resistant strains is concerning due to limited treatment options, with carbapenems often being the last line resort. This study intends to determine the microbiological profile of E. coli and K. pneumoniae uropathogens obtained from a tertiary care hospital. Methods: A prospective study was conducted from October 2023 to June 2024 in a tertiary care hospital in Eastern India. Urine samples received for routine culture in the central laboratory were processed following standard microbiological protocols. Bacterial identification and antibiotic susceptibility testing were performed using the VITEK-2 compact system. A total of 958 isolates of E. coli and K. pneumoniae were obtained. Of these, 198 were identified as carbapenem-resistant as per the Clinical Laboratory Standard Institute 2023 guidelines. Results: Of the 7,228 urine samples processed, 4,336 (60%) were gram-positive and 1,552 (35.80%) were gram-negative bacteria. Among gram-negative bacteria, 1,209 (77.88%) belonged to Enterobacterales, of which 562 (36.21%) were E. coli and 396 (25.51%) were K. pneumoniae. 147 (5.38%) were carbapenem-resistant E. coli and 85 (3.11%) were carbapenem-resistant K. pneumoniae. Both carbapenem-resistant E. coli and K. pneumoniae showed sensitivity to fosfomycin and nitrofurantoin. Conclusions: Urinary tract infections caused by Escherichia coli and Klebsiella pneumoniae are frequent, but carbapenem-resistant strains pose an emerging therapeutic challenge. This study highlights the prevalence and effective antibiotic options.

BACKGROUND AND OBJECTIVES:Patients admitted to the neurosurgery intensive care unit (ICU) are often exposed to mechanical ventilation, invasive procedures, and polypharmacy. Prolonged hospital stays and multiple antibiotics facilitate the development of hospital-acquired infections (HAI). We planned this study to determine the bacteriological profile and antimicrobial susceptibility testing (AST) patterns among neurosurgery ICU patients. METHODS:This cross-sectional study was conducted from May 2024 to April 2025 at the Kalinga Institute of Medical Sciences (KIMS) in Bhubaneswar, India. This study included adult patients hospitalized in the neurosurgery ICU within the above-mentioned time frame. Specimens like endotracheal tube (ETT) aspirate, blood, urine, and body fluids were collected from the eligible participants and were assessed for the bacteriological profile. Culture media like MacConkey agar, chocolate agar, 5% sheep blood agar, and cysteine lactose electrolyte-deficient (CLED) agar were employed for the growth of pathogenic bacteria. For AST, we used the VITEK 2 system (bioMérieux, Marcy-l'Étoile, France). We used the R software Version 4.4.3 (R Foundation for Statistical Computing, Vienna, Austria) for analysis. RESULTS:Four hundred twenty-five patients were eligible for the study. The male-to-female ratio was 3:2. The average age of the participants was 58.9 (51.7-72.3) years. The majority of samples were obtained from ETT (308, 72%), followed by blood (79, 19%) and others like urine, pus, etc. (38, 9%), respectively. Most of the pathogens belonged to Enterobacterales (253, 59.5%), followed by non-fermenters (130, 30.6%) and Gram-positive cocci (42, 9.9%), respectively. Klebsiella pneumoniae (162, 38.1%), Acinetobacter baumannii (71, 16.7%), Pseudomonas aeruginosa (50, 11.8%), Escherichia coli (46, 10.8%), and Staphylococcus aureus (32, 7.5%) were the most common pathogenic bacteria. We also discovered some emergent pathogens like Proteus mirabilis (21, 4.9%), Serratia marcescens (7, 1.6%), Elizabethkingia meningoseptica (2, 0.5%), and Morganella morganii (1, 0.2%). Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii isolates demonstrated the highest sensitivity towards tigecycline. Pseudomonas aeruginosa isolates were highly sensitive to cefoperazone-sulbactam and imipenem. Antibiotics like linezolid, vancomycin, tigecycline, daptomycin, and teicoplanin were very effective against Staphylococcus aureus. CONCLUSION:ETT was the most common sample collected, and most pathogens were from Enterobacterales.The most prevalent pathogens were Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli, and Staphylococcus aureus. We also noticed a few cases of emerging pathogens like Elizabethkingia meningoseptica and Morganella morganii. Acinetobacter baumannii, Escherichia coli, and Klebsiella pneumoniae were highly sensitive to tigecycline. Cefoperazone-sulbactam was highly effective against Pseudomonas aeruginosa. Staphylococcus aureus isolates showed maximum sensitivity towards linezolid and vancomycin.

INTRODUCTION AND AIM:Diabetic foot ulcer (DFU) is a frequent and critical complication associated with diabetes mellitus. They carry a higher risk of infection, longer hospital stays, and increased healthcare costs. This study aimed to identify the microbiological profile and antibiotic susceptibility pattern of organisms isolated from infected diabetic foot ulcers. MATERIAL AND METHODS:A retrospective, record-based, cross-sectional study was conducted by retrieving data on culture isolates obtained from diabetic foot ulcers and the clinical data of these patients over a period of two years (from August 2022 to August 2024) at a tertiary care hospital. The demographic, clinical, and laboratory data were retrieved from the laboratory information system; all data were entered into an Excel spreadsheet (Redmond, WA: Microsoft Corp.), and the variables were analyzed. RESULTS:A total of 100 patients with DFUs, and the details of 156 samples obtained from the diabetic foot ulcers of these patients, were included in the study. Among the 100 patients, the majority were male (76%, 76/100), and the age group most commonly affected was 50-60 years (40%, 40/100). Pus was the predominant sample (41.7%, 65/156) among the total 156 samples collected. Among the 156 samples collected, 62.2% (97/156) showed mono-microbial growth, and 37.8% (59/156) showed poly-microbial growth. The total number of bacterial and fungal isolates was 213 and five, respectively. All fungal isolates were identified to be Candida  tropicalis. The most common bacterial isolates were Pseudomonas aeruginosa (18.8%, 40/213), Klebsiella pneumoniae (17.8%, 38/213), Escherichia coli (14.1%, 30/213), and Enterococcus spp. (12.7%, 27/213), and Staphylococcus aureus (11.7%, 25/213). The most effective antibiotics for Pseudomonas aeruginosa were carbapenems, imipenem (90%, 36/40) and meropenem (80%, 32/40), followed by piperacillin-tazobactam (75%, 30/40) and amikacin (75%, 30/40). Imipenem (55%, 21/38) was the most sensitive antibiotic for Klebsiella pneumoniae followed by gentamicin (45%, 17/38). For Gram-positive isolates, Enterococcus spp. was most sensitive to teicoplanin and linezolid (100%, 27/27), followed by ampicillin (96.3%, 26/27) and vancomycin (77.8%, 21/27). Staphylococcus aureus isolates were most sensitive to vancomycin and teicoplanin (92%, 23/25), followed by daptomycin (84%, 21/25). A total of 25 Staphylococcus aureus isolates were obtained, of which 92% (23/25) were found to be methicillin-resistant Staphylococcus aureus (MRSA). CONCLUSION:This study has enhanced our understanding of the epidemiology of diabetic foot ulcers by identifying common pathogens. The antibiotic susceptibility pattern of the pathogens will help clinicians provide better empirical therapy, thereby promoting faster wound healing.

Background Acinetobacter baumannii, an opportunistic pathogen associated with healthcare-associated infections, poses a major clinical challenge due to its ability to develop resistance to multiple drugs, particularly carbapenems. Objective The aim of the study was to detect the presence of different carbapenem resistance genes in clinical isolates of Acinetobacter baumannii. Materials and methods A cross-sectional study was conducted from March 2023 to December 2023 in the Department of Microbiology of a tertiary care hospital, India. A total of 107 non-duplicate clinical isolates of Acinetobacter baumannii resistant to carbapenems were screened and collected. Bacterial species identification and antimicrobial susceptibility testing were performed using the VITEK 2 automated system (AST N405 panel). Carbapenem resistance genes were detected by real-time polymerase chain reaction (q-PCR) targeting blaNDM, blaOXA48, blaVIM, blaKPC and blaIMP genes using multiplex TRUPCR UTI AST Panel Kit. Data analysis was performed using Microsoft Excel (Microsoft Corp., Redmond, WA, USA), and the frequency of detected genes was expressed in percentages. Result Out of the 107 carbapenem-resistant A. baumannii isolates, 20 isolates were subjected to molecular detection of carbapenem-resistant genes. Out of the 20 isolates tested for resistance genes, blaNDM was detected in 35% (7/20) of the isolates, while blaOXA-48 was found in 30% (6/20). blaNDM+blaOXA-48 were found to co-exist in 20% (4/20) of the isolates. blaIMP+blaKPC, blaOXA48+IMP, blaIMP+blaNDM genes were found in one isolate each (5%, 1/20). Conclusion The detection of blaNDM and blaOXA-48 genes in carbapenem-resistant Acinetobacter baumannii highlights the growing threat of multidrug-resistant pathogens in clinical settings. The co-existence of these resistance genes underlines the need for routine molecular surveillance and stringent antimicrobial stewardship to prevent the spread of such high-risk clones.

BACKGROUND:Neonatal sepsis is considered one of the major causes of morbidity and mortality in low and middle-income countries, with a rising burden of multidrug-resistant (MDR) gram-negative bacilli (GNB). The emergence of antimicrobial resistance (AMR) has significantly compromised treatment outcomes in neonatal intensive care units (NICUs). This study aimed to determine the prevalence, antibacterial susceptibility patterns, and associated risk factors of MDR GNB among septic neonates over a four-year period. MATERIALS AND METHODS:A retrospective study was carried out from January 2021 to December 2024 in a tertiary care health setting in India. Data regarding septic neonates were retrieved from NICU records, and culture details were retrieved from the LIS (laboratory information system). Blood and cerebrospinal fluid (CSF) samples from neonates with clinically suspected sepsis were processed using the BACT/ALERT® three-dimensional (3D) system (bioMérieux SA, Marcy-l'Étoile, France). Identification and antibiotic sensitivity testing were done by the VITEK® 2 Compact automated system (bioMérieux SA), and interpretation was done as per standard microbiological protocol. Demographic, clinical, and bacterial profile data were analysed using the IBM SPSS Statistics for Windows, version 27.0 (IBM Corp., Armonk, New York, United States) Results: Altogether 2,670 neonates were admitted to the NICU during the study period. Out of 424 culture-positive samples, 201 (47.4%) were gram-negative isolates. The most prevalent bacteria were Klebsiella pneumoniae (26.4%), followed by Acinetobacter spp. (23.9%), and Escherichia coli (10.4%). The highest number of MDR strains was observed in K. pneumoniae isolates (73.6%), followed by E. coli (61.9%). K. pneumoniae showed better sensitivity to trimethoprim/sulfamethoxazole (57.64%) and gentamicin (53.13%), Acinetobacter spp. to minocycline (77.4%) and ciprofloxacin (66.7%), and E. coli to gentamicin (60%) and carbapenems (50%). Neonates with low birth weight (LBW) and very low birth weight (VLBW) showed a higher proportion of MDR infections than extremely low-birth-weight neonates (ELBW) (p= 0.02). These observations emphasize the importance of implementing antimicrobial surveillance and tailored antibiotic strategies in managing neonatal sepsis. CONCLUSION:The findings highlight the predominance of MDR GNB in neonatal sepsis and emphasize the need for species-specific antibiotic strategies with continuous resistance monitoring.

Introduction: This study aimed to detect the co-occurrence of carbapenem resistance genes along with aminoglycoside-modifying enzyme (AME) genes in clinical Enterobacterales isolates to understand the distribution of multiple resistance genes among clinical isolates. Methods: This prospective study was conducted for six months (November 2024 to April 2025) in the department of microbiology of a tertiary care hospital. A total of 30 blood culture isolates were identified as resistant to both carbapenem and aminoglycoside antibiotics using the automated VITEK 2 compact system. The genes responsible for carbapenem resistance (blaNDM, blaOXA-48, blaKPC, blaIMP, and blaVIM) were detected by multiplex realtime PCR, and the aminoglycoside-modifying enzyme genes [APH(3’)-Ia, APH(2”)-Ib, AAC(3)-IIc, AAC(6’)-Ib, and ANT(3”)-I] were detected by the conventional polymerase chain reaction method. All the clinical data, patient demographics, and molecular findings were entered in an MS Excel spreadsheet version 14.0.4734.1000 and analyzed using GraphPad/PRISM software version 10.5.0. Results: Of the 30 Enterobacterales isolates, Klebsiella pneumoniae was the most common isolate (66.7%). Molecular detection revealed blaNDM in 40% isolates and blaOXA48 in 10% isolates. The majority of the AME genes were in combination. The most common combination of the AME gene was AAC(6’)-Ib+ AAC(3)-IIc+ ANT(3”)-I + APH(3’)-I detected in 4 (13.3%) isolates. The most common combination of carbapenem and aminoglycoside resistant genes was blaNDM + blaOXA48 + AAC(6’)-Ib+ AAC(3)-IIc+ ANT(3”)-I+ APH(3’)-I (13.3%). The blaOXA-48 gene had a statistically significant association with AAC(6’)-Ib, ANT(3”)-I, and APH(3’)-I (p <0.05). Conclusion: The Co-occurence of carbapenem resistance and aminoglycoside-modifying enzyme genes in clinical Enterobacterales isolates limits the therapeutic option.

Urinary tract infections (UTIs) are predominantly caused by bacteria, with Escherichia coli and Klebsiella pneumoniae being predominant causative agents. This retrospective study evaluated the antibiotic susceptibility profiles of E. coli and K. pneumoniae isolates obtained from urine culture of patients with UTI symptoms presenting at the Pradyumna Bal Memorial Hospital, Kalinga Institute of Medical Sciences, Bhubaneswarr, Odisha. With increasing antibiotic resistance, particularly in bacterial strains that synthesize extended-spectrum beta-lactamases (ESBLs), identifying effective treatment options is crucial. From January to November 2023, 1,798 urine cultures were analyzed using the VITEK 2 Compact System, revealing E. coli 432 (60%) and K. pneumoniae 239 (33.2%) as the predominant pathogens. E. coli isolates exhibited high susceptibility to fosfomycin (98.6%), nitrofurantoin (80%), and amikacin (75.8%). K. pneumoniae showed high susceptibility to fosfomycin (73.9%) and amikacin (50.2%) but significantly lower susceptibility to nitrofurantoin (17.2%). Approximately 307 (58.03%) isolates were ESBL-synthesizing E. coli (57.9%) and K. pneumoniae (42.01%). ESBL synthesizing E. coli and K. pneumoniae were highly susceptible to fosfomycin (71.5%) and amikacin (62.4%). Our results emphasize the need to consider local resistance patterns when choosing empirical antimicrobial treatments for UTIs. Although fosfomycin demonstrated the highest sensitivity, being a reserve drug requires cautious use. Amikacin, with its favorable susceptibility profile is a valuable alternative especially for UTIs caused by ESBL-synthesizing, nitrofurantoin-resistant, and fosfomycin-resistant K. pneumoniae and E. coli, and offers a potential single-dose treatment option. This targeted approach can help preserve last-resort antibiotics in more critical cases.

BACKGROUND AND OBJECTIVES:Stroke-associated pneumonia (SAP) is the aftermath of aspiration of oropharyngeal secretions or stomach content. Mechanical ventilation and lowered immunity and consciousness facilitate the etiopathogenesis of SAP. Antibiotic prophylaxis and repeated culture and sensitivity testing dampen the drug susceptibility patterns of the pathogens. We accomplished this study to determine the bacteriological profile of patients with SAP and the antimicrobial susceptibility patterns of the pathogenic bacteria. METHODS:This cross-sectional study was executed from August 2022 to May 2024 at Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, India. We included adult patients who endured treatment in the neurosurgery intensive care unit (ICU) throughout the study period due to a stroke and developed pneumonia within 48 hours of admission. The endotracheal tube (ET) aspirate and bronchoalveolar lavage (BAL) fluid specimens collected from the eligible participants were analyzed. Enriched and selective media such as 5% sheep blood agar, chocolate agar, and MacConkey agar were used to culture pathogenic bacteria. The VITEK 2 system was used to identify isolates and assess antimicrobial susceptibility testing (AST). The pathogenic bacteria and their antimicrobial susceptibility patterns were gauged. We leveraged R software (version 4.4.1) for data analysis. RESULTS:Two hundred forty bacterial isolates were found in the 181 eligible patients. Forty-eight (26.52%) participants were females. The median age of the study population was 64.50 (58.74-70.24) years. Fifty-nine (32.60%) participants had two different isolates in their culture reports. We found the following non-fermenters: Acinetobacter baumannii (55, 22.92%), Pseudomonas aeruginosa (31, 12.92%), Burkholderia cepacia (6, 2.50%), and Elizabethkingia meningoseptica (4, 1.67%). Klebsiella pneumoniae (88, 36.67%) and Escherichia coli (15, 6.25%) were the most commonly noticed Enterobacterales. Other Enterobacterales were Proteus mirabilis (9, 3.75%), Serratia marcescens (8, 3.33%), Klebsiella oxytoca (3, 1.25%), Enterobacter aerogenes (1, 0.42%), Providentia stuartii (1, 0.42%), and Enterobacter cloacae complex (5, 2.08%). Staphylococcus aureus (14, 5.83%) was the only gram-positive cocci in our study population. The sensitivity of A. baumannii was maximum for minocycline. P. aeruginosa was highly sensitive to imipenem and completely resistant to tigecycline. Minocycline was the only effective drug against E. meningoseptica. Similarly, the Enterobacterales had the greatest sensitivity for tigecycline. All 14 specimens of S. aureus were sensitive to both vancomycin and linezolid. They were responsive to tigecycline as well. CONCLUSION:The most common pathogenic bacteria in our study were K. pneumoniae, A. baumannii, P. aeruginosa, E. coli, and S. aureus. Enterobacterales were highly sensitive to tigecycline. A. baumannii and E. meningoseptica had maximum sensitivity for minocycline. All isolates of S. aureus were sensitive to both vancomycin and linezolid. We warrant further research with a larger sample size to investigate the bacteriological profile among other critically ill patients and their AST findings.

INTRODUCTION:The rising incidence of carbapenem resistance in Enterobacterales and Pseudomonas aeruginosa is a concern. Since carbapenemase production is the primary resistance mechanism, detecting and identifying the genes responsible for it is crucial to effectively monitor its spread. OBJECTIVE:This study aims to detect positivity for the modified carbapenem inactivation method (mCIM) and ethylenediaminetetraacetic acid (EDTA)-carbapenem inactivation method (eCIM) for the detection of carbapenemase-producing Enterobacterales and Pseudomonas aeruginosa. METHODS:Methods: A cross-sectional study was carried out at a tertiary care hospital, including 250 clinical isolates of Enterobacterales and Pseudomonas aeruginosa. These isolates exhibited resistance to at least one of the carbapenems as determined by the VITEK AST 2 System (bioMérieux, USA). The isolates were subjected to mCIM testing, and those that tested positive were further tested using eCIM. The results were interpreted in accordance with the guidelines provided by the Clinical and Laboratory Standards Institute (CLSI) 2023. RESULTS:Out of the total 250 carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa isolates, 151 (60.4%) were Klebsiella pneumonia, 44 (17.6%) were Escherichia coli, 10 (4.0%) were Enterobacter cloacae, 6 (2.4%) were Providencia spp., 4 (1.6%) were Serratia marcescens, 4 (1.6%) were Proteus mirabilis and 31 (12.4%) were Pseudomonas aeruginosa. Positivity for the mCIM was observed in 96% (240 out of 250) of the isolates. Of the mCIM-positive isolates, 234 (97.5%) also tested positive for eCIM, indicating metallo-β-Lactamase (MLB) production. A statistically significant association was found between both mCIM and eCIM positivity and the degree of resistance to carbapenem (p<0.05). Conclusion: This study shows that the inexpensive method, a combination of mCIM and eCIM assists in differentiating between serine carbapenemase producers and MLB producers, thereby guiding the selection of appropriate therapy and useful in infection control in resource-limited settings.

INTRODUCTION:Non-fermenting gram-negative bacilli (NFGNB) infections have emerged as a serious health concern in ICUs. Multi-drug resistant (MDR) strains of NFGNB can evolve by acquiring resistance genes to at least one agent in three or more antibacterial categories. This study aimed to analyse the prevalence of NFGNB, the distribution of MDR strains, and antibiotic resistance trends of NFGNB in different ICUs of a tertiary care hospital over a period of five years. MATERIALS AND METHODS:This retrospective study was conducted in a tertiary care teaching hospital in eastern India, including a total of 20,256 samples received from various ICUs over five years. Data retrieved from the Laboratory Information System (LIS) of the hospital, and repetitive isolates from the same patients, were excluded. All samples were processed according to standard microbiological protocols by automated systems. Data were entered into a Microsoft Excel spreadsheet (Microsoft® Corp., Redmond, WA, USA), analysed using Epi Info software, and presented using descriptive statistics. Chi-square and Fisher's exact tests (where appropriate) were used as tests of significance, with a p-value of <0.05 considered statistically significant. RESULTS:A total of 18,032 culture-positive samples out of 20,256 samples showed growth of 18,659 bacteria. Out of these, 952 isolates were NFGNB. The prevalence of NFGNB was found to be 5.10% among all isolated bacteria. The predominant sources were respiratory samples (37.3%). Acinetobacter spp. emerged as the most prevalent NFGNB (46.5%), followed by Pseudomonas spp. (31%) and Burkholderia spp. (14.3%). Among the NFGNB isolates, 61.76% exhibited MDR, with the highest prevalence of MDR strains seen in Elizabethkingia spp. (94.7%). Among the most prevalent NFGNB, Acinetobacter spp., 64.8% were MDR strains. Trend analysis of antibiotic resistance patterns of Acinetobacter spp. indicated a substantial increase for trimethoprim-sulfamethoxazole by 18.5%, minocycline (44.4%), amikacin (20.4%), and ceftazidime (7.4%), whereas there was a reduced trend in resistance to carbapenems (6.5%), ciprofloxacin (4.7%), and cefepime (3.7%) over five years. In Pseudomonas spp., resistance to meropenem increased by 17.4%, and for ceftazidime (11.8%), amikacin (10.6%), and piperacillin-tazobactam (7.9%), whereas resistance to aztreonam diminished by 13.9%. Burkholderia spp. exhibited a 23.5% escalation in resistance to meropenem and ceftazidime (5.9%), while resistance to levofloxacin experienced a decrease of 30.2%. CONCLUSIONS:The study showed the prevalence of various NFGNB as 5.10% in ICU settings, with Acinetobacter spp. (46.5%) being the most common isolated bacteria. Notably, 61.76% of the isolates were MDR. Antibiotic trend analysis over five years showed increasing resistance of Acinetobacter spp. to trimethoprim-sulfamethoxazole, minocycline, and ceftazidime, with improved susceptibility for carbapenems, ciprofloxacin, and cefepime. Pseudomonas spp. showed increased susceptibility to aztreonam and rising resistance for meropenem, piperacillin-tazobactam, ceftazidime, and amikacin. In Burkholderia spp., there was increased susceptibility to levofloxacin and rising resistance to meropenem and ceftazidime. These findings focus on the need for vigilant antibiotic stewardship, with the adoption of appropriate infection prevention and control practices to restrict the emergence and spread of MDR NFGNB infections in ICU settings of hospitals.

Aim of the study wasto evaluate the immunomodulatory effects of Aqueous extracts of Aloe vera in Wistar albino rats using humoral immune response (antibody titre), a cellular immune response, and a neutrophil adhesion test after oral administration. : 24 healthy Wistar albino rats of either sex were divided into 4 different groups containing 6 rats for each immunomodulatory model. Group I ,the control group received gum acacia suspended in normal saline; Group II rats were treated with dexamethasone (1 mg/kg bw)whereas Groups III & IV received AloeVera aqueous extract at a dose of 125 mg/kg and 250 mg/kg, respectively. Each rat was antigenically challenged by injecting 0.1 ml of 0.5 × 10 SRBCs (suspended in normal saline) intraperitoneally. The study of humoral immune response was seen by measurement of antibody titre obtained on 20 day (7 day of Ag challenge) and 27 day (14 day of challenge) with sRBC considered the primary and secondary humoral immune response, respectively. For the cellular immune response, foot pad edema was calculated due to a hypersensitivity reaction after injection of sRBC into the .rat hind paw. A test of neutrophil adhesion is used to evaluate immunomodulatory activity. Aloe vera aqueous extracts at 250 mg/kg significantly improved a significant increase in paw edema volume indicated increased cell-mediated immunity, and elevated Ab titre on the 20th and 27th days served as a marker of increased humoral immune response. Additionally, AVE 250 mg/kg caused an increase in neutrophil adhesion, demonstrating its immunomodulatory effects. Aloe vera aqueous extracts at a dose of 250 mg/kg demonstrated immunomodulatory activity in a model using Wistar albino rats.Aloe vera extract at a dose of 250 mg/kg significantly increased hemagglutination antibody titers compared to the control group, indicating enhanced humoral immunity. This study demonstrates the immunostimulant properties of orally administered Aloe vera aqueous extract in Wistar albino rats. The extract increased antibody production, enhanced cell-mediated immunity, and improved neutrophil function. These findings support the potential of Aloe vera as a natural immunomodulator and warrant further exploration of its therapeutic applications.

During the onset of the pandemic, a common research question was asked by the hospital staff, and family members who were handling COVID-19-infected cadavers, "does COVID-19-positive dead body harbor SARS-CoV-2 viral RNA?" Several research findings were reported but due to the lack of proper research findings, the question remained unanswered. The present study was planned to observe the virus transmission risk from cadavers to the handlers. A pilot study was conducted on 54 cadavers who died in COVID-ICU (SARS-CoV-2-positive diagnosed by RT-PCR) during 2021-2022. Skin swab sample from 54 dead bodies and 54 glove samples of handlers were taken within 1 hour of death for the RT-PCR test. Viability results from RT-PCR show that the infection risk was 50% in cadavers, whereas the transmission risk to handlers while handling was 7%, which is minimal. The SARS-CoV-2 viability was high in cases of those died after a long time of infection. Based on the RT-PCR result and data analysis the interpretation of the study was that the SARS-CoV-2 transmission risk from dead bodies to the handlers is minimal but the SARS-CoV-2 viability persists in the cadavers. This fact is helpful for the people who will conduct funeral activities, autopsy staff, and hospital staff handling dead bodies.

Strongyloides stercoralis is an intestinal nematode which persists as chronic asymptomatic infection for several years. Clinical manifestations become apparent long after initial infection which includes non specific gastrointestinal (GI) symptoms like pain abdomen, nausea, vomiting, altered bowel habits or weight loss. Larval reproduction can lead to disseminated infection in the immunocompromised. Very rarely, hyperinfection or disseminated strongyloides can lead to ulceration, bleeding, small bowel obstruction, colitis or ascites. In severe cases, electrolyte disturbances and protein losing enteropathy may occur. We present a unique case of intestinal infestation of Strongyloides stercoralis in a 42-year-old immunocompetent male with a rare manifestation of protein losing enteropathy and dyselectrolytaemia without any GI symptoms at the outset, whose presentation was anasarca and initial investigations including work-up for cardiovascular, hepatic and renal causes of anasarca were unremarkable except for hypoalbuminaemia and electrolyte abnormalities and notable absence of peripheral eosinophilia. The diagnosis was arrived at by simple and conventional investigations like stool microscopy which demonstrated the Strongyloides larvae and upper GI endoscopy aided the biopsy which was confirmatory. He responded to appropriate medical treatment. Helminthic infestation should be kept in mind as a rare cause of malabsorption syndrome manifesting as protein losing enteropathy in a tropical and endemic country like India. These are treatable causes and respond to specific cost-effective antihelminthic treatments.

The incidence of acute post-operative endophthalmitis (APOE) following cataract surgery in India is comparable to most of the developed world despite performing high-volume cataract surgery. Most infections are caused by bacteria, Streptococcus and Staphylococcus species being the predominant pathogens, which are similar to the findings of most published literatures. However, there is also a significant number of infections seen to be caused by Gram-negative bacteria and fungus. Amid Gram-negative microbes, Pseudomonas aeruginosa is the most common organism followed by Acinetobacter spp. , Klebsiella spp . , Escherichia coli , Enterobacter spp ., and Alkaligenes spp . Another rare newly emerging ocular pathogen is Pasteurella species. Human infections by some species of Pasteurella involving soft tissue, skin, bone, joints, and wounds have been reported following animal exposure. However, there are no documented cases of ocular involvement in humans by Pasteurella caecimuris . We herein report the first case of APOE by this species. P. caecimuris induced endophthalmitis is very fulminant in nature and should be dealt with aggressive intervention.

BACKGROUND:Needle stick injury (NSI) is one of the significant and serious health hazards encountered by healthcare workers (HCWs), as it is a risk factor for transmission of blood-borne infections like HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV). This study aims to describe the frequency and distribution of the NSIs reported in the institution over a period of four years, the factors associated with it and the immediate post-exposure prophylaxis administered. METHODS:A record-based retrospective analysis of the NSIs suffered by HCWs working in the Pradyumna Bal Memorial Hospital (PBMH), Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar over a period of four years (2019 - 2022) was conducted. Data was extracted from the Exposure Prevention Information Network (EPINet) using a researcher-made proforma and analysed using Epi Info software 7.3.2. RESULTS:There were a total of 115 reported cases of NSIs, the incidence being 2.52%, 1.55%, 0.85% and 1.64% in the years 2019,2020,2021 and 2022 respectively. The most commonly affected age group was 18-30 years with females constituting the majority. Nurses were more commonly affected in the first two years of the study (2019 and 2020) whereas in 2021 and 2022 housekeeping staff suffered more injuries. The highest incidence of NSIs (40%-59%) was noted to have occurred in the morning shift. Inpatient department (IPD) contributed the maximum number of cases of NSIs. Out of the 93 cases with known source patient, HIV serological status was negative for all, while HBV and HCV status was positive in nine and two cases respectively. The serology status for the three viral markers (HIV, HBV and HCV) was unknown in 22 cases. After evaluation for the necessity of post-exposure prophylaxis (PEP), initial PEP was given to 14 persons for prevention of HBV and to 20 persons for HIV prevention. CONCLUSION:Of the total NSIs reported over the four years, the incidence of NSIs per thousand HCWs showed a declining trend; with the younger age group and female gender reporting a higher incidence. Job category wise, housekeeping staff and nursing staff suffered more NSIs. Highest number of NSIs were reported from IPD. A greater proportion of NSIs were due to hollow bore needles. Most of the injuries occurred during daytime. Source patient could be identified in majority of the cases. HCWs who were identified to be at risk received immediate PEP as per the institutional policy. Stringent documentation of NSIs can assist in root cause analysis and to implement measures to prevent their occurrence.