INTRODUCTION:Antimicrobial resistance due to bloodstream infections (BSIs) in low and middle-income countries remains unclear. Characterising the resistant patterns is crucial for limiting the spread of resistance and improving treatment strategies. This study aims to evaluate the antimicrobial resistance profile and co-existence of genes in organisms causing BSI. MATERIAL & METHODS:This is a 5-year retrospective cohort study conducted in an Indian tertiary care hospital. The blood samples collected from BSI patients were cultured in BacT/ALERT blood culture bottles. Pathogens were identified using MALDI-TOF, and antimicrobial susceptibility profiling was done using the automated VITEK-II system. The presence of antimicrobial-resistant genes was identified using PCR. The statistical analysis was done using SetupStata17. RESULTS:A total of 296 isolates were obtained from 281 patients having BSIs. Klebsiella pneumoniae (115/296, 38.8%), Acinetobacter baumannii (51/296, 17.2%), Escherichia coli (34/296, 11.4%) and Pseudomonas aeruginosa (14/296, 4.76%) were the most commonly isolated Gram-negative bacilli (GNB) (214/296, 72.29%). A higher frequency of MDR 149/214 (69.6%) was observed in overall GNBs. The highest percentage (>70%) of resistance was observed for K. pneumoniae and A. baumannii to most cephalosporins, carbapenems, and fluoroquinolones. The prevalence of ESBL producers was observed in 168/214 (78.5%) isolates, whereas the Carbapenemase gene was observed in 176/214 (82.2%) isolates, where bla-NDM (144/214, 67.2%) was the most predominant gene. A lower proportion of AmpC producers (117/214; 54.6%) was observed out of all three β-lactamases classes studied. The co-occurrence of ESBL genes was observed in 95.4% (168/176) carbapenemase producers. CONCLUSION:The high prevalence and co-occurrence of bla-NDM, ESBLs, and carbapenemase indicate an evolving resistance pattern across ICU and ward settings. Strengthening infection prevention, integrated surveillance, and antimicrobial stewardship is essential to limit the emergence and transmission of resistant GNBs and support timely, appropriate clinical management.

Burkholderia species are emerging as significant pathogens in nosocomial bloodstream infections, particularly central line-associated bloodstream infections (CLABSIs). These infections present a clinical challenge due to their association with invasive devices and their prevalence in critical care settings. Understanding the epidemiological trends and outcomes is vital for strengthening infection prevention strategies and resource planning in Indian healthcare facilities.Demographic, Clinical, and Outcome Profile of Patients with Burkholderia Bloodstream Infections (2017–2024) This retrospective multicenter study included 802 confirmed cases of Burkholderia bloodstream infections reported between 2017 and 2024 across hospitals under the Indian Council of Medical Research (ICMR) and National Centre for Disease Control (NCDC) networks. Data on demographics, infection type, hospital setting (public vs. private), admission source, clinical outcomes, and unit distribution were analyzed. The study encompassed multispecialty, trauma, and oncology hospitals from various geographic regions of India. Among the 802 patients, 67.3% were male, and 85.5% had a central line. CLABSI was the most common infection type (81%). Patients were primarily admitted from the home/community (418 cases), followed by referrals from other hospitals (359). The majority of infections (82%) were reported from public hospitals, with the rest from private institutions. Burkholderia cepacia was the predominant organism isolated (728 cases), with smaller numbers of B. pseudomallei, B. cenocepacia, and others. During the 14-day surveillance period, 295 patients (36.8%) died, while the final outcome data showed a mortality of 49.2% (395 patients). A total of 308 patients were discharged, 21 left against medical advice, and 13 were transferred to other hospitals. These findings reflect a high disease burden, especially in patients with central lines and those admitted to public sector hospitals. Burkholderia bloodstream infections, particularly CLABSIs, are associated with significant morbidity and mortality in Indian hospital settings, predominantly affecting patients in public sector multispecialty units. These findings suggest centralized monitoring to reduce the burden of these healthcare-associated infections. All Authors: No reported disclosures

Objectives: Blood stream infections (BSIs) are potentially fatal healthcare associated infections (HAIs). The COVID pandemic had a huge impact on hospital processes and health care outcomes. We studied the impact of COVID pandemic on the prevalence of ICU acquired BSIs in our established Indian HAI surveillance network. Material and methods: This study included adult patients from ICUs in AIIMS HAI network that conducted BSI surveillance in COVID and non-COVID ICUs during and before the pandemic periods. Of the 40 hospitals in the network, ICUs from 16 hospitals conducted HAI surveillance in COVID ICUs and were included for the purposes of this study. Hospitals identified BSI and reported clinical and microbiological data to the network as per established and previously published protocols. Results: A total of 1,863 events of BSI were identified during pre-pandemic and 2,571 events during pandemic period. During the pandemic, 557 (21.6%) were reported from COVID ICUs. The BSI rate during the pandemic was 8.9/1,000 patient days, and during pre-pandemic 5.4/1,000 patient days (P < 0.01). The central line associated BSI (CLABSI) rates increased from 9.2/1,000 central line days during the pre-pandemic period to 11.3/1,000 central line days during pandemic. Conclusion: An increase in BSIs during the COVID pandemic was observed, which may be attributed to increased susceptibility of the patients or suboptimal infection control practices in COVID ICUs.

Needle stick injuries (NSIs) remain a significant occupational hazard among healthcare workers (HCWs), exposing personnel to blood-borne pathogens. Evidence regarding long-term NSI trends and the effectiveness of sustained prevention strategies in resource-constrained healthcare settings remains limited. This study evaluated the epidemiology of NSIs over a 14-year period at a tertiary care teaching hospital in India and the impact of implemented quality-improvement (QI)-driven prevention intervention. A retrospective observational surveillance study was conducted between January 2010 and December 2023 at a 400-bed tertiary care hospital. The study included all reported NSIs (n = 910) among doctors, nurses, technicians, and housekeeping attendants. Both contaminated and non-contaminated percutaneous injuries caused by needles and other sharp devices were analyzed. Information regarding healthcare worker category, mechanism of injury, source device, and intervention outcomes was obtained from institutional surveillance records. Descriptive statistics were used to summarize injury patterns. Differences between HCW were assessed using the chi-square test, while temporal trends in annual NSI counts were evaluated using quasi-poisson regression. Statistical significance was defined as p < 0.05. A total of 910 NSIs were reported during the study period. Nurses (n = 395, 43.4

Abstract Background Candida auris is an MDR yeast causing invasive candidiasis with high mortality (29%–62%). It also has an outbreak potential in healthcare settings. Accurate antifungal susceptibility testing (AFST) is critical due to its very high resistance profile to azoles, polyenes, and echinocandins. The absence of C. auris specific breakpoints, complicates patient’s treatment. Commercial automated antimicrobial susceptibility testing (AST) platforms do not show reliable results. So, the need for a feasible, reliable, technically non-demanding process for AFST is need of the hour. Objective This study is to evaluate a commercial system (Sensititre YeastOne from Thermo Scientific) with gold standard broth microdilution (BMD) method. Methods This study was conducted at a Level-1 trauma centre in India from 2024 to 2025. It is a tertiary care facility and manages a high volume of critically ill patients, including those with severe trauma, surgical complications, and nosocomial infections, making it a relevant setting for studying C. auris outbreaks. Samples were collected from patients in intensive care units (ICUs) and surgical wards. Primarily blood, urine, and wound samples were collected, reflecting common sources of invasive candidiasis. Twenty C. auris isolates were obtained from clinical samples and were identified using VITEK-MS (MALDI-TOF MS) system. This method was chosen as phenotypic characteristics cannot reliably distinguish C. auris from other Candida species. AFST was done using two phenotypic methods: Sensititre-system and gold standard BMD. Sensititre-system is a US Food and Drug Administration (US-FDA) approved automated BMD method for AFST. It utilizes 96-well microtitre plates. Wells are precoated with increasing concentration of different antifungals and resazurin as indicator of growth. It is used for in vitro diagnostic (IVD) and research use only (RUO) purposes. All isolates were cultured on Sabouraud Dextrose Agar (SDA) at 37°C for 24 h prior to testing. Candida parapsilosis (ATCC: 22019) and Candida krusei (ATCC: 6258) were used as quality control strains. 0.5 McFarland turbidity of inoculum was prepared by using densitometer. US centres for disease control and prevention (CDC) tentative breakpoints applied (e.g. fluconazole ≥32 mg/L, amphotericin B ≥2 mg/L, anidulafungin ≥4 mg/L, caspofungin ≥2 mg/L, micafungin ≥4 mg/L). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) was calculated. Results Fluconazole susceptibility: Sensititre system showed 100% concordance with gold standard BMD test. All isolates were fluconazole-resistant by both methods. Caspofungin, micafungin and anidulafungin susceptibility: There was 100% concordance between these two tests. All isolates were anidulafungin susceptible by both methods. Amphotericin B susceptibility: 2 out of 20 samples were resistant by both methods. There was one false positive and one false negative result by Sensititre-system. Cohen’s kappa value showed moderate agreement of gold standard method with proposed method (κ=0.44) with sensitivity of 94%, specificity of 50%, PPV of 94% and 50% NPV. Conclusions The Sensititre system demonstrated, susceptibility results of fluconazole and echinocandins with high accuracy. But in comparison with gold standard BMD method, amphotericin B susceptibility results showed moderate agreement. These findings highlight the need for standardized C. auris specific breakpoints and improved AFST methods to guide therapy in outbreak-prone settings.

Background: Ventilator-associated pneumonia (VAP) remains a frequent and clinically important complication of mechanical ventilation, and its diagnosis is inherently challenging in critically ill adults. In many Asian ICUs, Acinetobacter baumannii is a leading VAP pathogen, with high rates of multidrug resistance and carbapenem resistance. Therapeutic options are constrained by resistance and the toxicity/pharmacokinetic limitations of polymyxins and sulbactam. Given the uncertainty regarding the optimal companion agent to polymyxin B, this study aimed to test whether polymyxin B plus minocycline is non-inferior to polymyxin B plus high-dose sulbactam for carbapenem-resistant A. baumannii CRAB VAP. Materials and methods: We conducted a prospective randomized double-blind non-inferiority trial in medical and surgical ICUs at AIIMS, New Delhi, enrolling adults (≥18 years) with microbiologically confirmed CRAB VAP, whose isolates were intermediate to polymyxins and susceptible to minocycline; patients with short ventilation (<48 h), prior exposure to study drugs, polymicrobial/culture-negative VAP, allergy, or pregnancy were excluded. Participants were randomized (74/group) to polymyxin B (25,000 U/kg loading, then 12,500 U/kg q12h) plus minocycline 200 mg IV q12h, or the same polymyxin B plus sulbactam 9 g/day (as plain sulbactam or cefoperazone–sulbactam by prolonged infusion), planned for 14 days with blinded clinical management and independent microbiological review. Results: 148 patients were included in the final analysis (74 per group). By day 14, clinical cure occurred in 77.03% of the minocycline group versus 67.57% in the sulbactam group (risk difference +9.46%); the lower bound of the 90% confidence interval for the difference (−2.57%) exceeded the prespecified −20% margin, confirming non-inferiority. Microbiological eradication, ventilator-free days, ICU length of stay, VAP-related mortality, 28-day mortality, and new-onset AKI did not differ significantly between the groups. Multivariable analysis identified baseline SOFA (adjusted OR, 0.79 per point) and early clinical progress days (adjusted OR, 1.68 per day) as independent predictors of cure, with no interaction by ICU type or severity. Conclusion: Polymyxin B plus minocycline, therefore, provides randomized evidence of non-inferior clinical efficacy to polymyxin B plus high-dose sulbactam for CRAB VAP, supporting minocycline as a pragmatic companion agent in settings with prevalent sulbactam resistance and limited access to newer therapies, while underscoring the dominant influence of baseline organ failure on outcomes. Trial Registration: CTRI/2024/08/071797. (Registered on 1-08-2024)

Purpose There is a need for rational prescribing of drugs to achieve healthcare outcomes. One of the major consequences of irrational drug use is the emergence of antibiotic resistance. Therefore, drug prescribing practices must be scrutinized at regular intervals to ensure patient safety. In this study, we aimed to evaluate the prescribing pattern of physicians using the ‘WHO-recommended core prescribing indicators’ in the OPD of a tertiary care trauma centre in North India. Materials and Methods This was a prospective, cross-sectional study conducted at all the outpatient departments of a tertiary care trauma centre hospital for a period of 3 months from February to May 2024. A total of 822 prescriptions were assessed based on the World Health Organization (WHO) core prescribing indicators according to guidelines and methods for data consistency. Descriptive statistical analyses (frequencies, mean, percentages, and standard deviation) were used to report the data. Results The WHO core prescribing indicators analysis showed that the average number of drugs per encounter was 1.25, 47.47% of the drugs were prescribed by generic name, and duration was mentioned only for 55.04% drugs. The percentage of antibiotics prescribed per encounter was 4.86% which was much lower than the ideal WHO recommendations. The most frequently prescribed antibiotic was Cefuroxime, which belongs to WATCH group according to AWaRe classification list, and only 53.68% (n=553) of the drugs were from the National List of Essential Medicines. Conclusion The present study on audit of prescription practices was performed using ‘WHO core prescribing indicators, highlights adherence to rationality and completeness. Improvement is needed in generic prescribing and completeness of prescriptions. Regular audits and AWaRe-based practices could enhance rational, cost-effective healthcare delivery.

BACKGROUND:Effective surgical site infections (SSIs) surveillance improves patient outcomes and ensuring evidence-based prevention strategies. However, data generated by surveillance programs is hindered by data of patients lost to follow-up (LTFU), which introduces bias. AIM:This study was conducted to evaluate and reduce LTFU rates among lower-segment cesarean section (LSCS) patients enrolled in SSI surveillance. METHODS:This prospective observational study analyzed 5,057 LSCS surgeries (962 elective and 4,095 emergent) from February 2021 to December 2021 (baseline phase) and December 2022 to September 2024 (intervention phase). Women who underwent LSCS procedures were enrolled in an SSI surveillance program, with follow-up data collected through structured protocols. Targeted interventions, including enhanced communication methods, expanded contact information collection, and patient engagement, were implemented to address identified barriers. Chi-square tests and regression was assessed between the occurrence of LTFUs, demographics, and procedure types FINDINGS: LTFU rate in the baseline phase was 10.9% (125/1152), with key reasons including incorrect data (0.88%), network/issues (1.4%), non-communicative behavior of patients (1.2%) and patient related logistics (0.5%) (e.g. poverty). After interventions, the LTFU rate decreased to 2.2% (85/3905) in the intervention phase (P<0.05, OR=5.470, 95% CI 4.117-7.267). CONCLUSION:This study highlights the multifactorial nature of LTFU during SSI surveillance, influenced by individual, systemic and environmental factors. Targeted interventions, such as improved communication strategies, tailored patient engagement, leveraging technology and robust data collection protocols, significantly enhanced follow-up rates. These findings provide actionable insights to optimize SSI surveillance and mitigate LTFU-related challenges in healthcare settings.

Abstract Background Sepsis is a serious, life-threatening condition which warrants rapid diagnosis and treatment. Molecular tests can save valuable time by their rapid turn-around time and accuracy. Objectives To evaluate the diagnostic accuracy of BioFire Blood Culture Identification2 (BCID2) Panel (bioMérieux, France) in detecting bacteraemia and antimicrobial resistance determinants in shortest possible time, as compared to conventional culture-based methods. Methods A prospective comparative study was conducted between 2024 and 2025 in Microbiology laboratory, at a level-1 trauma centre in India. 46 blood culture bottles, flagged positive by BACT/ALERT (bioMérieux, France) were analysed. Due to cost considerations, BCID2 testing was performed primarily on samples from critically ill patients. Gram staining was done for every positive bottle, but only those showing Gram-negative bacilli (GNB) or budding yeast cells (BYC) were processed using BCID2 assay. Samples were inoculated on blood agar and MacConkey agar and incubated in ambient air overnight at 37°C. Organisms were identification by VITEK-MS (bioMérieux, France) and antimicrobial susceptibility testing (AST) was done using both disc diffusion and VITEK-2 Compact (bioMérieux, France) were carried out following day. For BCID2 assay samples were processed according to manufacturer’s instructions. Phenotypic culture and AST method was taken as gold standard. Results BCID2 assay took about 1 h to provide results from a positive blood culture. Organisms were isolated in 42 out of 46 samples. 2 samples, initially negative by BCID2, showed bacterial growth on culture. Sphingomonas paucimobilis and Corynebacterium striatum grown on culture next day. Two samples were negative by both methods. BCID2 assay demonstrated a sensitivity of 95.5%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 50%. The agreement between two test by using Cohen’s kappa value showed moderate agreement (k=0.65). Fisher exact test statistic value is 0.0058. The result is significant at P<0.05. Eight Candida spp. among which Candida tropicalis (5/8), Candida albicans (2/8) and one Candida auris identified by both methods. Klebsiella pneumoniae showed 100% concordance, with eight resistant and one susceptible isolate. BCID2 assay failed to detect resistance genes in 3/11 carbapenem-resistant Acinetobacter baumannii isolates. Lowest concordance was observed with Escherichia coli. Both assays showed similar results in case of only 3 carbapenemase producing Enterobacterales (CRE) isolates. BCID-2 panel detected 6 out of 7 isolates as CRE among which 3 were only ESBL-producing isolates. Conclusions Molecular tests are critical for rapid, highly sensitive detection of infectious diseases, genetic disorders, and cancers. At present they are far surpassing traditional culture methods in speed and accuracy. BCID2 panel provides rapid and accurate species identification in bacteraemia patients. Due to multifactorial nature of β-lactam resistance in GNBs, BCID-2 assay should be used in conjunction with conventional phenotypic susceptibility testing for comprehensive AMR detection. We found in our study that BCID2 assay can play an important role in antimicrobial stewardship programme. Most importantly, in case of candidaemia, antifungals were started early. Also, in bacteraemia cases, antibiotic escalation was helpful in decreasing mortality.

Importance:Gut colonization by multidrug-resistant organisms (MDROs) is a risk factor for infection with these pathogens. There are no approved therapeutic interventions to combat it. Objective:To assess the efficacy of fecal microbiota transplant (FMT) in causing MDRO decolonization and decreasing antimicrobial resistance (AMR) genes and its impact on gut microbiome, virome, and mycobiome composition in patients with gastrointestinal (GI) diseases. Design, Setting, and Participants:This randomized, double-blind, sham-controlled clinical trial was conducted in a gastroenterology ward and intensive care unit at a tertiary care center in India. Participants were patients with GI diseases with persistent MDRO colonization. Patient recruitment occurred from July 2022 to June 2024, with follow-up completed in July 2024. Data were analyzed from October 1, 2024, to April 25, 2025. Intervention:FMT via colonoscopy or sham intervention (sigmoidoscopy with saline injection). Main Outcomes and Measures:Co-primary outcomes were MDRO decolonization rate and decrease in antimicrobial resistance genes (AMR) at 4 weeks after the intervention. Secondary outcomes included changes in stool microbiome (16S ribosomal RNA amplicon sequencing), virome (viruslike particles shotgun sequencing), and mycobiome (ITS2 sequencing); incidence of MDRO infections; and adverse events within 4 weeks. Results:Of 114 randomized patients (mean [SD] age, 40.6 [12.5] years; 80 [70.2%] male; 52 patients [45.6%] with pancreatitis; 43 patients [37.7%] with cirrhosis; 19 patients [16.7%] with other GI disorders), 58 received FMT and 56 received the sham intervention. Most patients were colonized with carbapenem-resistant Enterobacteriaceae or extended-spectrum β-lactamase-producing Enterobacteriaceae at baseline (55 patients [94.8%] in the FMT group and 56 patients [100%] in the sham group). Five patients (2 in the FMT group, 3 in the sham group) were lost to follow-up. Intention-to-treat analysis showed no significant differences in MDRO decolonization (18 patients [31.0%] in the FMT group vs 17 patients [30.4%] in the sham group; absolute difference, 0.6% [95% CI, -16.2% to 17.6%]; P = .94) or AMR genes (median [IQR], 2.5 [1.2 to 3.0] genes in the FMT group vs 2.0 [1.0 to 3.0] genes in the sham group; P = .68), with comparable adverse events. Among 71 patients who underwent 16S ribosomal RNA gene sequencing at 4 to 6 weeks after the intervention, enrichment of bacteria capable of producing short-chain fatty acids was observed in the FMT group. These microbial alterations were not observed in the sham group. However, viral diversity remained unchanged after FMT. Mycobiome analysis revealed that FMT induced only modest, transient alterations in the gut mycobiome. Conclusions and Relevance:This randomized clinical trial found that while a single session of FMT did not significantly enhance MDRO decolonization or decrease AMR genes in patients with GI diseases, it modulated gut microbiome diversity and composition. Trial Registration:Clinical Trials Registry-India Registration No. 2022/07/043847.

Gut colonization with multidrug-resistant organisms (MDRO) is associated with poor outcomes in hospitalized patients. This cross-sectional study determined prevalence of MDRO colonization among patients admitted in gastroenterology ward and intensive care unit (ICU) at All India Institute of Medical Sciences, New Delhi. Rectal swabs for bacterial culture were obtained at a single time point from consecutive patients over two-month period (October–November 2022). Isolates were tested for antibiotic sensitivity using VITEK 2 compact (bioMérieux Inc., Marcy-L'Étoile, France) and anti-microbial resistance (AMR) genes by polymerase chain reaction (PCR) (Bio-RadTM). Prevalence of MDRO in other clinical samples and concordance between fecal and other samples were also assessed. Among 107 patients (mean age 40.3 ± 14.8 years, 27.1

Abstract Background MDR Gram-positive bacterial infections remain a major therapeutic challenge in high-acuity trauma settings. MRSA and VRE are frequent causes of skin and soft tissue infections, nosocomial infections and bacteraemia. The emergence of linezolid resistance has further restricted available options. Objective To evaluate the susceptibility of tedizolid, a newer oxazolidinone, against VRE and MRSA isolates. Data from India regarding its efficacy is lacking. Material and methods A prospective surveillance study was conducted on 103 non-duplicate MRSA and VRE isolates, obtained between 2023 and 2025 from a level-1 trauma centre in India. The collection included 53 MRSA and 50 VRE isolates. Susceptibility testing for VRE and MRSA were performed using gradient diffusion Etest strips. MRSA isolates were also tested by using Kirby-Bauer disc-diffusion method. The breakpoints are based on recent CLSI guidelines. Linezolid (30μg disc) and tedizolid (2 μg disc) were used. For quality control (QC) Staphylococcus aureus (ATCC 25923) was used and Enterococcus faecalis (ATCC 29212) was used as a supplemental strain. By using densitometer,.5 McFarland standard density of test organisms was made. Lawn culture was done according to Kirby-Bauer disc diffusion method. The tedizolid Etest strip was kept in the middle of the lawn culture and gently pressed. Categorical agreement between linezolid and tedizolid results was analysed using Cohen’s Kappa and sensitivity, specificity, and positive predictive value (PPV), negative predictive value (NPV) were calculated. Results Drug susceptibility tests revealed that 7 linezolid-resistant VRE isolates had low (≤.5 mg/L) tedizolid MIC. Two tedizolid resistant VRE strain showed susceptibility against linezolid. Tedizolid demonstrated almost perfect agreement with linezolid among VRE isolates (Cohen’s κ=0.852), with 95% sensitivity, 100% specificity, 100% PPV, and 77.8% NPV. Among 53 MRSA isolates 3 isolates were linezolid resistant which were also resistant against tedizolid. By E strip method, there was 100% concordance between linezolid and tedizolid susceptibility of MRSA isolates. Two out of 50 linezolid susceptible MRSA isolates were resistant against tedizolid by disc diffusion method. Cohen’s kappa value showed substantial agreement of the disc diffusion method for tedizolid and linezolid (kappa=0.731) with sensitivity of 96%, specificity and PPV of 100, NPV of 60%. Conclusions Tedizolid exhibited potent in vitro activity against MRSA and VRE isolates, collected from a high-burden trauma centre. Importantly, it retained activity against the majority of linezolid-resistant VRE isolates, supporting its role as a therapeutic option where linezolid resistance is encountered. In view of low NPV of detecting susceptibility of MRSA against tedizolid by disc diffusion method is a concern. Perfect agreement between e strip method can be used in difficult scenarios. To our knowledge, this is the first study to report tedizolid susceptibility in VRE and MRSA from India, addressing a critical gap in regional antimicrobial resistance surveillance.

The Enterobacter cloacae complex (ECC) is increasingly recognized as a major opportunistic pathogen in healthcare-associated infections (HAIs), particularly in intensive care settings. Its clinical relevance has risen in parallel with the global spread of MDR strains, including carbapenemase producers, which complicate management and contribute to excess morbidity, prolonged hospitalization and increased healthcare costs. Outbreaks caused by ECC are often traced to contaminated water systems, medical devices, or the hands of healthcare workers, but reports from low and middle income countries (LMICs) remain scarce. In August–September 2023, a cluster of ECC infections was detected at a Level-1 trauma centre in northern India. An urgent epidemiological and microbiological investigation was undertaken to delineate transmission dynamics, identify reservoirs and guide infection prevention and control (IPC) measures. We conducted a prospective outbreak investigation of all culture-confirmed ECC cases occurring ≥48 h after admission during August–September 2023. Cases were identified in real time and reported in parallel with implementation of control measures. Clinical and epidemiological data included demographics, comorbidities, prior antibiotic exposure, invasive device use and outcomes. Environmental surveillance targeted high-risk areas such as water sources, sinks, taps and hand swabs from healthcare workers. Antimicrobial susceptibility testing (AST) was performed using standard protocols. Infection prevention and control (IPC) interventions included reinforcement of hand hygiene, environmental decontamination, chlorination and treatment of hospital water systems, and central line-associated bloodstream infection (CLABSI) care bundles. WGS was undertaken on 10 representative isolates (5 clinical, 5 environmental) to determine clonal relatedness, sequence types, plasmid profiles and antimicrobial resistance A total of 19 developed ECC infections; 63% were admitted to the ICU. No deaths occurred. Prior antibiotic exposure was reported in 68% and invasive procedures in 74%. Median ICU stay among infected patients was 14 days compared to 8 days in non-ICU cases (P=0.03). Environmental surveillance yielded 52 ECC isolates: 60% from healthcare worker hand swabs and 40% from hospital water samples. All isolates were resistant to cefuroxime. 80% were susceptible to amikacin, meropenem, imipenem, cefepime, tigecycline and cotrimoxazole. WGS showed clonal dissemination of ST97 (60%) and ST171 (40%) with >99.8% identity between clinical and environmental isolates. Plasmids IncX3_1 and IncFII(pECLA)_1_pECLA carried blaNDM, blaACT-5 and blaSHV. Genes oqxA/oqxB (100%) and fosA (68%) were detected. Following IPC interventions, ECC incidence decreased from 15.8 to 6.7 cases per 1000 patient-days (P<0.05). Water contamination fell from 40% to 10%, and hand hygiene compliance improved from 60% to 85%. No additional cases occurred after September 2023. This outbreak was driven by clonal dissemination of ECC, primarily through water systems and healthcare worker hands. WGS provided high resolution evidence linking clinical and environmental isolates, enabling targeted interventions. The multimodal IPC response including reinforced hand hygiene, water decontamination and central line care bundles successfully reduced transmission and contained the outbreak. However, residual water contamination highlights the resilience of ECC in biofilm-associated reservoirs. Our findings underscore the value of integrating genomic epidemiology into outbreak investigations in LMIC settings and the need for sustained environmental monitoring.

Carbapenem-resistant Acinetobacter baumannii (CRAB) is a WHO designated ‘critical priority’ pathogen because of its high capacity for multidrug resistance and association with mortality rates approaching 50% in severe hospital-acquired infections. CRAB is a major driver of ventilator-associated pneumonia (VAP), bloodstream infections and wound infections in critically ill patients, especially in intensive care units. Treatment options are severely limited, with colistin and minocycline often used as last-resort agents despite toxicity concerns. The recently concluded ATTACK trial demonstrated that sulbactam/durlobactam, a novel β-lactam/β-lactamase inhibitor combination, was superior to colistin in terms of efficacy and safety, establishing it as a preferred therapeutic option in global guidelines. Surveillance programmes have consistently reported very high activity, with more than 96% of CRAB isolates worldwide remaining susceptible. However, antimicrobial resistance (AMR) in India is distinct, with carbapenem resistance driven not only by OXA-type carbapenemases but also by endemic metallo-β-lactamases (MBLs) and frequent treatment exposures to broad-spectrum agents. Therefore, regional evaluation of sulbactam/durlobactam is crucial before incorporation into local treatment algorithms. A prospective laboratory-based surveillance was conducted over four months at a tertiary-care teaching hospital. A total of 175 non-duplicate CRAB clinical isolates were collected. The majority originated from respiratory samples (n=140; 80%), reflecting the heavy burden of ventilator-associated and hospital-acquired pneumonia. Additional sources included blood (n=18; 10%), pus/wound swabs (n=7; 4%) and other sterile body fluids (n=10; 6%). All isolates were confirmed as A. baumannii by VITEK MS® (bioMérieux®, France). Antimicrobial susceptibility testing was performed by disc diffusion, and sulbactam/durlobactam activity was assessed using CLSI-M100 2024. A. baumannii SAMN04901667(AR Bank) was included as a quality control strain. Comparative susceptibility to colistin and minocycline was also assessed. Sulbactam/durlobactam exhibited susceptibility in 120 of 175 isolates (68.6%). Non-susceptibility was noted in 31.4% of isolates, substantially higher than resistance rates reported in global surveillance (<2%) or European studies (87.9–96% susceptibility). In contrast, minocycline and colistin demonstrated higher retention of activity, with susceptibility rates of 92.0% (161/175) and 94.0% (164/175), respectively. Respiratory isolates dominated the dataset, accounting for 80% of cases, consistent with India’s disproportionate burden of ventilator-associated pneumonia. No difference in sulbactam/durlobactam susceptibility was observed across specimen types. This study provides the first institutional-level data from India on sulbactam/durlobactam activity against CRAB. Unlike international reports where the agent has emerged as a highly reliable option, our findings reveal considerably reduced susceptibility, with nearly one-third of isolates resistant. This discrepancy likely reflects region-specific resistance mechanisms, such as mutations in penicillin-binding protein 3 (PBP3), the target of sulbactam, or the presence of MBLs that confer cross-resistance. The high prevalence of combination resistance mechanisms in Indian CRAB strains may further compromise efficacy.

Objectives:This study was designed to assess the bacterial profile and their phenotypic and genotypic antimicrobial resistance pattern in samples from a level I trauma center in India. Methods:A total of 387 samples were collected from surfaces, equipment, water, and hand swabs of intensive care units (ICUs), wards, and other hospital locations between May 2021 and July 2022 and analyzed for bacterial identification (MALDI-TOF), antimicrobial susceptibility (Vitek2), extended-spectrum beta-lactamase (ESBL and AmpC), and carbapenemase genes. Results:The majority of isolates (91.5%) were Gram-negative; 44.1% of Gram-negative isolates were either multidrug-resistant (MDR) or extensively drug-resistant (XDR), with MDR being most common in Acinetobacter spp. (54.5%) and XDR in Escherichia coli (37.8%). Isolates also have a high prevalence of ESBL (55.5%), AmpC (45%), and carbapenemase (64.7%) genes. Isolates from ICUs and equipment had a significantly higher resistance and MDR percentage (34.5%, 38.7%). ICU isolates also have a significantly higher prevalence of carbapenemase genes (76%). Conclusions:This study provides baseline data on antimicrobial resistance within the hospital and underlines the role of ICUs and equipment in cross-contamination, which can be used to devise evidence-based infection control practices.

Enterococcus faecium drives healthcare-associated bloodstream infections (BSIs) globally, with multidrug resistance and high mortality posing challenges, particularly in trauma settings. Scarce data from Indian trauma centres necessitate analysis to guide management. To assess the epidemiology, clinical characteristics, antimicrobial resistance and outcomes of E. faecium BSIs in a tertiary trauma care facility in India. A retrospective study analysed all E. faecium BSI cases in ICUs of a public-sector tertiary trauma centre. Demographic, clinical, microbiological and antimicrobial susceptibility data were collected. BSIs were classified as primary (central line-associated bloodstream infections [CLABSI] or non-CLABSI) or secondary per CDC definitions. Outcomes were evaluated at 14 days and final follow-up using R software. Of 97 BSI events involving 112 E. faecium isolates, 51.5% occurred in the trauma ICU. Median patient age was 40 years (IQR: 27–55), with 75.3% male. Median time to infection was 8 days (IQR: 5–12) post-admission. CLABSIs, primarily associated with non-tunnelled jugular lines (81.4%), accounted for most cases, followed by non-CLABSI (12.4%) and secondary BSIs (6.2%). Median ICU stay was 21 days (IQR: 14–30). Antimicrobial resistance showed 92.5% of isolates resistant to ampicillin and 37.6% non-susceptible to vancomycin. Linezolid susceptibility was 86.8% and tigecycline susceptibility was 100%. Mortality was 30.9% at 14 days and 48.4% at final follow-up. Early catheter removal occurred in 45.3% of CLABSI cases. The predominance of CLABSIs (81.4%) aligns with global data, where E. faecium is a leading ICU pathogen, driven by catheter use, as seen in European and North American studies. High vancomycin resistance (37.6%) mirrors Indian (up to 81% in high-risk settings) and global (34–81%) VREfm trends, limiting therapeutic options. Linezolid and tigecycline’s efficacy is consistent with international meta-analyses but risks emerging resistance with overuse. Prolonged LOS (21 days) and high mortality (48.4%) reflect VREfm severity, comparable to Chinese (24%) and Italian (27.5–36.6%) studies. Early catheter removal, effective in North American studies, occurred in only 45.3% of CLABSI cases, suggesting underutilization in resource-constrained settings. These findings underscore the need for enhanced catheter care protocols and antimicrobial stewardship to curb MDR E. faecium. Future research should explore molecular resistance mechanisms and cost-effective interventions tailored to Indian trauma settings. E. faecium BSIs in Indian trauma ICUs require urgent infection control and stewardship to address high resistance and mortality.

Catheter-associated urinary tract infections (CAUTIs) are a major healthcare-associated infection (HAI) in trauma care settings, contributing to morbidity, mortality and antimicrobial resistance. In this study we characterize the epidemiology, microbiological profile, antimicrobial resistance patterns, and clinical outcomes of CAUTIs and non-CAUTI urinary tract infections (UTIs) at a Level 1 Trauma Centre in India from 2017 to 2024, using a modified CDC-NHSN definition and digital surveillance. A retrospective analysis of 723 UTI events was conducted using Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC-NHSN) definitions, modified to include Candida spp. at ≥ 105 CFU/mL. Surveillance was performed by dedicated Hospital Infection Control Nurses (HICNs) using a digital system. Microbiological identification and antimicrobial susceptibility testing (AST) were conducted via the conventional manual methods and automated systems. of 723 UTI events, 608 (84.0

Background:Rising antimicrobial resistance (AMR) necessitates innovative metrics, such as days of antibiotic spectrum coverage (DASC), to optimize antibiotic stewardship. This study evaluated antibiotic use in an Indian trauma center using DASC, defined daily doses (DDD), and the World Health Organization (WHO) Access, Watch, Reserve (AWaRe) classification. Methods:This retrospective cohort study analyzed data from 1,812 adult inpatients (mean age: 35 years; 70% male; 80% with polytrauma) admitted to a 250-bed Level-1 Trauma Center at the All India Institute of Medical Sciences (AIIMS), India, from August to October 2022. We measured days of therapy (DOT), DDD, and DASC for 46 antibiotics across 12 pathogens [e.g., methicillin-susceptible Staphylococcus aureus (MSSA), carbapenem-resistant Enterobacteriaceae]. DASC scores were developed through expert consensus and local antibiogram data, and validated using Pearson's correlation with DOT (R = 0.43, p < 0.1) and DDD (R = 0.21). Differences in antibiotic usage between the ICU and ward were analyzed using a t-test in R software. Results:Total antibiotic consumption was 81,064.6 g (3,142 DDD/1,000 patient-days). The Watch group antibiotics dominated usage (37%, 16,018.6 g), resulting in a low Access-to-Watch ratio (0.47). ICU settings showed higher DDD values (326 vs. 193/1,000 patient-days, p < 0.05) and DASC/DOT ratios (mean: 3; 95% CI: 2.73-4.01). Piperacillin-tazobactam accounted for the largest share of the Watch category use (5,952.9 g). DASC values (mean 4401.5, 95% CI: 3592-5211.1) showed a moderate correlation with DOT (R = 0.43, p < 0.1), offering spectrum-specific insights. Conclusions:Excessive use of the Watch group antibiotics contributes significantly to AMR. However, DASC's novel, spectrum-focused approach offers a transformative tool for antibiotic stewardship, supporting targeted de-escalation and improved benchmarking. These findings underscore the urgent need for policy reforms to enforce adherence to the WHO AWaRe classification in Indian centers, potentially reducing AMR-related mortality (30% higher with resistant infections). Integrating DASC into global Antimicrobial stewardship (AMS) programs may redefine antibiotic prescribing practices and help mitigate the AMR crisis.