BackgroundTo investigate the geospatial epidemiology, clinical features, treatment patterns, and antimicrobial resistance (AMR) trends of Stenotrophomonas maltophilia bloodstream infections (BSIs) in Indian intensive care units (ICUs) participating in a standardized healthcare-associated infection (HAI) surveillance program from 2017 to 2024.MethodsThis retrospective, multicentric study analyzed surveillance data from 54 ICUs across India. Standardized HAI definitions and protocols were applied to characterize infection types, clinical outcomes, and antimicrobial susceptibility.ResultsA total of 271 S. maltophilia isolates were identified, with the highest burden in 2023–24 (n = 76, 28.0%). Central line-associated BSIs (CLABSIs) predominated (64.9%), though their proportion decreased over time, with non-CLABSIs rising from 7.4% (2017–18) to 42.1% (2023–24). Mortality was highest in secondary BSIs (60%), followed by CLABSIs (50.3%) and non-CLABSIs (36.4%). The median ICU stay for CLABSI patients was 21 days. No significant associations were observed between infection type and time to infection or length of stay. High resistance was observed to tobramycin (92%), amikacin (80%), and piperacillin-tazobactam (70%), while trimethoprim-sulfamethoxazole (64.7–94.7%), levofloxacin (93%), and minocycline (94.1%) retained activity.ConclusionS. maltophilia represents a significant ICU pathogen in India, underscoring the urgent need for genomic surveillance and resistance-guided therapeutic strategies.

OBJECTIVES:To estimate the profile of non-central line-associated primary bloodstream infections (non-CLABSIs) in intensive care units of Indian hospitals participating in the standardized health-care-associated infection surveillance program. METHODS:This is a multicentric, network-based, prospective surveillance study conducted in 180 individual intensive care units of 47 Indian tertiary care hospitals that were part of the Health-Care-Associated Infection Surveillance Network between May 2017 and April 2024. The non-CLABSIs were defined, monitored, and observed using standardized definitions and surveillance protocols (www.haisindia.com). RESULTS:A total of 7092 laboratory-confirmed non-CLABSI cases and 30,74,954 patient days from 2017 to 2024 were recorded. The overall pooled non-CLABSI rate was 2.3 per 1000 patient days. Gram-negative isolates were the most predominant (5240/7659; 68.4%), including Klebsiella spp. (1766/5240; 33.7%), Acinetobacter baumannii (1613/5240; 30.8%), and Escherichia coli (582/5240; 11.1%). Gram-positive isolates (1728/7659; 22.6%) predominantly included Staphylococcus aureus (953/1728; 55.1%) and Enterococcus spp. (747/1728; 43.2%). Carbapenem resistance was common in Gram-negative infections, particularly in A. baumannii (1253/1554; 80.6%) and Klebsiella spp. (1209/1697; 71.2%). Among Gram-positive, S. aureus exhibited a high level of resistance to methicillin (529/748; 70.7%). CONCLUSIONS:This surveillance study underscores the need to expand infection prevention and control strategies to include non-device-associated risk factors. This will lead to the formulation of comprehensive infection prevention and control programs, mitigating the burden and clinical outcomes of non-CLABSI.

Objectives:Knowledge of local antibiotic susceptibility rates is essential to strengthen antimicrobial stewardship programs. DASH to Protect Antibiotics (https://dashuti.com/), promotes the dissemination of focused local antibiograms in community urinary tract infection (UTI). This study mapped the susceptibility profile of Klebsiella pneumoniae from 18 Indian centers. Methods:The centers spanned nine Indian States and three Union Territories. Urinary K. pneumoniae antibiograms from the outpatient clinic were collated and analyzed. Standardization was achieved through online training. For epidemiological purposes, five centers tested fosfomycin. Results:Overall, low susceptibility (<60%) was observed for the standard oral antibiotics prescribed for cystitis: co-trimoxazole, 54% (36-68%); ciprofloxacin, 52% (29-55%); amoxicillin-clavulanic acid, 46%, (35-82%); nitrofurantoin, 39% (19-78%); and cefuroxime, 30% (15-62%). The rates for third- and fourth-generation cephalosporins were 49% (45-52%) and 60% (36-76%), respectively. Extended-spectrum beta-lactamases ranged from 36-61% in India. Piperacillin-tazobactam 74% (65-87%), amikacin 76% (45-91%), and meropenem 81% (61-87%) exhibited higher activity. Fosfomycin was the most active antimicrobial, with 89% (92-97%) susceptibility. K. pneumoniae susceptibility was directly linked to geographic region, log gross domestic product (P <0.001), and humidity, and low and high temperatures (P <0.05). Conclusions:Oral treatment options for K. pneumoniae cystitis are rapidly decreasing. Northern and southern India showed significant differences in antimicrobial susceptibility, highlighting the importance of local antibiograms for promoting antimicrobial stewardship. For uncomplicated cystitis, co-trimoxazole (54%) may be the empirical choice. Good susceptibility to fosfomycin was observed (89%). The empirical use of fluoroquinolones, cephalosporins, and amoxicillin-clavulanic acid has been discouraged. Piperacillin-tazobactam and aminoglycosides are carbapenem-sparing agents.

Antimicrobial resistance (AMR) represents one of the most crucial public health threats worldwide. Hence, rapid detection of resistance patterns is of paramount importance. Vitek 2 AES (advanced expert system) can generate rapid and accurate AST reports, which can aid in starting the pathogen-directed treatment on time. We have analyzed the utility of Vitek AES in reporting various resistance patterns among gram-negative bacterial clinical isolates. About fifty multi-drug-resistant gram-negative bacterial isolates were subjected to AST testing by VITEK N407 card. The micro broth dilution method was used to estimate colistin minimum inhibitory concentration. The resistant phenotypes reported as per Vitek AES were documented and analyzed. Vitek AES grouped the resistance mechanisms into carbapenamase (58%), carbapenamase with AmpC (10%), carbapenamase with ESBL (12%), carbapenamase±ESBL (14%) and ESBL (6%). This study highlights using Vitek 2 AES as a rapid tool for reporting antimicrobial susceptibility and drug-resistant phenotypes.

CONTEXT: Rapid detection of pathogens in infected body fluids will help in establishing an aetiological diagnosis, thereby facilitating specific therapy. Molecular methods have an advantage over conventional bacteriological techniques in particularly identifying slow-growing, fastidious or non-cultivable organisms.AIM: The aim of this study is to evaluate the use of 16S rRNA polymerase chain reaction (PCR) for detecting bacterial pathogens in body fluids and compare with conventional culture methods.SETTINGS AND DESIGN: This study was done at the Clinical Laboratory of the Department of Microbiology. This was a cross-sectional study design.MATERIALS AND METHODS: A total of 100 consecutive samples which included synovial fluid, cerebrospinal fluid, ascitic fluid and pleural fluid received in the laboratory during the study period were subjected to PCR for 16S rRNA using specific primers and conventional culture by standard protocol. Samples which were positive for 16S rRNA were sequenced to identify the organism. Results of sequenced products were compared in terms of number of organisms, with culture isolates.RESULTS: The detection rate of 16S rRNA PCR was at 13% as compared to culture at 3% (P = 0.0009). The diagnostic sensitivity and specificity of the PCR were 100% and 89.7%, respectively. The concordance of PCR and culture for both identical positive and negative samples was 90%.CONCLUSIONS: The 16S rRNA PCR proved to be rapid method for detection of bacterial pathogens in body fluids. It may be a valuable tool in the diagnostic armamentarium for differentiating bacterial infection from others and starting empiric treatment.

Introduction: A substantial quantity of pure/ultrapure water is required to initiate hemodialysis (HD)/hemofiltration (HF) therapy for patients with renal failure. Routine disinfection of the water treatment plant is highly needed to produce ultrapure/pure water for HD. To the best of our knowledge and belief, this study is the first of its type and origin to evaluate ozone disinfection levels in a HD unit. Objectives: This study was conducted in the Pondicherry Institute of Medical Sciences (PIMS) HD unit and examined the treated product’s bacteriological quality. Methods and Materials: The hospital record was utilized to obtain the product water culture reports based on the ozone disinfection and product water culture strategy. The product water culture fraction was investigated in concordance with the recommended limits. Results: Of 109 product water culture report samples, 108 (99.1%) aligned with the recommended limits. The product water was cultured via the sterile molten nutrient agar approach; satisfactory numbers of colony counts (<100 CFU/mL) were obtained within 24–48 hours of analysis. The product water purification/disinfection was undertaken per week via the 0.1 Parts-Per-Million ozone dose, administered consistently for 15 minutes. Conclusion: The purification/disinfection of the product water in a HD unit may be undertaken by expert supervision via the ozone disinfection strategy.

Melioidosis, caused by Burkholderia pseudomallei, is known for its diverse clinical presentations and high mortality rate. This brief communication reports the clinico-microbiological profile of twenty cases of melioidosis in a tertiary care hospital over three years. We have analyzed demographic data, clinical presentations, microbiological findings, and treatment outcomes to enhance the understanding and management of this under-recognized infection.

Clinical isolates of multi-drug resistant Acinetobacter baumannii are a major cause of nosocomial infections, often attributed to the highly adaptable genome that helps it to thrive under environmental selection pressure. Here, we aim to provide genotypic-based surveys and comparative whole genome sequencing (WGS) analysis to explore the genomics of the rare pyomelanin-forming clinical isolates of A. baumannii from India. A total of 54 clinical isolates of A. baumannii obtained from two tertiary care hospitals were genotyped using repetitive sequence-based PCR (REP-PCR) for elucidating their molecular epidemiology, followed by their resistance profiling through the determination of minimum inhibitory concentration using the micro broth dilution method. The isolates’ virulence and antibiotic-resistant determinants were detected by PCR screening, followed by biofilm quantification. Pyomelanin pigment produced by A. baumannii isolates was isolated and chemically characterized. Finally, WGS of three pigment-producing and one non-producing A. baumannii strains was performed to explore the factors contributing to their variability. REP-PCR genotyping identified around 8 clusters, with all isolates being multidrug-resistant (MDR). Pyomelanin-producing isolates were strong biofilm formers, characterized by the concurrent presence of ‘pgaB, BfmR, BfmS, ompA, and cusE’ biofilm-related genes. These pigmented strains belonged to ST2Pas and co-harbored blaOXA−23, blaADC−25, aph (3’)-VIa, armA, aph (6)-Id, tet(B) and msr(E) genes. Thirteen common IS elements and biosynthetic gene clusters of arylpolyene, NI-siderophore, and NRP-metallophore were identified. Notably, genomic islands containing aminoglycoside 3’-phosphotransferase, oxidative stress, two-component response regulators, efflux pump-related, toxin-antitoxin protein, and virulence-related genes were also mapped by WGS. The pyomelanin-forming isolates were MDR and virulent. The elucidation of WGS analysis provided critical insights for understanding the epidemiology, virulome, and mobilome of rare pigment-producing A. baumannii strains.

BACKGROUND AND OBJECTIVES:Candidaemia is a potentially life-threatening emergency in the intensive care units (ICUs). Surveillance using common protocols in a large network of hospitals would give meaningful estimates of the burden of candidaemia and central line associated candidaemia in low resource settings. We undertook this study to understand the burden and epidemiology of candidaemia in multiple ICUs of India, leveraging the previously established healthcare-associated infections (HAI) surveillance network. Our aim was also to assess the impact that the pandemic of COVID-19 had on the rates and associated mortality of candidaemia. METHODS:This study included adult patients from 67 Indian ICUs in the AIIMS-HAI surveillance network that conducted BSI surveillance in COVID-19 and non-COVID-19 ICUs during and before the COVID-19 pandemic periods. Hospitals identified healthcare-associated candidaemia and central line associated candidaemia and reported clinical and microbiological data to the network as per established and previously published protocols. RESULTS:A total of 401,601 patient days and 126,051 central line days were reported during the study period. A total of 377 events of candidaemia were recorded. The overall rate of candidaemia in our network was 0.93/1000 patient days. The rate of candidaemia in COVID-19 ICUs (2.52/1000 patient days) was significantly higher than in non-COVID-19 ICUs (1.05/patient days) during the pandemic period. The rate of central line associated candidaemia in COVID-19 ICUs (4.53/1000 central line days) was also significantly higher than in non-COVID-19 ICUs (1.73/1000 central line days) during the pandemic period. Mortality in COVID-19 ICUs associated with candidaemia (61%) was higher than that in non-COVID-19 ICUs (41%). A total of 435 Candida spp. were isolated. C. tropicalis (26.7%) was the most common species. C. auris accounted for 17.5% of all isolates and had a high mortality. CONCLUSION:Patients in ICUs with COVID-19 infections have a much higher risk of candidaemia, CLAC and its associated mortality. Network level data helps in understanding the true burden of candidaemia and will help in framing infection control policies for the country.

Gordonia bronchialis is an aerobic gram-positive bacilli and also weakly acid fast. It requires a long incubation time and extensive biochemical reactions for identification. Therefore, use of broad-range polymerase chain reaction (PCR) for amplification of genes such as 16S rRNA or hsp65 followed by sequencing or advanced techniques like MALDI-TOF MS is needed for identification. Here, we present a case of persistent sternal wound infection following open heart surgery, caused by G. bronchialis in a 58 years old male, identified using MALDI-TOF MS-based system. The patient improved with oral Cefpodoxime 200 mg BD for four weeks.

Objectives: Evidence-based prescribing is essential to optimize patient outcomes in cystitis. This requires knowledge of local antibiotic resistance rates. Diagnostic and Antimicrobial Stewardship (DASH) to Protect Antibiotics (https://dashuti.com/) is a multicentric mentorship program guiding centers in preparing, analyzing and disseminating local antibiograms to promote antimicrobial stewardship in community urinary tract infection. Here, we mapped the susceptibility profile of Escherichia coli from 22 Indian centers. Methods: These centers spanned 10 Indian states and three union territories. Antibiograms for urinary E. coli from the outpatient departments were collated. Standardization was achieved by regional online training; anomalies were resolved via consultation with study experts. Data were collated and analyzed. Results: Nationally, fosfomycin, with 94% susceptibility (inter-center range 83-97%), and nitrofurantoin, with 85% susceptibility (61-97%), retained the widest activity. The susceptibility rates were lower for co-trimoxazole (49%), fluoroquinolones (31%), and oral cephalosporins (26%). The rates for third- and fourth-generation cephalosporins were 46% and 52%, respectively, with 54% (33-58%) extended-spectrum beta-lactamase prevalence. Piperacillin-tazobactam (81%), amikacin (88%), and meropenem (88%) retained better activity; however, one center in Delhi recorded only 42% meropenem susceptibility. Susceptibility rates were mostly higher in South, West, and Northeast India; centers in the heavily populated Gangetic plains, across north and northwest India, had greater resistance. These findings highlight the importance of local antibiograms in guiding appropriate antimicrobial choices. Conclusions: Fosfomycin and nitrofurantoin are the preferred oral empirical choices for uncomplicated E. coli cystitis in India, although elevated resistance in some areas is concerning. Empiric use of fluoroquinolones and third-generation cephalosporins is discouraged, whereas piperacillin/tazobactam and aminoglycosides remain carbapenem-sparing parenteral agents.

Introduction: Evidence-based prescribing in cystitis requires knowledge of local antibiotic resistance rates; national guidelines may not be representative across a country as large and complex as India. Accordingly, DASH to Protect Antibiotics is a multicentric mentorship programme guiding Indian centres in preparing, analysing and disseminating their own antibiograms to promote stewardship in community UTI. Material and Methods: Twenty-two centres were recruited, spanning 10 Indian States and three Union Territories. Using local antimicrobial susceptibility results, these assembled antibiograms for urinary Escherichia coli from the outpatient departments they served. Standardisation was carried out by region-wide online sessions; anomalies were resolved after consultation with the study experts and patron. Data were collated and analysed. Results: Nationally, fosfomycin (94% susceptibility, range: 83-97%) and nitrofurantoin (85%, range: 61-97%) retained the widest activity. Susceptibility rates were lower for co-trimoxazole (49%), fluoroquinolones (31%) and oral cephalosporins (26%). Susceptibility rates for third- and fourth- generation cephalosporins were 46% and 52%, respectively, according with ESBL prevalence of 54% (33%-58%). Piperacillin-tazobactam (81%) amikacin (88%), meropenem (88%) retained better activity, but one centre in recorded only 42% meropenem susceptibility. Higher susceptibility rates were seen in South, West and Northeast India, whereas centres in the heavily-populated Gangetic plains, across North and Northwest India, reported greater resistance. Conclusions: Fosfomycin and nitrofurantoin are the preferred oral empirical choices for uncomplicated E. coli cystitis in India, though locally-elevated resistance is concerning and will exert constrains. Piperacillin-tazobactam and aminoglycosides remain the best carbapenem-sparing agents if ascending infection precludes use of fosfomycin and nitrofurantoin.Funding: The study was unfunded and relied entirely on the existing infrastructure, manpower, motivation and goodwill.Declaration of Interest: There is no Competing Interest Declaration by any of the authors.Ethical Approval: Institution Ethical Committee approvals (IEC) were obtained at all centres.

Background. Streptococcus agalactiae apart from being a colonizer in the genital region is also associated with several other invasive infections in all age groups. With the varied distribution of serotypes across different regions of the world, universal vaccination is also unattainable. However, in India, the knowledge of group B Streptococcus (GBS) genotype distribution is deficient. Thus, this study was initiated to add data on this aspect. Methodology. A cross-sectional study was conducted using isolates of group B Streptococcus from all clinical specimens. Along with that, the clinical specimen type and the antibiotic resistance profile of the isolates were correlated with the genotypes recognized through a multiplex PCR assay. Results. Among the 86 isolates subjected to multiplex PCR for genotype identification, five genotypes were identified with genotype Ib as the predominant one (34.9%), followed by III (20.9%), II (16.3%), Ia (12.7%), and V (11.6%). Conclusion. The results demonstrated a correlation of types Ib and III with vaginal colonization and type II with urine specimens in the current study. This preliminary study exhibited the distribution of common genotypes and their antibiotic resistance profiles in various GBS isolates. However, multiple studies across the country with larger sample sizes are needed to validate these findings.

Background: Hand hygiene (HH) remains a simple, cost-effective method to prevent healthcare-associated infections. Although the recent COVID-19 pandemic has brought out the importance of HH, its compliance remains below the set standards. Hence, monitoring HH compliance in hospital setup through audits remains vital as part of hospital infection prevention and control practices. Aim: The present study was done with the aim of assessing HH compliance in critical care units during the COVID-19 pandemic. Materials and Methods: This prospective cross-sectional study was conducted in the COVID intensive care unit (ICU) of 750-bed tertiary care hospital for 6 months among the healthcare workers in ICU. The HH audit was conducted by direct observation method adapted and modified from the world health organization (WHO)’s HH audit tool through the hand hygiene audit App (Ibhar). Results: The HH complete adherence rate, HH partial adherence rate and HH adherence rate (HHAR, complete + partial) were determined. Profession-specific HHAR (e.g. doctors, nurses and others), gender-specific HHAR and moment-specific HHAR (for each WHO moment) were also calculated. Conclusion: This study highlights the differences in HH compliance between different groups of healthcare workers, and the need to address these gaps by adopting multimodal strategies to modify the behaviour and attitude.

Peritonitis is a serious but preventable complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). It is an important cause of treatment failure and patient drop out. Early diagnosis and treatment of peritonitis helps sustenance of the program and favourable outcomes. Bacteria still remain the predominant cause of peritonitis though fungi and parasites are also known to be etiological agents. Identification by culture and antimicrobial susceptibility testing where applicable remains the gold standard. Appropriate collection of sample and concentration of the sample to perform microscopic examination, culture and /or molecular diagnostic tests are valuable tools for diagnosis in addition to the cell count of the fluid and biochemical analysis. An array of supplementary tests useful as markers of peritonitis have emerged, but their role has to be evaluated further. The chapter describes the microbiological diagnostic testing methods for CAPD peritonitis and the newer emerging technologies recommended.

The study revealed the differential ability of cefepime/taniborbactam and cefepime/zidebactam in tackling carbapenemase-producing Indian clinical isolates that also harbored additional mechanisms of resistance. NDM-expressing E. coli with 4-amino-acid insert in PBP3 are predominately resistant to cefepime/taniborbactam, while the β-lactam enhancer mechanism-based cefepime/zidebactam showed consistent activity against single- or dual-carbapenemase-producing isolates including E. coli with PBP3 inserts.

This study has investigated a total of 51 Acinetobacter baumannii isolates for the prevalence of resistant determinants in tigecycline susceptible and non-susceptible clinical isolates of A. baumannii. Antimicrobial susceptibility testing revealed 74% of isolates were tigecycline resistant. Mutations in RND-efflux pump regulatory genes and the expression of efflux pump genes were measured in tigecycline resistant isolates. There was a strong co-relation between the blaNDM-1 and armA wherein majority of the isolates that are positive for blaNDM-1 have also harbored armA. Compared with TSAB (tigecycline susceptible A. baumannii), TNAB (tigecycline non-susceptible A. baumannii) isolates show increased distribution of blaNDM-1 (P = 0.048), blaIMP-1 (P< 0.0001) and blaOXA-51 (P = 0.0029) carbapenemase genes. The variants of RND-efflux pump regulatory genes due to amino-acid mutations in adeS (F12S, K84E, W61R, N268H and Q299R) and adeL (G21R and Q262R) were identified in tigecycline resistant isolates as well as ISAba1 mediated disruption of adeN were observed causing overexpression of adeIJK efflux pump. Additionally, mutations in adeRS were also associated with increased expression of adeABC efflux pump. Besides, TNAB isolates showed significantly (P< 0.0001) higher ability of biofilm formation as compared to TSAB isolates. The tigecycline resistance due to mutations in contemporary A. baumannii isolates having a higher ability to form biofilm may pose therapeutic difficulties.

PURPOSE:Peritonitis is the most important complication with high rate of morbidity and mortality in patients on continuous ambulatory peritoneal dialysis (CAPD) despite the success and advances. Rapid and accurate identification of pathogens causing peritonitis in a CAPD patient is essential for early targeted treatment. The aim of the study was to evaluate the role of 16S rRNA gene and ITS region PCR and sequencing in detecting bacterial and fungal pathogens from the dialysate of patients undergoing CAPD.METHODS:Fifty eight peritoneal dialysate from suspected cases of peritonitis on CAPD were subjected to conventional culture as per the ISPD guidelines and automated culture system. A conventional PCR was performed to detect the 16S rRNA gene and ITS region. Sequencing and analysis were performed to identify the etiological agent from the remaining dialysate.RESULTS:Among the 58 dialysate fluid, the etiological agents were identified in 8(14%) samples by conventional culture, 28(48%) by automated culture and 47(81%) by 16S rRNA sequencing and analysis. In 8 samples there was discordance in the results of the culture and 16S rRNA PCR. BLAST search of nine sequences obtained from 16S rRNA PCR revealed that these sequences matched best with uncultured bacterial clones. In eleven samples the sequence failed.CONCLUSION:The molecular tool 16S rRNA gene and ITS region PCR and sequencing cannot be used as a standalone test as it lacks sensitivity to identify some bacterial species due to high genetic similarity in some cases and inadequate database in GenBank. However, it could be used as a supplementary test to the culture method especially in the diagnosis of culture negative peritonitis.

Trichosporon colonizes the skin, vagina, gastrointestinal and respiratory tract of humans. Superficial infections are common, while disseminated trichosporonosis is rare, specifically seen among immunocompromised patients and often associated with high mortality. We report a rare case Trichosporon asahii infection in a 78-year-old diabetic, with associated acute interstitial glomerulonephritis. Molecular identification of the isolate was confirmed by sequencing IGS1 region of rDNA. Our study adds to a rather limited literature on renal complications of Trichosporonosis.

Background and Objectives: Surgical site infection (SSI) is a challenge for the surgeon. Incidence of SSI reported in literature varies from 0.5% to 15%. Severity of SSI ranges from superficial skin infection to life-threatening condition like septicaemia. It is responsible for increased morbidity, mortality, and economic burden to the hospital in general, and the patient in particular. The aim of this study was to assess the risk factors, bacteriological profile, length of hospitalization, and cost due to orthopaedic SSI in patients admitted to a tertiary care hospital. Materials and Methods: This was a prospective case control study. Cases were diagnosed based on CDC definition of nosocomial SSI. All cases were assessed preoperatively, intraoperatively and postoperatively, according to type of surgery, wound class, duration of operation, antimicrobial prophylaxis, use of drain, preoperative hospital stay, causative micro organism, total hospital stay, re-admission rates and cost incurred. Age, sex and surgical procedure matched controls without SSI, were also assessed. Chi- square test and Fisher's exact test were used for analysis. P= <0.05 was considered significant. Results: Out of 1023 patients, 47 cases had SSI, with a rate of 4.6%. Cigarette smoking was a risk factor for SSI (P = 0.0035). The most common etiologic agents were Acinetobacter baumannii and Staphylococcus aureus. Incidence of re- admission among SSI cases was more compared to controls (P= 0.0001). Costs attributable to SSI (Indian Rupees) was Rs 32,542 (17,054 to 87,514) which was significantly more than those without SSI (P= <0.001). Conclusion: Despite latest surgical amenities, meticulous sterilization protocols and pre-operative antibiotic prophylaxis, SSI continues to be present in healthcare settings. The increase in duration of hospital stay due to SSI adds to additional burden to an already resource-constrained healthcare system.