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The majority of hospital visits worldwide are caused by urinary tract infections, which are one of the leading causes of morbidity and comorbidity in patients with underlying illnesses. Both urinary tract infections (UTIs) and the rise in antibiotic resistance among uropathogenic bacteria remained important public health concerns. A targeted empirical antibiotic therapy requires routine evaluation of the microbiological organisms responsible for UTIs and their antimicrobial resistance. The aim and objectiveof this study is Prevalence of Urinary Tract Infection its Bacteriological Profile and the Drug Resistance Pattern of the patients at a Tertiary Care Centre in Uttar Pradesh, India. This was a cross sectional study carried out in the Department of Medical Microbiology, at Chhatrapati Shahu Ji Maharaj University (CSJMU), Kanpur from October 2022 to April 2023. A total of 350 freshly voided mid- stream urine sample were collected in a sterile wide mouth container from the individual’s preliminary routine urine tests positive for pus cells and albumin. All the urine samples were processed within one hour after the collection for aerobic bacterial culture. If delayed, samples were refrigerated and processed within 4 - 6 hrs. The identification, biochemicals and the AST pattern was done accoding to the CLSI guidelines 2022. In the present study, total of 350 urine samples were received in which 90 (26%) urine samples were showing significant growth for UTI. The ratio of females were 55 (61%) more as compared to that of the males 35 (38.8%) with the maximum age of 21-30 (47.7%) been affected the most followed by 31-40 (24.4%) years of age and least in the age group above 61 years of age (2.2%). It was noted that the maximum number of isolates were from the gram negative (92.2%) isolates as compared to the gram positive isolates (7.8%). The maximum number of isolates were from the E. coli 44 (48.8%) followed by Klebsiella pneumonia 17 (18.8%) and least for Proteus vulgaris, Acinetobacter baumannii, Staphylococcus saprophyticus with 1 (1.1%). There was high rate of resistance (>70%) among E. coli isolates to piperacillin. Among Klebsiella isolates, no resistance was found for meropenem and low resistance was found for ciprofloxacin (5.8%), norfloxacin (5.8%), and cefotaxime (23.52%) but high for nitrofurantoin (94.15%) and trimethoprim/sulfamethoxazole (41.17%). The best antimicrobials for Gram-negative organisms were meropenem (8.43%), cefoxitin (10.84%) gentamicin (14.45%) cefuroxime (15.66%), cefpodoxime (15.66%), cefotaxime (16.86%), amikacin (19.27%), tobramycin (20.48%) and cefepime (20.48%) and moderate resistance rate were ceftazidime ( 22.89%), ciprofloxacin (30.12%), norfloxacin (32.53%), piperacillin/tazobactam (38.55%) and however, the high resistance rate was found to be against, trimethoprim/sulfamethoxazole (45.78%), nitrofurantoin (30.12%), amoxicillin/clavulanic acid (46.98%), piperacillin (85.85%) and ampicillin (78.31%). In conclusion, the best antimicrobials for Gram-negative organisms were meropenem (8.43%), cefoxitin (10.84%) gentamicin (14.45%) cefuroxime (15.66%), cefpodoxime (15.66%), cefotaxime (16.86%), amikacin (19.27%), tobramycin (20.48%) and cefepime (20.48%) and moderate resistance rate were ceftazidime ( 22.89%), ciprofloxacin (30.12%), norfloxacin (32.53%), piperacillin/tazobactam (38.55%) and, however, the high resistance rate was found to be against, trimethoprim/sulfamethoxazole (45.78%), nitrofurantoin ( 30.12%), amoxicillin/clavulanic acid (46.98%), piperacillin (85.85%) and ampicillin (78.31%). The sensitivity pattern of antimicrobials for Gram-positive organisms was linezolid, teicoplanin, vancomycin, nitrofurantoin and levofloxacin ; however high resistance rate was found against erythromycin, trimethoprim/sulfamethoxazole, gentamicin, tobramycin, fosfomycin, clindamycin, oxacillin, tetracycline and benzylpenicillin 100% resistance rate. Among the Gram-positive isolated organisms, there was no inducible clindamycin resistance (0.0%). The cost of UTI prevention can be reduced by doing the routine checks and the strict implementation of the antibiotic stewardship programs. The cost of UTI prevention can be reduced by doing these routine checks. [ABSTRACT FROM AUTHOR]

The goal of this research is on antibiotic resistance and biofilm formation of Escherichia coli on different surfaces. 37 E.coli isolates were obtained from K.A.P. Viswanatham Government Medical College, Tiruchirappalli, Tamil Nadu, India. Biochemical assays were used to re-confirm all the isolates. Ampicillin, Cefepime, Cefotaxime, Co-trimoxazole, Tetracycline and Levofloxacin showed substantial levels of resistance. Meropenem, Tigecycline, and Colistin showed the least amount of resistance. 75.6% of the E.coli strains were multidrug resistant (MDR). Biofilm formation of E.coli was higher in TS BG than in TS B in all (polystyrene, polypropylene, glass and stainless steel) surfaces. It is evident that the presence of glucose or any sugar substrate promotes biofilm development, resulting in notable antibiotic resistance. This situation is hazardous to human health. [ABSTRACT FROM AUTHOR]

In this study, 504 urine samples collected from patients suffering from urinary tract infection (UTIs) were screened for the presence of Klebsiella pneumoniae. The overall occurrence of Klebsiella spp. and K. pneumoniae was found to be 23·2% (117/504) and 16·8% (85/504) respectively. Antibiotic susceptibility testing of 85 K. pneumoniae isolates was carried out by disc diffusion which revealed alarming levels of antibiotic resistance (ABR). Antimicrobial resistance was prominently observed against cefpodoxime (76·47%) followed by ampicillin (70·59%), ceftriaxone (52·94%), cefoxitin (50·59%), amoxyclav (48·24%), ofloxacin (45·88%), cefotaxime (44·71%), cefepime (43·53%) and doxycycline hydrochloride (40%). A small percentage of strains also exhibited resistance to other antimicrobials in the range of 7–35%. Around 77·6% of the isolates were found to be resistant to three or more antibiotic classes and 66·7% of the isolates had multiple antibiotic resistance index values >0·2. Screening of virulence genes in 85 K. pneumoniae isolates revealed that uge gene was the most predominant (11/85, 12·9%), followed by rmpA (9/85, 10·5%), kfu (4/85, 4·7%) and aerobactin genes (2/85, 2·35%). Further, the overall percentage of biofilm producers were found to be 17·65% (15/85). This study warrants hospitals and health care centres to reduce misuse of antibiotics and manage UTI with appropriate treatment after performing antibiotic susceptibility testing. [ABSTRACT FROM AUTHOR]

Background: Recent reports reveal the emergence of Escherichia coli isolates harbouring a novel resistance mechanism based on four-amino-acid inserts in PBP3. These organisms concomitantly expressed ESBLs or/and serine-/metallo-carbapenemases and were phenotypically detected by elevated aztreonam/avibactam MICs.Objectives: The in vitro activities of the investigational antibiotic cefepime/zidebactam and approved antibiotics (ceftazidime/avibactam, ceftolozane/tazobactam, imipenem/relebactam and others) were determined against E. coli isolates harbouring four-amino-acid inserts in PBP3.Methods: Whole-genome sequenced E. coli isolates (n = 89) collected from a large tertiary care hospital in Southern India (n = 64) and from 12 tertiary care hospitals located across India (n = 25) during 2016-18, showing aztreonam/avibactam MICs ≥1 mg/L (≥4 times the aztreonam epidemiological cut-off) were included in this study. The MICs of antibiotics were determined using the reference broth microdilution method.Results: Four-amino-acid inserts [YRIK (n = 30) and YRIN (n = 53)] were found in 83/89 isolates. Among 83 isolates, 65 carried carbapenemase genes [blaNDM (n = 39), blaOXA-48-like (n = 11) and blaNDM + blaOXA-48-like (n = 15)] and 18 isolates produced ESBLs/class C β-lactamases only. At least 16 unique STs were noted. Cefepime/zidebactam demonstrated potent activity, with all isolates inhibited at ≤1 mg/L. Comparator antibiotics including ceftazidime/avibactam and imipenem/relebactam showed limited activities.Conclusions: E. coli isolates concurrently harbouring four-amino-acid inserts in PBP3 and NDM are an emerging therapeutic challenge. Assisted by the PBP2-binding action of zidebactam, the cefepime/zidebactam combination overcomes both target modification (PBP3 insert)- and carbapenemase (NDM)-mediated resistance mechanisms in E. coli. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Acinetobacter spp. has emerged as a major cause of nosocomial outbreaks. Multiple antibiotic resistance is an important problem in Acinetobacter isolates in recent years. The aim of this study was to evaluate the rate of antimicrobial resistance and changes in resistance pattern over a period of 5 years (2012-2016) in Acinetobacter spp. isolated from trauma patients. MATERIALS AND METHODS: Acinetobacter spp. was identified by VITEK 2 and antibiotic susceptibility of isolates was investigated by disc-diffusion method and VITEK 2 automated system. Interpretation of susceptibility results was based on the Clinical and Laboratory Standards Institute guidelines. RESULTS: Out of the total 16,210 isolates obtained throughout the period of 5 years, Acinetobacter spp. accounted for 3744 (28.9%). Out of which, the species which was maximally isolated was Acinetobacter baumannii (98.5%), followed by Acinetobacter lwoffii (1.4%) and Acinetobacter hemolyticus (0.1%). The highest number of clinical isolates of Acinetobacter were recovered from neurosurgical ward (n = 1210), followed by the neurosurgical intensive care unit (ICU) (n = 1000) and surgical ICU (n = 948) and the most common sample of Acinetobacter isolation was from tracheal aspirate (37.1%), followed by wound swab (18.8%). The highest level of resistance was observed against ciprofloxacin (96%), followed by cefepime (95%), ceftazidime (95%), piperacillin (95%), and amikacin (92%). The trend of antibiotic resistance was found to be statistically significant (P < 0.001) for most of the antibiotics being tested such as amikacin and carbapenems. CONCLUSION: The high rate of antibiotic resistance of the Acinetobacter strains indicated that there is an urgent need for controlled antibiotic usage and appliance of hospital infection control measures. [ABSTRACT FROM AUTHOR]

Objective: To evaluate clinically the efficacy and safety in northern India of cefepime monotherapy versus piperacillin-tazobactam in patients of paediatric age group with febrile neutropenia.Material and Methods: Children aged ≤18 years admitted febrile with chemotherapy-induced neutropenia were randomised into two groups comprising 20 cases in each group viz. CEF (receiving cefepime only) and PIP-TAZO (receiving piperacillin-tazobactam). Based on clinical and laboratory tests, patients were classified into: microbiologically documented infections (MDI); clinically documented infections (CDI); and unexplained fever (UF). They were assessed for clinical signs and symptoms as well as laboratory parameters at the time of enrolment and subsequently on days 3 and 7.Results: Incidence of MDI, CDI and UF were 22.5%, 47.5% and 30%, respectively. The mean duration of neutropenia (in days) was 5.45 ± 2.1 in the PIP-TAZO group and 5.5 ± 1.5 in the CEF group (P = 0.305). The success rate defined as clearing infection effectively and improvement of neutropenia was comparable (P = 0.705). There was a mortality rate of 20% in the PIP-TAZO group as compared to 10% in the CEF group.Conclusion: We conclude that cefepime monotherapy and piperacillin-tazobactam are equally efficacious and safe in treating patients with febrile neutropenia. Empirical monotherapy with cefepime would prevent an unnecessary extra economic burden as well as avoiding the serious adverse or toxic effects of multi-drug regimes, especially in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

B Background: b Antibiotic resistant bacteria present a growing global healthcare challenge. For amplification and characterization of bla SB ESBL sb genes, a set of eight primers was used namely: bla SB TEM sb , bla SB CTX-M sb , bla SB SHV sb , bla SB OXA-2 sb , bla SB OXA-10 sb bla SB GES sb , bla SB PER sb , and bla SB VEB sb Antimicrobial susceptibility testing was performed by Kirby Bauer disc diffusion method (CLSI, 2017) on Muller-Hinton agar plates using antibiotics viz. cefopodoxime, amikacin, gentamicin, ciprofloxacin, trimithoprim/sulphamethoxazole,tigecycline, cefepime, imipenem, meropenem and aztreonam. The distribution of CTX-M genes in our isolates indicating communication between the genetic pools of ESBLs in clinical and environmental isolates. [Extracted from the article]

Objectives: Cefepime/tazobactam is a new β -lactam/β -lactamase inhibitor combination licensed for clinical use by Drugs Controller General of India. Aim of our study was to analyze the clinical efficacy and safety of cefepime/tazobactam in patients with sepsis. To the best of our knowledge, this is the first published clinical study on this drug. Materials and methods: A retrospective observational study on the efficacy and safety of cefepime/tazobactam was conducted at a tertiary care hospital, South India. Patients who had a clear source of infection, having a single organism as the causative agent and being treated with cefepime/tazobactam alone were analyzed for efficacy and those cases who had a clear source of infection but either had multiple organism grown or cultures being negative or those patients who received a combination of antibiotics were analyzed for the safety analysis. Results: Thirty two patients satisfied our study criteria. All 15 patients in the efficacy group (nine with ventilator associated pneumonia, three tracheitis, two bacteraemia and one with urosepsis) had complete clinical cure, with microbiological cure in cases where a repeat culture was indicated. There were no significant side effects in any of the evaluable 32 patients assessed for safety. Conclusion: Cefepime/tazobactam is a safe and effective agent to treat patients with nonlife threatening sepsis due to Gram negative bacteria. [ABSTRACT FROM AUTHOR]

Background & Objectives: AmpC β-lactamases are clinically significant since these confer resistance to cephalosporins in the oxyimino group, 7-α methoxycephalosporins and are not affected by available β-lactamase inhibitors. In this study we looked for both extended spectrum β-lactamases (ESBL) and AmpC β-lactamases in Klebsiella pneumoniae clinical isolates., Methods: One hundred consecutive, non-duplicate clinical isolates of K. pneumoniae collected over a period of one year (June 2008 - June 2009) were included in the study. An antibiotic susceptibility method was used with 10 antibiotics for Gram-negative infections which helped in screening for ESBL and AmpC β-lactamases and also in confirmation of ESBL production. The detection of AmpC β-lactamases was done based on screening and confirmatory tests. For screening, disc diffusion zones of cefoxitin <18 mm was taken as cefoxitin resistant. All cefoxitin resistant isolates were tested further by AmpC disk test and modified three dimensional test. Multiplex-PCR was performed for screening the presence of plasmid-mediated AmpC genes., Results: Of the 100 isolates of K. pneumoniae studied, 48 were resistant to cefoxitin on screening. AmpC disk test was positive in 32 (32%) isolates. This was also confirmed with modified three dimensional test. Indentation indicating strong AmpC producer was observed in 25 isolates whereas little distortion (weak AmpC) was observed in 7 isolates. ESBL detection was confirmed by a modification of double disk synergy test in 56 isolates. Cefepime was the best cephalosporin in synergy with tazobactam for detecting ESBL production in isolates co-producing AmpC β-lactamases. The subsets of isolates phenotypically AmpC β-lactamase positive were subjected to amplification of six different families of AmpC gene using multiplex PCR. The sequence analysis revealed 12 CMY-2 and eight DHA-1 types., Interpretation & Conclusions: Tazobactam was the best β-lactamase inhibitor for detecting ESBL in presence of AmpC β-lactamase as this is a very poor inducer of AmpC gene. Amongst cephalosporins, cefepime was the best cephalosporin in detecting ESBL in presence of AmpC β-lactamase as it is least hydrolyzed by AmpC enzymes. Cefepime-tazobactam combination disk test would be a simple and best method in detection of ESBLs in Enterobacteriaceae co-producing AmpC β-lactamase in the routine diagnostic microbiology laboratories.