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Medicinal plants provide a significant supply of natural compounds that can be used to develop new therapeutic medicines for treating severe illnesses including microbial infections. The genus Bambusa, which belongs to the Poaceae family, encompasses a vast and widely distributed collection of plants that possess a wide range of traditional uses in the treatment of various diseases. This study examined the ethanolic extracts of Bambusa tulda, along with its fractions such as ethyl acetate, petroleum ether, n-butanol, and water, to investigate their qualitative and quantitative phytochemical, antioxidant, and antibacterial properties. FTIR analysis of ethanolic powdered shoot extracts shows, presence of different functional groups including C-H, C-O, O-H and aromatic groups by showing stretching’s in different wavelengths. The extracts underwent testing to evaluate their antimicrobial activity against various strains of bacteria by using agar disc diffusion method and micro-dilution techniques to determine the minimum inhibitory and bactericidal concentrations. Additionally, the antioxidant activity of the extracts was assessed using the scavenging activity of DPPH radical methods. The extracts exhibited a robust positive connection between their antioxidant activity and the combined amounts of phenolics and flavonoids. The IC50 values of n-butanol, ethanol, water, petroleum ether, and ethyl acetate fraction show in ascending order 10.77+0.24 μg/ml, 11.35+0.13 μg/ml, 13.36+0.11 μg/ml,13.93+0.71 μg/ml and14.25+ 0.27 μg/ml respectively. The extracts have been shown effective efficacy against Escherichia coli and Staphylococcus aureus bacteria. However, it did not show any responses against Klebsiella pneumoniae and Pseudomonas aeruginosa. Escherichia coli exhibited greater susceptibility to the extracts compared to S. aureus, with the n-butanol fraction being the most potent extract. [ABSTRACT FROM AUTHOR]

BACKGROUND: K.pneumoniae is a gram-negative bacterium belonging to the Enterobacteriaceae family. This microorganism is a part of the healthy microbiome of individuals and colonizes many parts of the body. The incidence of carbapenemresistant Klebsiella pneumoniae (CRKP) infections is increasing globally. In India, around 65% of K. pneumoniae isolates are resistant to carbapenem antibiotics. The blaNDM is the predominant carbapenem-resistant gene in CRKP isolates. AIM AND OBJECTIVE: To Study the Molecular Characterization of blaNDM-1 Resistant genes in Carbapenem Resistance Klebsiella Pneumonia Clinical isolates. MATERIAL AND METHODS:This was a cross sectional study carried out for a period of 1 year i.e, during 2023 to 2024at K.G.M.U, Lucknow . Samples like urine, sputum, ET tube, pleural fluid, pus, CSF, blood and Ascitic fluid were included in this study. Carbapenemase resistance was detected phenotypically by MHT, mCIM and eCIM methods and genotypically by using PCR where the DNA extraction was done and the resistant gene blaNDM-1 was confirmed by PCR assay. RESULT:A total of 350 isolates of K. pneumoniae were collected from patients, with 127(36.28%) identified as CRKP. There were 30 (57.69%) isolates obtained from male and 22(42.30%) were obtained from female, while the maximum number of patients belong to the age group <50 years and maximum patients were engaged as Student/Housewife/Retired (44.09%) followed by Clerical/Shopkeeper/Farmer (36.22%) and others. In our study,it was also observed that, in phenotypic test 81.88% were positive for M-CIM while 77.95% were positive for E-CIM and in genotypic test there were 86.61 % positive for NDM-1. CONCLUSION: The study highlighted the existence of carbapenemase-producing K. pneumoniae, particularly in blaNDM-1, in patients with comorbidities. Our findings emphasize the importance of the molecular characterization of resistance-determinant-carrying bacterial pathogens as a part of infection control and prevention in hospital settings. [ABSTRACT FROM AUTHOR]

To the best of our knowledge, this paper presents the first report on the microbial status of wild bees (A. dorsata and A. florea) honey collected from different northern states of India. In total, 17 bacterial morphotypes (9 from A. dorsata and 8 from A. florea) were recovered. The bacterial load (log CFU/g) was observed to be maximum (4.01) in A. dorsata honey from Sirmour-Puruwala whereas, lowest load (3.49) was recorded in Punjab-Rupnagar honey. Likewise, A. florea honey from Sirmour-Kala Amb and Punjab-Doraha were recorded with maximum and minimum bacterial loads of 4.17 and 3.40, respectively. Observance of lower bacterial load than hazardous limit ensured its safety for human consumption. Three most dominant bacteria viz., AD1, HF7 and AF4 were identified as Micrococcus endophyticus (MT938911), Bacillus subtilis subsp. stercoris (MT764923) and Bacillus pumilus (MT764923), respectively through 16S rRNA ribotyping. Moreover, the inhibitory activity of honey was good to excellent against Salmonella typhi NCTC 786 and fair to good against Bacillus subtilis ATCC 6633, Pseudomonas aeruginosa ATCC 10662 and Klebsiella pneumoniae ATCC 13883. The Escherichia coli ATCC 1041 was the most sensitive bacterium among all. These results justify wild bees honey as a natural remedy for curing and preventing numerous human ailments. [ABSTRACT FROM AUTHOR]

Background: Colistin is a last-resort antibiotic used in extreme cases of multi-drug resistant (MDR) Gram-negative bacterial infections. Colistin resistance has increased in recent years and often goes undetected due to the inefficiency of predominantly used standard antibiotic susceptibility tests (AST). To address this challenge, we aimed to detect the prevalence of colistin resistance strains through both Vitek®2 and broth micro-dilution. We investigated 1748 blood, tracheal aspirate, and pleural fluid samples from the Intensive Care Unit (ICU), Neonatal Intensive Care Unit (NICU), and Tuberculosis and Respiratory Disease centre (TBRD) in an India hospital. Whole-genome sequencing (WGS) of extremely drug-resitant (XDR) and pan-drug resistant (PDR) strains revealed the resistance mechanisms through the Resistance Gene Identifier (RGI.v6.0.0) and Snippy.v4.6.0. Abricate.v1.0.1, PlasmidFinder.v2.1, MobileElementFinder.v1.0.3 etc. detected virulence factors, and mobile genetic elements associated to uncover the pathogenecity and the role of horizontal gene transfer (HGT). Results: This study reveals compelling insights into colistin resistance among global high-risk clinical isolates: Klebsiella pneumoniae ST147 (16/20), Pseudomonas aeruginosa ST235 (3/20), and ST357 (1/20). Vitek®2 found 6 colistin-resistant strains (minimum inhibitory concentrations, MIC = 4 μg/mL), while broth microdilution identified 48 (MIC = 32–128 μg/mL), adhering to CLSI guidelines. Despite the absence of mobile colistin resistance (mcr) genes, mechanisms underlying colistin resistance included mgrB deletion, phosphoethanolamine transferases arnT, eptB, ompA, and mutations in pmrB (T246A, R256G) and eptA (V50L, A135P, I138V, C27F) in K. pneumoniae. P. aeruginosa harbored phosphoethanolamine transferases basS/pmrb, basR, arnA, cprR, cprS, alongside pmrB (G362S), and parS (H398R) mutations. Both strains carried diverse clinically relevant antimicrobial resistance genes (ARGs), including plasmid-mediated blaNDM-5 (K. pneumoniae ST147) and chromosomally mediated blaNDM-1 (P. aeruginosa ST357). Conclusion: The global surge in MDR, XDR and PDR bacteria necessitates last-resort antibiotics such as colistin. However, escalating resistance, particularly to colistin, presents a critical challenge. Inefficient colistin resistance detection methods, including Vitek2, alongside limited surveillance resources, accentuate the need for improved strategies. Whole-genome sequencing revealed alarming colistin resistance among K. pneumoniae and P. aeruginosa in an Indian hospital. The identification of XDR and PDR strains underscores urgency for enhanced surveillance and infection control. SNP analysis elucidated resistance mechanisms, highlighting the complexity of combatting resistance. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate cord blood haematological parameters in pregnant mothers with high risk factors in predicting early onset neonatal sepsis. Methods: This is hospital based study done at Department of Obstetrics and Gynaecology, Siddhartha Medical College, Vijayawada. All examinations were done 24 hours after birth. Neonatal sepsis (NS) was characterized as a positive blood culture with symptoms of infection. All smears were examined by the pathologist blinded to the clinical findings. Platelet count & WBC, Differential leucocyte count, Nucleated RBC (for correction of leucocyte count), Neutrophil morphology for assessing degenerative changes.e A complete blood count, included TLC, platelet count, total neutrophil count (TNC). Absolute neutrophil counts (ANC) were calculated from the observed values. Results: Out of 100 high risk cases of neonatal septicaemia 56 culture positive cases 39 (69.64%) were males and 17 (30.36%) were females. Among the culture positive cases Klebsiella were the commonest isolates i.e, Klebsiella 23(41.07%), Staphylococci 12(21.43%), Pseudomonas6(10.71%), Enterobacter 5(8.93%), E.coli 4(7.14), Providencia 4(7.14%)And Acinetobacter 2(3.57%). 14. Haematological scoring system at score =2 was reliable since it had sensitivity & NPV of 100% but specificity and PPV of 54.7.A score of Haematological score of =5 had specificity and PPV of 100%. With increase in the score, the specificity and Positive predictive value increased. Among the different screening parameters assessed, total neutrophil count had highest sensitivity and Negative predictive value. Immature neutrophil count had highest Specificity and Positive predictive value. Conclusion: Neonatal septicemia is still a leading cause of mortality and morbidity in developing countries like India. Gram negative organisms are the predominant causative agents in neonatal septicemia with Klebsiella pneumonia leading the list. Blood culture is considered "Gold standard" for the diagnosis of septicemia in neonates. A hematological score of 0 and 1 suggested sepsis was unlikely, 2-3 - sepsis possible and score 4 and 5 indicated very likely. The study found that the higher the score the greater the certainty that sepsis occurs. [ABSTRACT FROM AUTHOR]

The present study aimed to determine the antibiotic resistance, underlying mechanisms, antibiotic residues, and virulence genes involved in 32 multi-drug-resistant Klebsiella pneumoniae isolates from freshwater fishes in Andhra Pradesh, India. Antibiogram studies revealed that all isolates were multi-drug-resistant, harbored tetA (96.8%), tetC (59.3%), tetD (71.9%), nfsA (59.3%), nfsB (53.1%), sul2 (68.7%), qnrC (43.7%), qnrD (50%), blaSHV (75%), blaTEM (68.7%), and blaCTX-M (93.7%) genes. Multiple antibiotic resistance index was calculated as 0.54. Sixteen isolates were confirmed to be hyper-virulent and harbored magA and rmpA genes. In total, 46.9, 31.2, and 21.9% of the isolates were categorized as strong, moderate, or weak biofilm formers, respectively. All isolates possessed an active efflux pump and harbored acrA, acrB, acrAB, and tolC genes in 94% of the isolates, followed by mdtK (56.2%). Porins such as ompK35 and ompK36 were detected in 59.3 and 62.5% of the isolates, respectively. Virulence genes fimH-1, mrkD, and entB were present in 84.3, 81.2, 87.5% of the isolates, respectively. These findings imply a potential threat that multi-drug-resistant bacterial pathogens could transmit to surrounding environments and humans through contaminated water and the aquaculture food chain. [ABSTRACT FROM AUTHOR]

Introduction: Klebsiella is the primary cause of respiratory tract infection like pneumonia, Rhinoscleromatis, sinusitis and cholecystitis. Klebsiella pneumoniae is primary pathogens and can cause a classic from of primary pneumoniae. Klebsiella pneumonia can also cause urinary tract infection, nosocomial infection, wound infection biliary tract infection, peritonitis, meningitis, bacteremia, enteritis, septicemia. Multidrug-resistant Klebsiella pneumoniae (MDRKP) has become an urgent risk to public health as its prevalence has sharply surged around the globe in recent decades. Therefore, to understand the antibiotic sensitivity pattern of K. pneumoniae from various specimens in West India and to provide a basis for the selection of appropriate antibiotics, this study was investigated. Materials and methods: This study was conducted at Diagnostic Microbiology section of Central laboratory, Dhiraj General Hospital, SBKS MI and RC, Piparia, Vadodara over the period of April 2022 to September 2022. There were various sample should be collected according to site of infection like urine, blood, pus, sputum and other body fluids. Data collection was carried out based on a questionnaire that was previously designed in terms of gender, age, the type of antibiotic. Detection and differentiation of sensitive, semi-sensitive and resistant conditions from each other was performed based on the diameter of the around the colony as millimeters and according to the relevant table in laboratory. The data were collected, recorded and analyzed statistically. Results: At the time study period, total 750 specimens was collected and 114 specimen was positive for Klebsiella isolates from various specimen. Most affected age group were 31-40 years (30), 41-50 years (23), 51-60 years (18). In the present study, out of 117 Klebsiella isolates, 91.87% resistant to Ampicillin, 58% to Amikacin, 88.03% to Cefuroxime, 69% to Ceftazidime, 63% to Cefepime, 86% to Ciprofloxacin, 61% to Imipenem, 62% to Gentamicin, 58% to Cotrimaxazole. Conclusion: We may draw the conclusion that K. pneumoniae antibiotic resistance is a real threat and requires close monitoring to be controlled. This study indicated relatively high prevalence of multidrug resistance Klebsiella species. This data had important implication for the quality of patient care in hospital settings specially in antibiotics selection, infection control practices and need for additional studies. [ABSTRACT FROM AUTHOR]

Carbapenems are effective and reliable β-lactam antibiotics often used as the last option for treating severe infections caused by MDR Gram-negative bacteria, including K. pneumoniae. Among the Enterobacteriaceae group, clinically significant carbapenemases are the Ambler molecular class A (blaKPC), class B (blaVIM, blaIMP, blaNDM-1) and class D (blaOXA-48-like) types. These types are commonly found in K. pneumoniae and are frequently associated with serious nosocomial infections and outbreaks leading to the emergence and distribution of multidrug-resistant (MDR) and carbapenemresistant Klebsiella pneumoniae (CRKP) that has become a global health threat. To study the molecular characterization of blaOXA-48 and blaNDM-1 Resistant genes in Carbapenem Resistance Klebsiella pneumonia clinical isolates. This was a cross sectional study carried out for a period of 1 year i.e, November 2022 to November 2023 period of at Index Medical College, Hospital & Research Centre (IMCHRC), Indore (M.P.), India. The study included all the patients of OPD and IPD. Samples like urine, sputum, ET tube, pleural fluid, pus, CSF, blood and ascitic fluid were included in this study. Carbapenemase resistance was detected phenotypically by MHT, mCIM and eCIM methods and genotypically by using RTPCR where the DNA extraction was done using the Qiagen DNA extraction kit and the resistant gene blaOXA-48 and blaNDM-1 was confirmed by RTPCR assay. A total of 430 clinical samples were screened, out of which 160 (37.20 %) samples showed growth of K. pneumoniae, while 270 (62.8 %) samples showed growth of bacteria other than K. pneumoniae or sterile samples. There were 69.37% (n=111) of total Klebsiella isolates, which were carbapenem resistant (suggestive of Carbapenemase producers) by Kirby-Bauer disc diffusion, but 56.76% (63/111) of Klebsiella isolates were confirmed for Carbapenemase production by real time PCR. In conclusion, prevalence of carbapenem resistance in the current study was observed to be 56% as confirmed by real time PCR. Male patients were predominant in our study, the most common age group being above 60 years in both the sexes. In this study our results indicate the phenotypic detection mCIM combined with eCIM showed high sensitivity and specificity to detect carbapenemase producing K.pneumoniae compared with MHT. [ABSTRACT FROM AUTHOR]

Context: At present, commonly encountered infections like urinary tract infections (UTIs) are becoming more and more difficult to treat. UTIs caused by extended‑spectrum β‑lactamase (ESBL) organisms tend to lead to uncertain outcomes and prolong hospitalization as these organisms are multidrug resistant. Such a situation has forced clinicians to reconsider the use of old antibiotics like fosfomycin. Aims: To determine fosfomycin susceptibility among ESBL‑producing Escherichia coli and Klebsiella pneumoniae isolates causing UTI in a tertiary care center in Western India. Settings and Design: This is a cross‑sectional study done in the Department of Microbiology between July 2021 and July 2022. Methods and Material: Urine samples from all outpatients and inpatients with suspected UTI which were received in the microbiology laboratory were inoculated in appropriate culture media. Pure growth of bacteria with a significant colony count was identified and antibiotic susceptibility testing was done as per standard guidelines. Statistical Analysis Used: The collected data were entered in a Microsoft Excel sheet and analyzed. Results: A total of 437 urine samples were collected from which 39 isolates of ESBL E. coli and 10 isolates of ESBL Klebsiella pneumoniae were obtained. All the E. coli isolates were sensitive to fosfomycin, while two of the Klebsiella pneumoniae isolates were resistant to fosfomycin. Conclusions: Older antibiotics like fosfomycin and nitrofurantoin attain high concentrations in the urinary tract, have a minimal impact on gastrointestinal flora, and do not develop resistance as compared to many other antibiotics. Therefore, fosfomycin should be preferred for the treatment of uncomplicated UTIs caused by resistant strains. [ABSTRACT FROM AUTHOR]

Antibiotic resistance in animals is a significant and highly challenging threat among animals. Extended spectrum β-lactamase (ESBL) producing E. coli amongst all bacteria have been categorized by the WHO as the most critical AMR pathogen to human health and a major public health concern. In an effort to study the prevalence of ESBL producing coliforms among the ruminant species, phenotypic screening and confirmation by Kirby Bauer diffusion method followed by genotypic characterization of the isolates were carried out to ascertain the type of β-lactamase involved in conferring resistance. A total of 50 fecal swabs were collected from the cattle (n=26), buffalo (n=11), goat (n=10) and sheep (n=3) species. A total of 72 (26/50) % and 68 (34/50) % of the coliform isolates from the ruminant species were found to be phenotypically resistant to most of the β-lactam group of antibiotics and third generation cephalosporins, respectively. The isolates showing phenotypic resistance to third generation cephalosporins were genotypically confirmed by multiplex PCR to determine the types of β-lactamase coding for the resistance. The multiplex PCR for TEM, SHV and OXA type ESBLs revealed the presence of 713 and 564 bp amplicon indicating the predominance of serine β-lactamases, viz., SHV (Class A) and OXA (Class D) type ESBL in 85.7 % and 7.0 % of the coliform isolates of ruminants. This study confirms and emphasizes the prevalence of ESBL producing coliforms and the hidden threat underlying in healthy ruminant species. [ABSTRACT FROM AUTHOR]

Mastitis associated Klebsiella pneumoniae species were isolated from bovine milk to characterize virulence genes (wabG and kfuBC) and extended spectrum ß-lactamase (ESBL) genes (blaCTX-M-1, blaCTX-M-2, blaCTX-M-9, blaTEM, blaSHV and blaOXA). A total number of 325 bovine milk samples (195 raw and 130 mastitic milk specimens) collected from Banaskantha, a milkshed district of Gujarat, India, were included in the study. A total number of 27 K. pneumoniae isolates were recovered, consisting of 17 (62.96%) isolates from raw milk and 10 (37.03%) isolates from mastitic milk samples, giving an overall prevalence of 8.31%. Antibiotic sensitivity patterns revealed that 20 out of 27 isolates were found to be multi-drug resistant. Based on combination disc diffusion test and HiCrome ESBL agar method, 20 (74.07%) and 25 (92.59%) isolates were detected as ESBL producers, respectively. Among virulence genes studied, presence of wabG (25/27; 92.59%) was higher than kfuBC (5/27; 18.51%). Beta-lactamase genes viz., blaSHV, blaTEM and blaCTX-M-1 were detected in 23/27 (85.18%), 3/27 (11.11%) and 2/27 (7.40%) of isolates, respectively; while, none of the isolates was found to be positive for blaCTX-M-9 and blaOXA-1 genes. Outcome of the study provided an insight into virulence genes and ESBL producing K. pneumoniae isolated from bovine milk samples in India. [ABSTRACT FROM AUTHOR]

Increasing prevalence of carbapenem resistance among Enterobacterales, particularly Escherichia coli and Klebsiella pneumoniae, poses a serious public health threat globally. Furthermore, these bacteria exhibit multidrug resistance, making treatment of infections caused by them challenging. Colistin is one of the antibiotics used in the treatment of infections caused by carbapenem resistant Enterobacterales; however, its unrestricted usage has resulted in the emergence of colistin resistant strains. The present study was conducted to determine the prevalence of carbapenem resistance and co‑resistance to carbapenem and colistin resistance among E. coli and K. pneumoniae isolated from various clinical specimens from patients attending various departments of a multispecialty teaching hospital in Haryana, India. Methods: A total of 597 isolates comprising 425 E. coli and 172 K. pneumoniae isolated between March 2019 to November 2021 were included in the study. The isolates were subjected to screening for the detection of carbapenemase production using carbapenem discs and a phenotypic test, that is, the CarbaNP test. Antibiogram of the carbapenem‑resistant isolates was further analyzed by the Kirby–Bauer disc diffusion method and to evaluate colistin resistance, isolates were subjected to colistin broth disc elution test. Results: The prevalence of carbapenemase production among the E. coli and K. pneumoniae isolates by the screening test were detected to be 98/425 (23.1%) for E. coli and 90/172 (52.3%) for K. pneumoniae, whereas the CarbaNP test confirmed 93/425 (21.9%) and 84/172 (48.8%) of the two categories of bacterial isolates, thus showing a false positivity rate of 2.6% (n = 11) by screening test for the detection of carbapenemase production. Among the bacterial isolates, 3 (1.7%) comprising 1 (1.1%) E. coli and 2 (2.6%) K. pneumoniae were found to be dual carbapenem‑ and colistin‑resistant strains. K. pneumoniae isolates showed higher resistance rates to non‑carbapenem antibiotics compared to E. coli isolates. Conclusions: The emergence of bacteria with concurrent resistance to carbapenems and colistin is a serious concern as they are the last‑resort drugs against multidrug‑resistant and extensively drug‑resistant bacteria. [ABSTRACT FROM AUTHOR]

Background: Ventilator‑associated pneumonia (VAP) in acute respiratory distress syndrome patients is expected in the setting of prolonged mechanical ventilation due to abridged immunity and dysregulation of the microorganisms inhabiting the oral cavity. We conducted this study to identify the spectrum of microorganisms causing VAP in patients admitted to the medicine intensive care unit (MICU) and their antibiotic susceptibility patterns. Materials and Methods: We conducted a retrospective cross‑sectional laboratory‑based study from January 2021 to April 2021. Our cohort included patients with respiratory distress who were admitted to the MICU. We observed the incidence of VAP and the risk factors responsible for multidrug resistance (MDR) microorganisms in the MICU, along with 250‑day survival in the existence of specific comorbidities along with VAP. Results: Clinical charts of patients (n = 366) admitted to the MICU between January 2021 and April 2021 were used. The mean age of patients admitted to MICU was 57.3 ± 18.7 years with a male predominance (n = 252, 68.8%). VAP was diagnosed in 69.1% (n = 253) of patients, and the most common microorganism in our cohort was Klebsiella pneumoniae (n = 78, 30.8%), followed by Acinetobacter spp. (n = 77, 30.4%). None of the K. pneumoniae isolates (n = 0/78) and only a minority of Acinetobacter spp. (n = 4/77, 5.2%) and Pseudomonas aeruginosa isolates(n = 8/54, 14.8%) were susceptible to fluoroquinolones. A higher proportion of K. pneumoniae (n = 1/78, 1.3%), Acinetobacter spp. (n = 2/77, 2.6%), and P. aeruginosa isolates (n = 9/54, 16.7%) were susceptible to aminoglycosides. The incidence rate of MDR microorganisms among the 253 patients diagnosed with VAP was 92.8% (n = 219/253). Conclusion: There is a high prevalence of multidrug resistance (MDR) isolates among those causing VAP in the MICU setting. Knowing the broad spectrum of causative pathogens and their susceptibility to various antibiotics may guide the physician in judicious and appropriate use of antibiotics for treatment. [ABSTRACT FROM AUTHOR]

Background: Urinary tract infection (UTI) is one of the most common infectious diseases at the community level and particularly in developing countries, overwhelmed with healthcare and economic constraints. Urinary tract infection can be called pyelonephritis (kidney infection), or cystitis (bladder infection). UTI bacteria include Escherichia coli (E. coli), Klebsiella pneumoniae (K. pneumoniae), Citrobacter species, Enterobacter species, Pseudomonas aeruginosa (P. aeruginosa), and Staphylococcus species. Aims & Objectives 1. To describe the bacteriological profile. 2. To identify the antimicrobial resistance (AMR) pattern. 3. To find the demographic characteristics associated with the presence of bacterial growth and multidrug resistance (MDR) in adult urine samples undergoing culture and drug susceptibility testing. Method of study: This was a hospital-based, cross-sectional study using routine laboratory records. The susceptibility of antibiotics and resistance pattern of bacteria responsible for UTI at a Tertiary care institution, MGM Hospital Warangal, Telangana, India, were examined from 2020 to 2023 in order to determine the adequacy of empirical therapy. Using a checklist, three years of urine culture findings, biochemical test results, and antibiotic susceptibility test results of isolates were acquired from the medical microbiology laboratory registration. Infection reports from people of all ages and genders were considered. SPSS version 23 was used to examine, input, and analyse data. We provided our findings in the form of descriptive tables and graphs. Results: With a prevalence rate of 72%, Escherichia coli was the most common uropathogen, followed by Klebsiella spp. (20%) and Pseudomonas spp. (8%). Penicillin was the least effective against UTI-causing E. coli, with fourth generation cephalosporins showing the greatest vulnerability. Klebsiella spp., another common uropathogen, was most resistant to broad-spectrum penicillin, followed by aminoglycosides and third generation cephalosporin. The infection incidence was approximately same in both sexes, but was greatest in those over the age of 60. Conclusion: In our hospital, the antibiotic resistance trend of two major UTI pathogens, E. coli and Klebsiella spp., appears to be comparable to that reported in other regions of the country. Broad-spectrum penicillin resistance was discovered to be greater than 50%. In South India, fourth generation cephalosporins and macrolides appear to be the drugs of choice for treating UTIs. Furthermore, enhanced infection incidence log keeping is required in hospitals to permit frequent tracking of the occurrence of antibiotic resistance patterns, as such levels vary. [ABSTRACT FROM AUTHOR]

In recent years, a wide range of clinical infections are being caused by carbapenem-resistant Enterobacterales, Acinetobacter baumannii and Pseudomonas aeruginosa. This is a matter of great concern, as carbapenem-resistant infections have fewer treatment options. The Enterobacterales comprises a large group of bacterial species commonly causing infections in healthcare settings. The most common bacteria are Escherichia coli and Klebsiella pneumoniae, which can cause both nosocomial and community-acquired infections. This study aimed to determine the prevalence of carbapenem- resistant Enterobacterales, P. aeruginosa, and A. baumannii, in a tertiary care center in India. The study was conducted over a period of seven months, from May 2022 to November 2022. The specimens were processed at the Microbiology Laboratory of Kalinga Institute of Medical Sciences- Pradyumna Bal Memorial Hospital, Bhubaneswar. Standard procedures were used to process the clinical specimens brought to the laboratory. Carbapenem-resistant isolates were screened according to the CLSI 2022 guidelines. This study included 3,006 isolates of Enterobacterales, A. baumannii, and P. aeruginosa. Of these, 29.40% (n = 844) were found to be carbapenem resistant. The breakup is as follows: 689 (77.94%) were Enterobacterales, 108 (12.21%) were A. baumannii, and 87 (9.84%) were P. aeruginosa. Thus, our investigation revealed an overall prevalence of carbapenem-resistant Enterobacterales, A. baumannii, and P. aeruginosa of 29.40%, which corresponds to previous studies in India. Early patient screening, isolation, and contact prevention measures will help reduce infection transmission. Further, larger multi-centric studies are required to obtain a wider perspective regarding this issue. [ABSTRACT FROM AUTHOR]

The emergence of microorganisms with resistance toward antibiotics has been widely recognized as a growing hazard to public health. Here, we report the whole genome sequence of Klebsiella pneumoniae strain THK, which was isolated from an aquaculture farm in Kerala, India. Standard disc diffusion and strip methods were used for antibiotic susceptibility testing and minimum inhibitory concentration detection. The isolate showed high level of resistance against beta-lactam, aminoglycosides, fluoroquinolones, macrolides, tetracyclines, chloramphenicol, sulfonamides, and cephalosporin class of antibiotics, but were sensitive to carbapenem and polymyxins. The whole genome sequence analysis revealed that the final assembly of THK strain consisted of 30 contigs of 5, 199,186 bp including four plasmid sequences plasmid_690 (1 contig), plasmid_710 (9 contigs), plasmid_1222 (6 contigs), and plasmid_1528 (1 contig). Sequence analysis revealed that the isolate has a number of genes encoding for antibiotic resistance and virulence. The findings indicated that antibiotics present in aquatic environments at sub-inhibitory concentrations increase the selection pressure affecting the cell function of even normal aquatic microorganisms to change the genetic expression of virulence factors or acquire resistance genes through various transfer mechanisms. This strain would be of significant interest for thorough comparative genomic study, given the known vast diversity of pathogenic and antibiotic resistance potentials. [ABSTRACT FROM AUTHOR]

Background: Infections by multidrug‐resistant organisms (MDRO) are a major hurdle in hematopoietic stem‐cell transplants (HSCTs). Conditioning regimens lead to mucosal barrier injury, which in‐turn leads to transmigration of gut bacteria and sepsis. Pre‐transplant stool and throat surveillance cultures can guide empirical antibiotic policy during the neutropenic period. In this paper, we document colonization with MDRO in pre‐transplant surveillance cultures and the correlation with bloodstream infections in HSCT patients and analyze transplant outcomes with respect to these infections. Methods: A single‐center, retrospective study on HSCT was performed between January 2021 and December 2021. The incidence of bacterial infections, percentage of MDROs, correlation with pre‐transplant stool/throat surveillance cultures, and their impact on overall 100‐day and post‐100‐day to 6‐month post‐transplant survival were analyzed. Results: Sixty‐four patients were included in the study. Pre‐transplant stool surveillance cultures were positive for MDRO in 85.9% of patients. Almost half (48.5%) of the isolates were positive for carbapenemase‐producing genes (mainly New Delhi metallo‐beta‐lactamase‐1 [NDM‐1] and oxacillinase‐48 [OXA‐48]). Eighteen patients (18/64, 28%) had a positive blood culture for MDRO in the peri‐engraftment neutropenic period. Correlation between surveillance and blood cultures was seen in 61% (11/18) of patients. All‐cause mortality was 14.1% (9/64) and 25% (16/64) in patients at 100 days and 6 months post‐HSCT, respectively. The 100‐day and post‐100‐day all‐cause mortality rates were higher in patients with Gram‐negative MDRO bloodstream infections (p <.012 and <.008, respectively). Conclusion: MDRO infections can adversely affect HSCT outcomes. Pre‐transplant stool and throat surveillance cultures may guide empirical antibiotic policy and lead to favorable transplant outcomes. [ABSTRACT FROM AUTHOR]

The emergence of antimicrobial resistance (AMR) and virulence in clinical isolates is a significant public health concern. The rapid and accurate detection of these traits in clinical isolates is essential for effective infection control and treatment. We demonstrated the integration of multiple detection methodologies, including phenotypic testing, quantitative polymerase chain reaction (qPCR), and genome sequencing, to detect AMR and virulence in clinical isolates. One hundred sixty-two gram-negative bacterial clinical isolates were selected for this study from the Shri Vinoba Bhave Civil Hospital, Silvassa, a tertiary government hospital. Antimicrobial susceptibility was detected by determining the Minimum Inhibitory Concentration (MIC) using Vitek-2, whereas the combined disk (CD) method was used for phenotypic detection of carbapenemase activity. The highest sensitivity rates were obtained for antibiotics colistin 87.93%, amikacin 67.52%, tigecycline 63.39%, nitrofurantoin 60.87%, and gentamycin 56.08%. The most resistant antibiotics were ceftazidime (71.93%), ciprofloxacin (67.95%) and trimethoprim/sulfamethoxazole (65.56%). Approximately 46.91% (76) of all the isolates were MBL isolates. The qPCR results confirmed the presence of blaNDM-1 in 29.01% of the isolates. The blaNDM-1 harbouring isolates in descending order, were Acinetobacter, Enterobacter cloacae, and Klebsiella pneumoniae. Klebsiella and Acinetobacter isolates were extensively drug-resistant. Whole genome sequencing performed on one of the Klebsiella pneumoniae isolates revealed the presence of many virulence factors, which increased the pathogenicity of the clinical isolates. The results showed that antimicrobial resistance, including carbapenem resistance, blaNDM-1, and virulence factors, was highly prevalent among isolates from tertiary clinical hospitals. The integration of multiple detection methodologies can potentially improve the detection of AMR and virulence in clinical isolates, leading to better patient outcomes and a reduced spread of these essential traits. [ABSTRACT FROM AUTHOR]

Introduction: One of the rapidly escalating public health problems worldwide is traumatic brain injury (TBI) due to road traffic accidents. In comparison to postneurosurgery patients and other patients inhabiting the intensive care units (ICUs), patients with TBI are more susceptible to nosocomially acquired infections from the hospital milieu. Methods: This retrospective study was conducted at a university hospital in Northern India from December 2018 to September 2022. All patients presenting with TBI formed the cohort of our study population. Results: A total of 72 patients with TBI were enrolled. The mean age of patients was 40.07 ± 18.31 years. The most common infections were ventilator-associated pneumonia (VAP) (44/72, 61.11%) and bloodstream infection (BSI) in 21 (21/72, 29.17%) patients. Concomitant infections were observed in 21 (21/72, 29.17%) patients. The common organism causing VAP was Acinetobacter spp. (29/58, 50.0%), BSI was Klebsiella pneumoniae (10/23, 43.48%), urinary tract infection was K. pneumoniae (5/16, 31.25%), and surgical site infection was Acinetobacter spp. (3/8, 37.5%) in TBI patients. An increased incidence of multidrug resistance was demonstrated in our patients. The increased length of hospital and ICU stay, ICU admission, intubation, diabetes mellitus, chronic kidney disease, and hypertension were statistically significant parameters that made TBI patients prone to develop an infection. Conclusion: TBI patients suffering from underlying comorbidities are prone to develop infections with multidrug-resistant bacteria was observed among our study cohort which also mirrors the lack of adherence to infection control measures. [ABSTRACT FROM AUTHOR]

Aims: The present study was aimed to detect clinically relevant carbapenemase encoding genes in carbapenem-resistant Enterobacter cloacae complex (CR-ECC), Klebsiella pneumoniae (CR-KP), and Serratia plymuthica (CR-SP) isolated from farmed freshwater fish. Methods and results: Out of 243 spatially diverse freshwater fish samples analysed, 5.3% were contaminated with CR-ECC, 1.6% with CR-KP, and 0.4% with CR-SP. The CR-ECC was further identified as E. asburiae (38.5%), E. mori (23.1%), E. cloacae (15.4%), E. hormaechei (15.4%), and E. kobei (7.7%) by 16S rRNA gene sequencing. The CR-ECC were resistant to carbapenems and cefoxitin, whereas CR-KP and CR-SP were multi-drug resistant (MDR). The CR-ECC harboured the carbapenemase gene blaIMI alone or in combination with blaTEM, blaEBC, blaCIT, blaACC, and tet(E). Whereas, CR-KP harboured carbapenemase gene, blaNDM-5 along with blaOXA-48, blaSHV, blaOXA-1, blaCTX-M-15, tet(A), sul1, and qnrB. No carbapenemase-encoding genes were detected in CR-SP. The MLST analysis showed that CR-KP belonged to ST231 and ST1561 lineages, while CR-ECC did not show exact match with any reported STs. The plasmid replicons predominantly detected were IncF and IncI1. Broth mating assays of CR-KP and CR-ECC with recipient Escherichia coli J53 indicated that blaNDM-5 was transferable but not blaIMI. Conclusion: This study highlights the low-level contamination of carbapenem-resistant Enterobacterales (CRE) harbouring clinically relevant carbapenemase-encoding genes in farmed freshwater fish from India. The CR-ECC of fish origin did not show the potential to spread carbapenem resistance. [ABSTRACT FROM AUTHOR]

Background: Intensive care units (ICUs) in developing countries constitute a high risk for patients acquiring infection by multidrug-resistant organisms (MDROs). The rise in antimicrobial resistance (AMR) threatens the effective prevention and treatment of an increasing range of infections. The present study analyzed the local trends of AMR in Gram-negative isolates of ICU patients from a tertiary care facility in North India. Methods: This retrospective study was conducted over 5 years (January 2018–December 2022). All bacterial isolates from patients admitted to ICU during the study period were included in the study, and their AMR pattern was analyzed. In addition, sensitivity trends of different antimicrobials against the common Gram-negative bacteria were analyzed, and AMR trends were analyzed over the study period. Results: Klebsiella spp. was the most common isolate in samples received from ICU. A rise of carbapenem-resistant microorganisms was observed over the study period. Escherichia coli and Klebsiella spp. showed around 10% and a 17% decrease in susceptibility to carbapenems, respectively. In contrast, a marked 29% decrease in sensitivity to carbapenems was observed in Acinetobacter spp. Conclusion: The inception of integrated stewardship measures has shown a rising trend in susceptibility and is the need of the hour to prevent the spread of MDROs. Surveillance studies help us understand the impact of AMR in hospitals and help plan prevention programs. [ABSTRACT FROM AUTHOR]

Background and Aim: Bacterial respiratory infections are most commonly causes of illness for all age group patients in ICU. Most of the patients suffer from urosepsis, postoperative disease and lower respiratory infection when admitted in ICU's. Broncho alveolar lavage (BAL) is an ideal sample that allows the recovery of pathogens cellular and noncellular components from the epithelial surface of lower respiratory tract. This study was performed to detect pathogenic organisms by microscopy of BAL fluid and isolate and identify various bacteria and fungi from BAL fluid in culture and analyze their antibiogram. Material and Methods: The cross-sectional prospective study was conducted in the Department of Microbiology, tertiary care teaching hospital, India. The study included 200 BAL samples taken from all consecutive patients referred with suspicion of pneumonia. Bronchial wash was done with the help of fibreoptic bronchoscope under local anaesthesia. All BAL samples were cultured on three bacteriological media agar plates using a sterile 4mm nichrome loop (0.01ml), and incubated at 37 C for 72 hours for quantitative bacterial culture using standard laboratory techniques. Bacterial isolates were identified by performing standard microbiological procedures such as study of colony morphology, Gram staining and standard biochemical tests. Results: Out of the total 200 samples, 120 (60%) were from males, and 80 (40%) were female patients. The predominant GNB was Klebsiella pneumoniae 45 (61%), followed by Pseudomonas aeruginosa 22(30%), Esch. coli 6(8%) and the fungal isolate was Aspergillus niger 5(1%). Klebsiella & Pseudomonas were highly sensitive to amikacin, piperacillin-tazobactam, imipenem, gentamycin, followed by tobramycin. Conclusion: Results of the present study demonstrate the high incidence of gram-negative isolates. The study also suggests that regular antimicrobial sensitivity monitoring should be done as most isolates are highly resistant to cephalosporin and other commonly used antimicrobials. [ABSTRACT FROM AUTHOR]

In India, ESBL & Cabapenems producerKlebsiella pneumoniae is treated by Colistin. Recently, Antimicrobial resistance to Colistindue to plasmid resistance is rapidly increasing is a matter of concern. The aim of this study is to evaluate the phenotypic assays for the detection of colistin resistance in Klebsiella pneumoniae isolates from critical care units. Department of Microbiology and Medicine carried out this research at RMCH&RC, Kanpur for 1year between November 2021 to November 2022.Clinical samples from CCU, were collected and processed by standard procedures to isolate and identify Klebsiella pneumoniae. We evaluated Disk diffusion method by Kirby baur’s method, Vitek 2, and standard broth micro dilution (BMD) method. Susceptibility category concordance is the proportion of test results falling into the same category as BMD. Minimal inhibitory concentrations (MIC) concordance was calculated similarly, but taking into account a 1 MIC titre error range. Of 100 isolates, highest MIC concordance to colistin was achieved by Broth micro dilution (23%), followed by Vitek 2® (21%) and detection by Disk diffusion - Kirby baures method, colistin resistance was (40%). Highest susceptibility category concordance to other antibiotics was achieved by Disk diffusion method (60 %) followed by Vitek 2® (79%) and Broth micro dilution (77%). In conclusion, highest MIC concordance was achieved by Broth micro dilution (23%), we found detection of colistin resistance in Klebsiella pneumoniae species by Broth Micro Dilution (BMD) is more reliable method as compared to others. [ABSTRACT FROM AUTHOR]

Photorhabdus and Xenorhabdus are the bacterial symbionts of insect pathogenic nematodes, Heterorhabditis and Steinernema, respectively. This study aims to characterize the bacterial symbionts from Mizoram, North-east India and to evaluate their antibacterial potential. The bacterial isolates were characterized using recA and gyrB gene regions. The ethyl acetate extract of bacterial isolates was tested against pathogenic bacterial strains, viz. Escherichia coli (ATCC 10536), Klebsiella pneumoniae (ATCC 10031), Pseudomonas aeruginosa (ATCC 10145), and Bacillus subtilis (ATCC 11774) using disk diffusion method. Analysis of recA and gyrB genes revealed that the Photorhabdus isolates were P. hindustanensis, and P. namnaonensis. This study constitutes the first documentation of P. namnaonensis from India. The two isolated Xenorhabdus belong to X. vietnamensis and X. stockiae. The ethyl acetate extracts of the studied bacteria suppressed the development of all the microorganisms tested. Based on MIC and MBC values, the highest activity was exhibited by TS (P. hindustanensis) and TD (P. namnaonensis) isolates against P. aeruginosa and K. pneumoniae respectively. The lowest inhibitory activity was observed on both Xenorhabdus isolates (RF and PTS) against B. subtilis. This study focuses on the existence and identification of symbiotic bacteria from Mizoram, an Indo-Burma biodiversity hotspot region, and details their activity against different pathogenic bacteria. Since these metabolites could be potent antibiotics, further research is required to better understand the genetic information, chemical composition, and method of action against other microorganisms. [ABSTRACT FROM AUTHOR]

Introduction: Mucormycosis is an opportunistic fungal infection that became a public health emergency during the second wave of Coronavirus Disease-2019 (COVID-19). It is an acute, angioinvasive, opportunistic, and emerging mycosis caused by mucormycetes, resulting in a significantly fatal fungal infection among immunocompromised and/or immunosuppressed individuals. Mucormycosis has a specific predilection for blood vessels (angioinvasive) and tissues, leading to extensive necrosis and thromboembolic events. Globally, the incidence rate of mucormycosis varies from 0.005 to 1.7 per million people. Early diagnosis and appropriate therapy are crucial for clinical outcomes. Aim: To evaluate the mycological profile of mucormycosis during the COVID-19 pandemic using automated Matrix Assisted Laser Desorption Ionisation Time of Flight Mass Spectroscopy (MALDI-ToF-MS) in comparison with conventional fungal identification methods. Materials and Methods: A retrospective cohort study was conducted, collecting data from July 2020 to June 2022, involving 1,176 patients from various clinical departments who attended PSG Hospitals affiliated with PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India. Data analysis was performed from July 2022 to August 2022. Clinical specimens, including Bronchoalveolar Lavage (BAL), Sputum, Cerebrospinal Fluid (CSF), nasal swabs, tracheal aspirates, pus, blood, corneal scraping, eye discharge, and necrotised tissues, were subjected to Potassium Hydroxide (KOH) mount, conventional culture coupled with micrometry-aided microscopy, and MALDI-ToF-MS among suspected mucormycosis cases. The results were collected in Microsoft Excel, and data analysis was conducted using the International Business Machines Statistical Package for the Social Sciences statistical software (IBM SPSS) version 24.0. The study variables were expressed as descriptive statistics: frequency (N) and percentage (%). The incidence of mucormycosis, mycological profile, and diagnostic utility of conventional micrometry-aided microscopy-assisted culture were compared with the automated MALDI-ToF-MS protein signature method of testing. Results: Fungal elements were positive in 130 (11.05%) out of a total of 1,176 clinical samples, such as necrotised tissue, biopsy, and sputum, in the KOH mount. Fungal culture was positive in 258 (21.94%) out of 1176 samples, with mucormycosis detected in 73 (28.29%) of the culture-positive samples. The incidence of mucormycosis in this study was 73 (6.21%) out of 1176. A total of 101 (8.59%) samples showed positive results for mucormycetes through KOH, culture, and MALDI-ToF-MS. MALDI-ToF-MS could rapidly and specifically identify and confirm the causative agents of mucormycosis at their genus and species levels compared to KOH or culture. Conclusion: Simple, low-cost, and less laborious conventional culture coupled with micrometry-aided microscopy can detect Mucorales at the species level, where KOH microscopy could not differentiate between species. MALDI-ToF-MS can be employed for the rapid detection and confirmation of mucormycosis agents at the genus or species level. [ABSTRACT FROM AUTHOR]

Emergence of antimicrobial resistance in animal husbandry is of utmost concern as it has resulted in therapeutic failure and nowadays it is one of the latest challenges faced by scientific community across the world. Extensive use of antibiotics without performing antibiotic susceptibility testing may lead to development of multidrug resistant (MDR) organisms. This study was undertaken to assess the AMR pattern and their correlation with plasmid profiling in ESBL producing Klebsiella spp. from bovine origin. Total 160 samples (80 mastitic milk and 80 diarrhoeic faeces) were collected from 2 district of Eastern Plain Zone of Uttar Pradesh (India) and 63 (39.37%) isolates were confirmed as Klebsiella spp. by conventional methods (cultural characteristics on selective media & biochemical tests). Antimicrobial susceptibility testing of confirmed isolates revealed 82.0%-94.0% resistance to 3rd & 4th generation cephalosporin, 100% to ampicillin and all isolates were found 100% sensitive to aminoglycosides, chloramphenicol and polypeptides class of antibiotics. Total 49 (77.8%) isolates were confirmed as ESBL producers using DDST and ESBL E-strip test, out of which 45 (71.43%) isolates revealed the presence of bla-CTX-M gp genes by PCR analysis. On plasmid profiling, total 82.82% isolates revealed the presence of plasmid with molecular weight between 2.5 kb to >10 kb and number 1-2. These high molecular weight plasmids are mostly situated on conjugative plasmid, which are horizontally transferred from one species to another in highly populous country like India. [ABSTRACT FROM AUTHOR]

Aims: To isolate and identify the bacteria in open fractures and determine the antimicrobial susceptibility pattern of isolates. Methods: A prospective study was carried out in a tertiary care hospital of rural India. The study was carried out on 100 patients of all age groups presenting with open fractures at Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana between March 2021 and September 2022. Two wound swabs, (one for culture and other for microscopy) and tissue specimens were collected to isolate and identify the bacteria causing infection in open fractures. All the bacterial isolates were then subjected to antibiotic sensitivity. Results: The results were statistically analyzed using SPSS version 17.0. Significant growth was reported in 46% of the debridement samples. Staphylococcus aureus was the most common organism isolated in 30% of cultures, followed by Pseudomonas aeruginosa in 22% of the cultures. In the post operative follow up period, 40 % of the patients reported significant growth. Pseudomonas aeruginosa was the most common organism isolated in 28% of cultures in follow up period. Among gram positive organisms, Staphylococcus aureus was 77% susceptible to Amikacin & 68% susceptible to Erythromycin. Gram negative organisms like Enterobacteriaceae were 100% susceptible to Imipenem, 71% susceptible to Amikacin and 71% to ciprofloxacin. Conclusion: Initial contamination in open fractures is by both gram positive and gramnegative organisms with Staphylococcus aureus being commonest. Broad spectrum antibiotics like ciprofloxacin along with amikacin form cornerstone therapy for prevention of infection. [ABSTRACT FROM AUTHOR]

Background and Objectives: Bacterial meningitis (BM) poses a considerable global public health concern. C-reactive protein (CRP) has emerged as a viable diagnostic marker, particularly in differentiating bacterial and aseptic meningitis, especially in cases where bacterial culture results are negative in both blood and cerebrospinal fluid (CSF) samples. The present study was done with the primary objective of estimating the serum CRP levels in pediatric meningitis cases caused by bacterial pathogens. Materials and Methods: A hospital-based descriptive cross-sectional study was undertaken at a renowned tertiary care hospital in India, involving the evaluation of 222 samples. Cerebrospinal fluid samples were collected following standard guidelines, and bacterial identification and antimicrobial susceptibility testing were carried out using an automated system. Quantitative estimation of CRP levels was performed using a solid-phase, sandwich-format immunometric assay employing a gold antibody conjugate. Results: The study cohort consisted of pediatric meningitis cases with a median age of 3.9 years, ranging from 1 to 4.6 years. Among the bacterial isolates, Escherichia coli was identified as the most prevalent pathogen, followed by Klebsiella pneumoniae. Notably, 31.32% of the participants exhibited elevated serum CRP levels. Moreover, a statistically significant association was observed between elevated serum CRP levels and cases with Gram-negative bacterial etiology. Conclusion: Elevated serum CRP can serve as a valuable diagnostic marker for identifying pediatric bacterial meningitis cases with a Gram-negative etiology. The utilization of CRP as a diagnostic adjunct can aid in timely and accurate differentiation between bacterial and aseptic meningitis, facilitating appropriate clinical management and improved patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Cystic fibrosis is a life-shortening disease of young children but it has been present in adults in recent days. Studies on epidemiology and microbiota of cystic fibrosis from the southern part of India are very few. So we tried to project the data of bacteria responsible for pulmonary exacerbations in cystic fibrosis patients and their antibiotic sensitivity. Materials and Methods: A total of 75 samples were collected from confirmed cystic fibrosis patients attending outpatient clinical departments and were processed for culture and sensitivity according to CLSI protocols. ESBL and MBL production among non fermenters were detected using antibiotic discs using modified Kirby bauer method. Results: Out of all isolated pathogens Pseudomonas aeruginosa isolates were 29 (40.8%), 15 (21.1%) isolates were Klebsiella pneumoniae, 12 (16.9%) Staphylococcus aureus, 7 (9.8%) Candida albicans, 4 (5.6%) Enterobacter cloacae, 2 (2.8%) Burkholderia cepacia, and 2 (2.8%) Burkholderia species. Out of 29 Pseudomonas aeruginosa isolates 68.9% showed ESBL production and 17.2% showed MBL production. All the Burkholderia cepacia tested were ESBL and MBL producers. 100% and 50% of Burkholderia species expressed ESBL and MBL enzymes respectively. Conclusion: Coexistence of S.aureus and P.aeruginosa in cystic fibrosis patients is still a matter of debate. Many hypotheses including the present study concluded that microorganisms are antagonistic invitro after a prolonged co-existence. [ABSTRACT FROM AUTHOR]

Background Healthcare-associated urinary tract infections (HAUTIs) caused by gram-negative pathogens have emerged as a global concern. So far, little is known about the epidemiology of extended-spectrum β lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae in HAUTIs in India. The study was carried to determine the antibiotic resistance pattern and ESBL-producing genes in E. coli and K. pneumoniae strains isolated from HAUTIs in a tertiary institute in North India. Methods A total of 200 consecutive, nonduplicate clinical isolates of E. coli and 140 isolates of K. pneumoniae from hospitalized patients with UTI were collected during a period of 1 year. Strains were studied for the presence of ESBL genes (blaCTX-M1, blaCTX-M2, blaCTX-M9, blaCTX-M15, blaSHV, blaTEM, blaOXA-1, blaVEB, blaPER-2, and blaGES) by multiplex polymerase chain reaction using gene-specific primers. Results ESBL was detected in 82.5% (165 out of 200) isolates of E. coli and 74.3% (104 out of 140) isolates of K. pneumoniae by phenotypic confirmatory testing. From 269 phenotypically positive ESBL isolates, blaTEM (49.4%) was the most common genotype followed by blaCTX-M1 (31.97%), blaOXA-1 (30.1%), and blaSHV(11.9%) either alone or in combination. In the present study, blaCTX-M-15 (84.89%) was the most common blaCTX-M1-type ESBL. In total, 2.6 and 5.2% of the isolates were positive for PER-2 and VEB genes, respectively. Conclusion To the best of our knowledge, this is the first study on ESBL resistance patterns and ESBL-producing genes in HAUTIs in North India. Our study reports high occurrence with ESBL types CTX-M-1, CTX-M-15, TEM, and SHV. Minor ESBL variants OXA-1, VEB-type, and PER-2-type β-lactamase are also emerging in HAUTIs infections in North India. [ABSTRACT FROM AUTHOR]

Plectranthus striatus Wight ex Hook. f., a medicinally important plant of the family Lamiaceae grows wild in the central Himalayan region of Uttarakhand, India. In view of the medicinal importance of this genus and the lack of any report on its essential oil composition and antibacterial activity, the present study was conducted. Volatile constituents from the whole aerial parts and roots of P. striatus were isolated by steam distillation process using a copper still connected to spiral glass condensers and analyzed by GC and GC/MS. A total of 45 compounds from the aerial part and 36 compounds from the roots representing 82.0% and 91.5%, respectively of the total essential oil composition were identified. The major constituents found in the essential oil from the whole aerial parts were phytol (32.0%), phytol acetate (8.3%) and octan-3-ol (6.5%). The major constituents from the essential oil of roots were octan-3-ol (47.4%) and 1-octen-3-ol (33.5%). The essential oil samples from the whole aerial and roots were further assessed for their antibacterial activity against ten different pathogens by using disc diffusion method. The essential oil from the aerial part displayed strong inhibition in initial screening against Xanthomonas phaseoli (14.66±1.15 mm), Klebsiella pneumoniae (13.33±1.15 mm) and Escherichia coli (13.00±2.64 mm) with bactericidal effect observed at lowest concentration of 31.25 µL/mL for Klebsiella pneumoniae and Escherichia coli. On the other hand, the essential oil from the roots showed broad spectrum activity in primary screening towards Pasteurella multocida (21.33±0.58 mm), Enterococcus faecalis (21.00±1.00 mm), Agrobacterium tumefaciens (20.33±0.58 mm) and Salmonella enterica (20.33±0.58 mm) with bactericidal effect observed at minimum concentration of 31.25 µL/mL for Pasteurella multocida. [ABSTRACT FROM AUTHOR]

Escherichia coli is quite a common and sometimes pathogenic bacterium that can cause acute to severe infection in poultry birds affecting their performance. E. coli can also cause a few extra-intestinal infections too in poultry birds. Nowadays antimicrobial resistance is quite a menace which is reported from several gram-negative bacteria including E. coli. These traits in E. coli are governed by a few b-lactamases producing genes which may also be associated with plasmids in the pathogen. This study aimed to detect the presence of extended-spectrum (ESBL) and AmpC (ACBL) beta-lactamases producing E. Coli from fecal samples of diseased and apparently healthy poultry birds from different districts of West Bengal, India. A total of 177 (62.32%) E. coli isolates were detected and confirmed from the poultry fecal samples/cloacal swabs (n=284) collected in this study. All isolates were typical in morphology. One hundred thirty-two (74.58%) bacterial isolates were positive for phenotypical beta-lactamases production, of which 83 (46.89%) were positive for phenotypical ACBL production. A total of 41 and 17 isolates were found to be positive for PCR detection of the blaCTXM and blaSHV genes respectively. No blaTEM gene was detected. Again 95 (53.67%) isolates possessed the blaAmpC gene as detected in this study. Antibiogram of the ESBLproducing E. coli isolates (49) revealed a significantly high level of resistance against most of the commonly used antimicrobials like ceftriaxone, ampicillin (both 100%), cefotaxime (97.96%), ceftazidime (91.84%) amoxicillin/clavulanic acid (85.71%), azithromycin, tetracycline, norfloxacin (@70-75%). These isolates were found to be sensitive (@ 96-81%) against a few antimicrobials, viz. amikacin, imipenem, gentamicin, and ampicillin/sulbactam which is a major point of concern. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to examine the evolution of carbapenem-resistant Klebsiella pneumoniae (CRKp) infections and their impact at a tertiary care hospital in South India. Methods: A comparative analysis of clinical data from two prospective cohorts of patients with CRKp bacteremia (C1, 2014–2015; C2, 2021–2022) was carried out. Antimicrobial susceptibilities and whole genome sequencing (WGS) data of selected isolates were also analyzed. Results: A total of 181 patients were enrolled in the study, 56 from C1 and 125 from C2. CRKp bacteremia shifted from critically ill patients with neutropenia to others (ICU stay: C1, 73%; C2, 54%; p = 0.02). The overall mortality rate was 50% and the introduction of ceftazidime-avibactam did not change mortality significantly (54% versus 48%; p = 0.49). Oxacillinases (OXA) 232 and 181 were the most common mechanisms of resistance. WGS showed the introduction of New Delhi metallo-β-lactamase-5 (NDM-5), higher genetic diversity, accessory genome content, and plasmid burden, as well as increased convergence of hypervirulence and carbapenem resistance in C2. Conclusions: CRKp continues to pose a significant clinical threat, despite the introduction of new antibiotics. The study highlights the evolution of resistance and virulence in this pathogen and the impact on patient outcomes in South India, providing valuable information for clinicians and researchers. [ABSTRACT FROM AUTHOR]

The oxacillinase-48 (OXA-48)-like carbapenemases are class D β-lactamases and increasingly reported in Enterobacterial species. The detection of these carbapenemases is challenging and little information is available on the epidemiology and plasmid characteristics of OXA-48-like carbapenemase producers. We detected the presence of OXA-48-like carbapenemases in 500 clinical isolates of Escherichia coli and Klebsiella pneumoniae, followed by detection of other carbapenemases, extended spectrum β-lactamases (ESBLs) and 16S rRNA methyltransferases in OXA-48 producers. Clonal relatedness was studied using pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Finally, plasmid characterisation was performed through conjugation experiment, S1-PFGE and Southern hybridisation. Around 40% of E. coli and K. pneumoniae isolates harboured OXA-48-like β-lactamases. Two OXA-48 allele variants, OXA-232 and OXA-181 were detected in our study. OXA-48 producers co-harbored diverse drug-resistant genes belonging to other classes of carbapenemases, ESBLs and 16S rRNA methyltransferases. OXA-48-like carbapenemase producers exhibited high clonal diversity. BlaOXA-48 carrying plasmids were conjugative, untypable and their size was ~ 45 kb and ~ 104.5 kb in E. coli and K. pneumoniae respectively. In conclusion, OXA-48-like carbapenemases have emerged as major cause of carbapenem resistance in Enterobacteriaceae and probably still being under reported. Strict surveillance and adequate detection methods are needed to prevent the dissemination of OXA-48-like carbapenemases. [ABSTRACT FROM AUTHOR]

Introduction: The emergence and increase of Carbapenem resistance in Escherichia coli is now posing a serious threat to human health around the world. Our study aimed to investigate the phenotypic and genotypic detection of Carbapenem resistance among E. coli isolates. Material Method: investigated irrespective of age, sex, departments and Carbapenemase resistance among various clinical samples such as urine, pus, blood, CSF and respiratory secretions received in microbiology laboratory. Results: It is observed that the total 215 isolates of E. coli were included in this study. About 153 (71.16%) isolates were from male patients while 62 (28.83%) were from female patients. The majority (53.95%) of isolates were from urine samples. Out of 215 E. coli isolates, total 63 (29.30%) were carbapenem resistant. Out of 63 carbapenem resistant isolates, maximum carbapenem resistance was found 59 isolates (12.20%) were having Oxa48 gene, 27 NDM (12.55%), 3 E. coli isolates were having gene KPC and 2 E.coli strains were found with both KPC & NDM gene. Conclusion: Carbapenem resistant E.coli are increasing rapidly and becoming major problem in the area of infectious diseases. Early detection of changing resistance patterns is very important in preventing the dissemination of resistant bacteria and modifying the treatment strategies. [ABSTRACT FROM AUTHOR]

Purpose: This study was conducted to find out the occurrence of hypervirulent Klebsiella pneumoniae (hvKP) isolates from different clinical specimens in a tertiary care hospital of eastern India and investigate the distribution of virulence factors, capsular serotypes and antibiogram profile. The distribution of carbapenemase-encoding genes in convergent (hvKP and carbapenem-resistant) isolates was also studied. Materials and methods: A total of 1004 K. pneumoniae isolates were obtained from different clinical specimens from August 2019 to June 2021 and hvKP isolates were identified using the string test. Genes of capsular serotypes K1, K2, K5, K20, K54 and K57, virulence-associated genes, rmpA, rmpA2, mrkD, allS, iroN, iutA, iuc, kfuB and ybtS, and carbapenemase-encoding genes, NDM-1, OXA-48, OXA-181, and KPC, were evaluated by polymerase chain reaction. Antimicrobial susceptibility was determined primarily by the VITEK-2 Compact automated platform (bioMérieux, Marcy-l'Étoile, France) and supplemented by disc-diffusion/EzyMIC (HiMedia, Mumbai, India) wherever needed. Results: Out of 1004 isolates, 33 (3.3%) were hvKP. Most frequent capsular serotype was K2 in 11 (33.3%). Amongst virulence genes, mrkD, iutA and kfuB were detected most frequently in 93.9%, 84.8% and 63.6% isolates respectively. Classical Klebsiella pneumoniae isolates were significantly more resistant than hvKP to cephalosporins, amoxicillin-clavulanic acid, and fluoroquinolones (p < 0.05). Carbapenem resistance was seen in 10 hvKP convergent isolates with the most prevalent carbapenemase-encoding gene being OXA-48 and OXA-181 in 50% isolates. Conclusion: There is a need for continued surveillance of hvKP strains in view of the impending threat of a global spread of convergent strains. [ABSTRACT FROM AUTHOR]

The biodiversity-rich forests of the Jhargram subdivision of West Bengal, India houses many lesser-known prospective plants. Four ethnomedicinal plants from this locality—Cleistanthus collinus, Tiliacora racemosa, Eupatorium odoratum, and Sida acuta reported for traditional medical uses by local forest tribes have been analyzed for phytochemical constituents and bioactivity potential, viz., antioxidant, antibacterial and antitumor activity. Cleistanthus and Tiliacora plants were rich in alkaloids while Eupatorium and Sida showed tannin abundance. Tiliacora showed maximum alkaloid content, that is, 711 mg strychnine equivalent/gm dry weight. Consequently, these plant extracts showed decent antioxidant activity which is reflected in their antibacterial and antitumor potencies. Cleistanthus showed strong bactericidal activity against Gram-negative bacteria, particularly against Klebsiella pneumoniae and Pseudomonas aeruginosa, while Tiliacora showed robust antitumor activity against cervical cancer cells SiHa at a 50% inhibitory concentration (IC50) of 86 µg/ml. Hence, the biodiversity-rich Jhargram forest should be conserved to protect the potential repertoire for ethnomedicinal plants. [ABSTRACT FROM AUTHOR]

Context: Knowledge of epidemiology of bacterial isolates and their anti-biograms in hospital settings is necessary for prompt empirical anti-microbial therapy of neonatal sepsis. Aims: To study risk factors, bacteriological profiles, and anti-biograms of blood culture isolates of both early and late onset neonatal sepsis. Settings and Design: It is a prospective observational study conducted from January 2020 till July 2021 at our tertiary care center. Material and Methods: Neonates (0–28 days) admitted to this neonatal intensive care unit clinically suspected with sepsis were subjected to blood cultures, and the isolates were identified both biochemically and by the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry system. Antibiotic susceptibility testing (AST) was performed as per CLSI guidelines. Statistical Analysis: Chi-square test was used. Results: Out of 280 suspected cases of neonatal sepsis, 43 (15.3%) cases showed positive blood culture. Of these, the majority (30, 69.8%) had late-onset neonatal sepsis. Major pre-disposing risk factors were pre-term birth and a low birth weight (26, 60.5%). Gram-negative bacteria and Gram-positive bacteria were isolated in 25 (58.1%) and 18 (41.9%) blood cultures, respectively. Klebsiella pneumoniae (37.5%) was the most predominant pathogen in both early-onset (23.1%) and late-onset (46.7%) sepsis. Coagulase negative Staphylococcus (34.8%) was the second most common organism and was more common in late onset (23.2%) neonatal sepsis. A high level of antibiotic resistance was noted in Klebsiella pneumoniae isolates, even to amikacin (76.5%) and carbapenems (66.7%). Conclusion: Increased resistance in bacterial isolates of neonatal sepsis emphasizes the need of AST of bacterial isolates for proper antibiotic administration. [ABSTRACT FROM AUTHOR]

Introduction: Urinary Tract Infections (UTI) are uncommon among men. It is because the male urethra is longer and is away from the anal opening. Moreover, the perianal area is dry, and the prostatic secretion prevents from occurring of any infection. Hence, if men suffer from UTI, it is considered as a complicated infection. Complicated UTIs are difficult to treat and are more prone to treatment failures. Microorganisms causing these infections have a wide spectrum ranging from a variety of both Gram-negative and gram-positive organisms. Early diagnosis and treatment of UTIs, plays a major role in preventing the spread of infection to the upper urinary tract. Aim: To determine the microbiological profile and antibiotic sensitivity pattern from urine samples of male patients. Materials and Methods: The present cross-sectional study was done for a period of two years (1/3/2019-31/4/2021) in the Department of Microbiology, Malla Reddy Institute of Medical Sciences and Research, Jeedimetla, Hyderabad, Telangana, India. Urine samples from male inpatients and outpatients suffering from various clinical conditions received in the microbiology laboratory were processed and analysed. These samples were cultured by conventional semi-quantitative methods and the organisms were identified using standard biochemical reactions. Antibiotic sensitivity testing was done on Mueller Hinton agar by Kirby Bauer's disk diffusion technique. Clinical history, associated conditions, and comorbidities were noted from the case sheets of all the culture-positive patients to identify the risk factors which made them prone to UTIs. The data was descriptive and percentages were calculated for all the numerical data obtained. Results: Out of 304 urine samples received, 104 (34%) were found to be positive for bacterial and fungal isolates. E.coli (44%) was the predominant organism, followed by Klebsiella spp (15%) among the Gram-negative bacteria isolated. Coagulase-negative Staphylococcus (5%) was the predominant organism among the gram-positive bacteria followed by Staphylococcus aureus (4%) and Enterococcus spp (4%). 84.8% of E.coli and 68% of Klebsiella spp were Extended Spectrum Beta Lactamase (ESBL) enzymes producing organisms. An analysis of the health conditions of the patients who were culture positive showed that 28% of patients had signs and symptoms suggestive of UTI. Diabetes (25%), Hypertension (20%), and Benign Prostatic Hypertrophy (BPH) (5%) were observed commonly in patients above 60 years. Conclusion: UTI in male patients are quite uncommon as in female patients. The microbiological profile and drug sensitivity pattern of these organisms causing the infection is similar to that in female patients suffering from UTI. But, as UTI in males is considered a complicated infection thorough investigation of these patients for various health conditions like diabetes mellitus, hypertension, and BPH has to be done, particularly in elderly males. This helps in initiating prompt treatment to prevent recurrent UTIs and drug resistance. [ABSTRACT FROM AUTHOR]

Klebsiella pneumoniae (Kp) has gained prominence in the last two decades due to its global spread as a multidrug-resistant (MDR) pathogen. Further, carbapenem-resistant Kp are emerging at an alarming rate. The objective of this study was (1) to evaluate the prevalence of β-lactamases, especially carbapenemases, in Kp isolates from India, and (2) determine the most prevalent sequence type (ST) and plasmids, and their association with β-lactamases. Clinical samples of K. pneumoniae (n = 65) were collected from various pathology labs, and drug susceptibility and minimum inhibitory concentrations (MIC) were detected. Whole genome sequencing (WGS) was performed for n = 22 resistant isolates, including multidrug-resistant (MDR) (n = 4), extensively drug-resistant (XDR) (n = 15), and pandrug-resistant (PDR) (n = 3) categories, and genomic analysis was performed using various bioinformatics tools. Additional Indian MDRKp genomes (n = 187) were retrieved using the Pathosystems Resource Integration Center (PATRIC) database. Detection of β-lactamase genes, location (on chromosome or plasmid), plasmid replicons, and ST of genomes was carried out using CARD, mlplasmids, PlasmidFinder, and PubMLST, respectively. All data were analyzed and summarized using the iTOL tool. ST231 was highest, followed by ST147, ST2096, and ST14, among Indian isolates. blaampH was detected as the most prevalent gene, followed by blaCTX-M-15 and blaTEM-1. Among carbapenemase genes, blaOXA-232 was prevalent and associated with ST231, ST2096, and ST14, which was followed by blaNDM-5, which was observed to be prevalent in ST147, ST395, and ST437. ST231 genomes were most commonly found to carry Col440I and ColKP3 plasmids. ST16 carried mainly ColKP3, and Col(BS512) was abundantly present in ST147 genomes. One Kp isolate with a novel MLST profile was identified, which carried blaCTX-M-15, blaOXA-1, and blaTEM-1. ST16 and ST14 are mostly dual-producers of carbapenem and ESBL genes and could be emerging high-risk clones in India. [ABSTRACT FROM AUTHOR]

Background We identified pathogens found in internal organs and placentas of deceased preterm infants cared for in hospitals in India and Pakistan. Methods Prospective, observational study conducted in delivery units and neonatal intensive care units. Tissue samples from deceased neonates obtained by minimally invasive tissue sampling and placentas were examined for 73 different pathogens using multiplex polymerase chain reaction (PCR). Results Tissue for pathogen PCR was obtained from liver, lung, brain, blood, cerebrospinal fluid, and placentas from 377 deceased preterm infants. Between 17.6% and 34.1% of each type of tissue had at least 1 organism identified. Organism detection was highest in blood (34.1%), followed by lung (31.1%), liver (23.3%), cerebrospinal fluid (22.3%), and brain (17.6%). A total of 49.7% of the deceased infants had at least 1 organism. Acinetobacter baumannii was in 28.4% of the neonates compared with 14.6% for Klebsiella pneumoniae , 11.9% for Escherichia coli/Shigella , and 11.1% for Haemophilus influenzae. Group B streptococcus was identified in only 1.3% of the neonatal deaths. A. baumannii was rarely found in the placenta and was found more commonly in the internal organs of neonates who died later in the neonatal period. The most common organism found in placentas was Ureaplasma urealyticum in 34% of the samples, with no other organism found in >4% of samples. Conclusions In organ samples from deceased infants in India and Pakistan, evaluated with multiplex pathogen PCR, A. baumannii was the most commonly identified organism. Group B streptococcus was rarely found. A. baumannii was rarely found in the placentas of these deceased neonates. [ABSTRACT FROM AUTHOR]

Infections caused by multi-drug resistant Klebsiella pneumoniae are a leading cause of mortality and morbidity among hospitalized patients. In neonatal intensive care units (NICU), blood stream infections by K. pneumoniae are one of the most common nosocomial infections leading to poor clinical outcomes and prolonged hospital stays. Here, we describe an outbreak of multi-drug resistant K. pneumoniae among neonates admitted at the NICU of a large tertiary care hospital in India. The outbreak involved 5 out of 7 neonates admitted in the NICU. The antibiotic sensitivity profiles revealed that all K. pneumoniae isolates were multi-drug resistant including carbapenems and colistin. The isolates belonged to three different sequence types namely, ST-11, ST-16 and ST-101. The isolates harboured carbapenemase genes, mainly blaNDM-1, blaNDM-5 and blaOXA-232 besides extended-spectrum b-lactamases however the colistin resistance gene mcr-1, mcr-2 and mcr-3 could not be detected. Extensive environmental screening of the ward and healthcare personnel led to the isolation of K. pneumoniae ST101 from filtered incubator water, harboring blaNDM-5, blaOXA-232 and ESBL genes (blaCTX-M) but was negative for the mcr genes. Strict infection control measures were applied and the outbreak was contained. This study emphasizes that early detection of such high-risk clones of multi-drug resistant isolates, surveillance and proper infection control practices are crucial to prevent outbreaks and further spread into the community. [ABSTRACT FROM AUTHOR]

Background: Carbapenem resistance is endemic in the Indian sub-continent. In this study, carbapenem resistance rates and the prevalence of different carbapenemases were determined in Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa during two periods; Pre-COVID (August to October 2019) and COVID (January to February 2021) in a north-Indian tertiary care hospital. Methods: Details of patient demographics and clinical condition was collated from the Hospital Information System and detection of carbapenemases NDM, OXA-48, VIM, IMP and KPC was done by Polymerase chain reaction (PCR) in 152 and 138 non-consecutive carbapenem resistant isolates during the two study periods respectively. Conjugation assay and sequencing of NDM and OXA-48 gene was done on a few selected isolates. Results: As compared to Pre-COVID period, co-morbidities and the mortality rates were higher in patients harbouring carbapenem resistant organisms during the COVID period. The overall carbapenem resistance rate for all the four organisms increased from 23 to 41% between the two periods of study; with Pseudomonas aeruginosa and Klebsiella pneumoniae showing significant increase (p < 0.05). OXA-48, NDM and co-expression of NDM and OXA-48 were the most common genotypes detected. NDM-5 and OXA-232 were most common variants of NDM and OXA-48 family respectively during both the study periods. Conclusion: Higher rate of carbapenem resistance in COVID times could be attributed to increase in number of patients with co-morbidities. However, genetic elements of carbapenem resistance largely remained the same in the two time periods. [ABSTRACT FROM AUTHOR]

The spread of extended-spectrum beta-lactamase (ESBL)-producing bacteria in the environment has been recognized as a challenge to public health. The aim of the present study was to assess the occurrence of ESBL-producing Escherichia coli and Klebsiella pneumoniae from selected water bodies receiving hospital effluents in Kerala, India. Nearly 69.8% of Enterobacteriaceae isolates were multi-drug resistant by the Kirby-Bauer disc diffusion method. The double disc synergy test was used to detect the ESBL production and the genes responsible for imparting resistance were detected by PCR. Conjugation experiments confirmed the mechanism of plasmid-mediated transfer of resistance. The prevalence of ESBL production in E. coli and K. pneumoniae was 49.2 and 46.8%, respectively. Among the ESBL-encoding genes, blaCTX-M was the most prevalent group followed by blaTEM, blaOXA, blaCMY, and blaSHV. The results suggest that healthcare settings are one of the key contributors to the spread of ESBL-producing bacteria, not only through cross-transmission and ingestion of antibiotics but also through the discharge of waste without a proper treatment, leading to harmful effects on the aquatic environment. The high prevalence of ESBL-producing Enterobacteriaceae with resistance genes in public water bodies even post-treatment poses a serious threat. [ABSTRACT FROM AUTHOR]

Globally, the issue of microbial resistance to medicines and heavy metals is getting worse. There are few reports or data available for Proteus vulgaris (P. vulgaris), particularly in India. This investigation intends to reveal the bacteria's ability to transmit genes and their level of resistance as well. The wastewater samples were taken from several hospitals in Lucknow City, India, and examined for the presence of Gram-negative bacteria that were resistant to antibiotics and heavy metals. The microbial population count in different hospital wastewaters decreases with increasing concentrations of metal and antibiotics. Among all the examined metals, Ni and Zn had the highest viable counts, whereas Hg, Cd, and Co had the lowest viable counts. Penicillin, ampicillin, and amoxicillin, among the antibiotics, demonstrated higher viable counts, whereas tetracycline and erythromycin exhibited lower viable counts. The MIC values for the P. vulgaris isolates tested ranged from 50 to 16,00 μg/ml for each metal tested. The multiple metal resistance (MMR) index, which ranged from 0.04 to 0.50, showed diverse heavy metal resistance patterns in all P. vulgaris isolates (in the case of 2–7 metals in various combinations). All of the tested isolates had methicillin resistance, whereas the least number of isolates had ofloxacin, gentamycin, or neomycin resistance. The P. vulgaris isolates displayed multidrug resistance patterns (2–12 drugs) in various antibiotic combinations. The MAR indexes were shown to be between (0.02–0.7). From the total isolates, 98%, 84%, and 80% had urease, gelatinase, and amylase activity, whereas 68% and 56% displayed protease and beta-lactamase activity. Plasmids were present in all the selected resistant isolates and varied in size from 42.5 to 57.0 kb and molecular weight from 27.2 to 37.0 MD. The transmission of the antibiotic/metal resistance genes was evaluated between a total of 7 pairs of isolates. A higher transfer frequency (4.4 × 10−1) was observed among antibiotics, although a lower transfer frequency (1.0 × 10−2) was observed against metals in both the media from the entire site tested. According to exponential decay, the population of hospital wastewater declined in the following order across all sites: Site II > Site IV > Site III > Site I for antibiotics and site IV > site II > site I >site III for metal. Different metal and antibiotic concentrations have varying effects on the population. The metal-tolerant P. vulgaris from hospital wastewater was studied in the current study had multiple distinct patterns of antibiotic resistance. It could provide cutting-edge methods for treating infectious diseases, which are essential for managing and assessing the risks associated with hospital wastewater, especially in the case of P. vulgaris. [ABSTRACT FROM AUTHOR]

Purpose: To assess the fluoroquinolone resistance pattern and trends among bacterial isolates from ocular infections over a 16-year period and explore alternative antibiotics in fluoroquinolone-resistant strains.Methods: In this retrospective, longitudinal study, the microbiology laboratory records of patients with different ocular infections diagnosed at an eye institute in central India from 2005-2020 were reviewed to determine the pattern of fluoroquinolone (ciprofloxacin, ofloxacin, gatifloxacin, and moxifloxacin) resistance. Antibiotic susceptibility testing was done using the Kirby-Bauer disc diffusion method.Results: In 725 Gram-positive bacteria, the resistance of ciprofloxacin, ofloxacin, gatifloxacin, and moxifloxacin was 55.9% (95% confidence interval [CI]: 52.2 - 59.6), 42.7% (95% CI: 39.0 - 46.4), 47.6% (95% CI: 43.9 - 51.3), and 45.6% (95% CI: 41.7-49.5), respectively. In 266 Gram-negative bacteria, the resistance of ciprofloxacin, ofloxacin, gatifloxacin, and moxifloxacin was 57.9% (95% CI: 51.9 - 63.9), 56.0% (95% CI: 49.7 - 62.1), 59.9% (95% CI: 53.8 - 66.0), and 74.3% (95% CI: 68.3 - 80.2), respectively. A declining trend in resistance to ciprofloxacin (P < 0.001), ofloxacin (P < 0.001), and moxifloxacin (P < 0.001) was seen in Gram-positive bacteria, whereas a reduction in resistance to only moxifloxacin (P = 0.04) was seen in Gram-negative bacteria. In fluoroquinolone-resistant Gram-positive bacteria, cefuroxime exhibited the highest susceptibility, whereas in fluoroquinolone-resistant Gram-negative bacteria, colistin exhibited the highest susceptibility.Conclusion: Fluoroquinolone resistance was high among bacteria from ocular infections in central India, but a declining trend in resistance to some of the fluoroquinolones was observed in recent times. Cefuroxime and colistin emerged as alternatives in fluoroquinolone-resistant Gram-positive and Gram-negative bacterial infections, respectively. [ABSTRACT FROM AUTHOR]

Background: Ventilator-associated pneumonia (VAP) is defined as nosocomial pneumonia that develops in patients who have been on mechanical ventilation for more than 48 hours. This study aimed to determine the bacteriological profile of VAP in the pediatric intensive care unit (PICU) as well as patient outcomes in a hospital in India. Methods: The study included 190 children (99 males and 91 females) aged 1 month to 12 years who were either manually or mechanically ventilated in a PICU. Clinical characteristics, microbiological profile, intubation details, complications, and outcomes were recorded. Blood and endotracheal aspirate were collected from VAP suspects and semi-quantitatively processed using standard microbiological techniques. Results: Septic shock, bronchopneumonia, acute encephalopathy, acute central nervous system infection, congenital heart disease, and snake envenomation poisoning were diagnosed in 57, 41, 23, 15, 11, and 7 cases, respectively. The most common neurological causes were status epilepticus, neuromuscular diseases, and raised intracranial pressure. Nosocomial pneumonia (16%) and air leak (8.9%) were the most common complications in ventilated children. There was a 10% mortality rate among children in PICU. There were 100 VAP suspects, with 33 developing VAP. There were 11 children with early-onset VAP (<4 days) and 22 children with late-onset VAP (>4 days). Pathogenic microorganisms were isolated from 31 intubated children who were suspected of having VAP. Klebsiella pneumoniae was the predominant isolate from both early-onset and late-onset VAP cases. The majority of deaths were related to infection with Acinetobacter baumannii. Gram-negative isolates from early-onset VAP showed sensitivity to meropenem (87.5%), piperacillin-tazobactam (75%), and ciprofloxacin (62.5%). Enterobacteriaceae isolates from late-onset VAP showed susceptibility to meropenem (82%) and piperacillin-tazobactam (27%). Conclusion: Infection with A. baumannii may be a risk factor for death in children with VAP. The most common pathogens isolated from children with VAP are K. pneumoniae and A. baumannii. [ABSTRACT FROM AUTHOR]

Background and aim: Multidrug resistant Klebsiella pneumoniae is associated with nosocomial infections in both outbreak and non-outbreak situations. The study intends to evaluate the potential of enterobacterial repetitive intergenic consensus- polymerase chain reaction (ERIC-PCR), a genomic based typing and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) proteomic-based typing techniques for clonal relatedness among multidrug resistant Klebsiella pneumoniae isolates. Methodology: Multidrug resistant clinical isolates of Klebsiella pneumoniae (n = 137) were collected from March 2019 to February 2020. Identification and protein-based phylogenetic analysis were performed by MALDI-TOF MS. Genomic typing was done by ERIC-PCR and analyzed by an online data analysis service (PyElph). Dice method with unweighted pair group method with arithmetic mean (UPGMA) program was used to compare the ERIC profiles. The samples were also evaluated by PCR for the presence of genes encoding carbapenemases, extended spectrum beta lactamases (ESBLs) and mobile colistin resistance-1 (mcr1). Result and conclusion: The study presents ERIC-PCR as more robust and better discriminatory typing tool in comparison to MALDI-TOF for clonal relatedness in multidrug resistant K. pneumoniae clinical isolates. Isolates were typed into 40 ERIC types, and six groups by MALDI-TOF-MS. PCR-based analysis revealed that all the strains harbored two or more ESBL and carbapenemase genes. None of the isolates revealed the presence of the plasmid mediated mcr-1 gene for colistin resistance. [ABSTRACT FROM AUTHOR]

Introduction: During the second wave of coronavirus disease 2019 (COVID-19), superinfection caused by fungus and multidrug-resistant bacteria worsened the severity of illness in COVID-19 patients. Limited studies from India reported the antimicrobial resistance pattern of secondary infections. In this study, we aim to study the epidemiology of pathogens causing superinfections and genotyping of Gram-negative isolates in COVID-19 patients. Methods: This retrospective study was conducted at a dedicated COVID-19 center, India. The identification of bacteria/fungi was done by Vitek2® and matrix-assisted laser desorption/ionization-time of flight mass spectrometry system. Identification of beta-lactamase genes was done using thermal cycler. The diagnosis of mucormycosis was based on 10% potassium hydroxide direct microscopy. Statistical analyses were performed using STATA version 15.1 (StataCorp., College Station, TX, USA). For continuous variables, mean and standard deviation were computed. For comparing proportions of secondary infections across admission location and outcomes, the Chi-squared test of independence was used. To compare the mean and median between intensive care units and outcomes, an independent t-test and a Mann–Whitney test were used. Results: Of all the clinical samples, 45.4% of samples were cultured positive for secondary infections. Acinetobacter baumannii (35%) was the most common Gram-negative pathogen, while among Gram positive, it was Enterococcus faecium (40%). Among fungus, Candida spp. (61%) predominates followed by molds. Colistin and tigecycline proved effective against these pathogens. blaNDM was the most prevalent gene followed by the blaOX among the carbapenemase genes. Conclusions: The mortality rate among COVID-19 patients with secondary infection was significantly higher compared to the overall mortality rate in COVID-19 patients. [ABSTRACT FROM AUTHOR]