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Introduction: The burden of acute febrile illness remains underestimated in many low- and middle-income countries. The rationale of this study revolves around the gaps in diagnostics for acute febrile illnesses in these regions. Aim: To highlight the seroprevalence and co-infections of different infectious aetiologies in blood culture negative febrile patients. Materials and Methods: This cross-sectional study was conducted at Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India from October 2021 to July 2022, involving 153 serum samples from patients presenting with fever for less than two weeks duration during outpatient and emergency visits. The blood culture negative samples were further tested for other aetiologies such as Leptospirosis, Dengue NS1 antigen, Dengue IgM antibody, Chikungunya, Scrub typhus IgM, and Widal, respectively. Convalescent sera were also tested for all positive Widal results. All statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) statistical software (IBM SPSS version 26.0, Armonk, N.Y.). Results: Out of the 153 patients enrolled, 120 patients were tested for a panel of serological tests. The majority 52 (43.3%) were aged between 21 and 40 years. Fifty-five patients (45.8%) exhibited positivity, among which Scrub typhus was the most common aetiology with 21 (17.5%) case, followed by Leptospirosis 19 (15.8%), Dengue 10 (8.3%), Chikungunya 3 (2.5%), and Enteric fever 2 (1.7%), with no cases of malaria reported. Overall, co-infections reported in present study included 7 (5.8%) cases, of which scrub typhus and Leptospirosis were the most prevalent in 5 (4.16%) cases. Two patients (1.6%) presented with a co-infection of dengue and chikungunya. Conclusion: The diverse aetiologies causing acute febrile illness necessitate a syndrome-based disease surveillance approach, accompanied by strong clinical acumen, for the betterment of patient outcomes.

Introduction: Leptospirosis is an anthropozoonotic disease. The wide spectrum of clinical manifestations of leptospirosis ranges from mild febrile illness without complications to severe disease with Multiorgan dysfunction. In the central and eastern parts of Uttar Pradesh, India, it is one of the major causes of acute febrile illness. Aim: To determine the seroprevalence, clinical features and geographical distribution of leptospirosis in Central Uttar Pradesh, India. Materials and Methods: This current retrospective observational study was conducted in the Serology Laboratory, Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh, India, from January 2022 to December 2022 and data were analysed from January 2023 to March 2023. A total of 625 patients with fever lasting >7 days attending the Outpatient Department (OPD) were included in the study. Serum samples of these patients were tested for Leptospira Immunoglobulin M (IgM) by Enzyme-linked Immunosorbent Assay (ELISA). Clinical, laboratory findings and demographic data were also collected from the hospital software. The patients were also tested for other infectious aetiologies such as malaria, typhoid, dengue and scrub typhus. Data were presented as percentages, and the Odds Ratio (OR), 95% CI, and p-value were used to test the level of significance. Results: Leptospirosis was found to be positive in 63 (10.08%) patients. The patients with leptospirosis belonged to the age group of 21-40 years with a male predominance. The maximum number of cases was from Lucknow district with 23.8% prevalence, followed by Prayagraj (11.11%). The common presenting symptoms were weakness, epigastric pain, myalgia and jaundice. Co-infection with scrub typhus was seen in 11 (17.4%) patients with leptospirosis. None of the other infections showed co-infection with leptospirosis. Coagulopathy and hepatic dysfunction were found in the majority of the patients with leptospirosis. Mortality was seen in five patients with Multiple Organ Dysfunction Syndrome (MODS). Conclusion: The seroprevalence of leptospirosis was found to be 10.08%. To reduce the morbidity and mortality linked to leptospirosis, it is necessary to improve diagnostic skills and the knowledge of physicians for screening the disease in patients with acute febrile illnesses, as it involves multiple systems and has overlapping common presenting symptoms.

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.

Background: Respiratory infections are common infections reported among human beings. Infections involving the respiratory tract can be mild and transient and people tend to neglect them. The chief cause of lower respiratory tract infections (LRTIs) can be attributed to hospitalization. Materials and Methods: We conducted a retrospective, cross-sectional study from January 2021 to April 2021. The clinical, demographic, and microbiological characteristics of the patients admitted to adult respiratory ward (ARW), pediatric ward (PW), and medicine intensive care unit (MICU) were extracted from the electronic records and laboratory registers for this study. Results: We included 788 patients in this study from January 2021 to April 2021. The mean age of patients was 52.67 ± 20.15 years with a male predominance in ARW (248/383, 64.75%) and MICU (252/369, 68.29%) and a female predominance in PW (28/36, 77.78%). Most patients were admitted to the ARW (383/788, 48.60%) followed by the MICU (369/788, 46.83%). Bacterial growth was seen in 358 (358/788, 38.89%) respiratory samples. Blood culture was positive in 188 (188/788, 23.86%) samples. The most common microorganism causing LRTI and bloodstream infection was Klebsiella pneumoniae with an infection rate of 32.68% (117/358, 32.68%) and 25.53% (48/188, 25.53%), respectively. Total leukocyte count (P < 0.0001) and procalcitonin (P = 0.0113) were statistically significant diagnostic parameters associated with MDR isolates. Conclusion: This study establishes the range of bacteria obtained from the respiratory samples of LRTI patients and guides the clinicians in the administration of appropriate antibiotics according to the antibiotic susceptibility pattern to eliminate MDR.

Background: Pseudomonas aeruginosa is a major cause of multidrug resistant (MDR) nosocomial pathogen isolated from clinical samples of patients admitted to the intensive care unit. Treating the ever-increasing antimicrobial resistance in P. aeruginosa isolates has turned into a challenge. Materials and Methods: All data were extracted from the hospital information system on P. aeruginosa pneumonia from July 2017 to July 2022. All isolates were identified by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry and routine biochemicals. A comparison between the consequences of antibiotic susceptibility testing, demographics, and risk factors between the patients with community-acquired and nosocomial-acquired pneumonia due to either P. aeruginosa or multidrug-resistant P. aeruginosa was performed. Results: In this study, 576 (576/19224, 2.99%) patients developed P. aeruginosa pneumonia over 6 years. There were 114 (19.79%) cases of community-acquired pneumonia and 462 (80.21%) cases of nosocomially acquired pneumonia in this study. P. aeruginosa showed high resistance to cefoperazone-sulbactam and imipenem, which was statistically significant in cases of patients suffering from nosocomially acquired pneumonia compared to community-acquired pneumonia. High susceptibility to colistin was statistically significant in cases of community-acquired pneumonia compared to nosocomially acquired pneumonia. A total of 182 (182/576, 31.59%) deaths occurred among cases of P. aeruginosa pneumonia. Conclusion: This study explains the emergence of resistance among the P. aeruginosa isolates causing community-acquired pneumonia or nosocomially acquired pneumonia over 6 years.

Introduction: Ralstonia spp. is an emerging non fermenting Gram negative bacillus implicated in cases of bloodstream infections in immunocompromised individuals. It is commonly found as an environmental contaminant in hospital settings. Several sporadic outbreaks have been reported from different parts of the world due to Ralstonia spp. This study reports a similar outbreak at a tertiary care hospital in Northern India. Aim: To determine the source of Ralstonia septicaemia in affected patients at a tertiary care centre. Materials and Methods: The present observational cross-sectional study was conducted at the Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India from February 2020 until the end of March 2020 (two months). A total of 2,650 blood cultures were received during the study period; of these, 53 (2%) patients were found to have Ralstonia mannitolilytica infection over a two month period. All patients from various wards whose blood cultures showed growth of Ralstonia species were included in this study. The organism was identified using both biochemical tests and Matrix-Assisted Laser Desorption Ionisation-Time of Flight Mass Spectrometry (MALDI-TOF MS). Antibiotic sensitivity testing was conducted using the Kirby-Bauer disk diffusion assay. Environmental surveillance was conducted to detect the source of origin. Patients’ age, sex, duration of hospital stay, co-morbidities, and other clinical parameters were recorded. Statistical analysis was performed using Microsoft Excel. Results: There were 52 cases of septicaemia due to Ralstonia mannitolilytica, and one Ralstonia isolate was obtained from intraoperative pus. Most of the Ralstonia isolates obtained were Multidrug-Resistant (MDR), showing resistance to imipenem, meropenem, amikacin, aztreonam, and sensitivity to first-line drugs such as ceftazidime, piperacillin-tazobactam, cefoperazone-sulbactam, levofloxacin, and trimethoprim-sulfamethoxazole, resulting in successful treatment. Out of 53 cases, one patient succumbed to death due to surgical complications. Environmental sampling did not yield any organisms resembling Ralstonia spp. Conclusion: The environmental source of the Ralstonia bacteraemia outbreak could not be identified in this study. All patients except one were successfully treated with antibiotics. Clinicians and microbiologists should remain vigilant in case any such case arises to prevent further outbreaks.

Introduction: Stenotrophomonas maltophilia is a Gram-negative, motile, and glucose non fermenting bacterium commonly found in hospital settings. It poses a significant risk to immunocompromised individuals, often causing nosocomial infections. Aim: To identify the risk factors associated with Stenotrophomonas maltophilia bacteraemia and compare the factors influencing patient survival and mortality. Materials and Methods: Clinical and laboratory data from 39 cases of Stenotrophomonas bacteraemia encountered between July 2021 and July 2022 in the Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, were analysed in the present retrospective study in August 2022. The study included all cultures positive for S. maltophilia bacteraemia, identified through Matrix-assisted Laser Desorption Ionisation Time-Of-Flight Mass Spectrometry (MALDI-TOF-MS). Antibiotic susceptibility testing was performed using the Kirby-Bauer disk diffusion method, following the Clinical and Laboratory Standards Institute (CLSI) guidelines. Statistical analysis and outcome assessment were conducted using Statistical Package for Social Sciences (SPSS) version 20.0. Results: Clinical data from all 39 bacteraemia patients were extracted from the hospital information system for analysis. The mean age of the patients included in the present study was 46.0±20.29 years, with a male predominance of 27 (69.23%). The most common risk factors associated with S. maltophilia bacteraemia were the presence of an indwelling catheter in 21/39 cases (53.8%) and co-existing pulmonary infections in 18/39 cases (46.2%). S. maltophilia isolates exhibited high susceptibility to Minocycline (94.87%), Ticarcillin-Clavulanic acid (87.18%), Levofloxacin (84.62%), and Cotrimoxazole (84.62%). The 30-day mortality rate was reported as 28.20% (11/39). Conclusion: S. maltophilia can cause various infections in immunocompromised patients. The appropriate use of empirical antibiotics and strict adherence to infection control measures can reduce hospital stays, as well as 14-day and 30-day mortality rates among affected patients.

Education plays a crucial role in creating individuals who contribute positively to the development of a country. The private education sector in Malaysia, has proven to be a major source of revenue for the Malaysian government, and it is the government’s aspiration to capture a large percentage of the higher education global market. The purpose of this paper is to analyse the challenges faced by academic leaders in managing private universities in Malaysia and to provide feasible recommendations to overcome them. The findings are expected to provide valuable information to the management of Malaysian private universities, policymakers, and regulatory agencies. The information gathered could provide enlightenment regarding the difficulties faced in order to design and implement further policies to elevate their operational method and ensure long-term survival. Valuable recommendations have been provided to ensure the institutions remain profitable and sustainable as the development of Malaysia’s social and economic sector is dependent on its education sector.

Introduction: Scrub typhus is a major cause of acute febrile illness in India. It presents with various clinical features that vary from fever to multiorgan dysfunction. Similar symptoms and presentations cause difficulty in diagnosis. Therefore, it is important to have early and prompt diagnosis with better prognostic markers to decrease morbidity and mortality. Aim: To determine the prognosis of scrub typhus patients based on the Procalcitonin (PCT) levels. Materials and Methods: This retrospective observational study was conducted in the Microbiology Department of Sanjay Gandhi Postgraduate Institute of Medical Sciences, Uttar Pradesh, India, from January 2022 to January 2023. A total of 120 patients admitted to the hospital, who tested positive for Scrub typhus IgM by ELISA during this period and had a negative blood culture, were included in this study. Data analysis was conducted from February 2023 to April 2023. PCT levels of all these patients at the time of admission were recorded. The demographic information, laboratory parameters, and treatment regimen of these patients were also compiled. Statistical analysis was performed, and p-value was used to determine statistical significance. Results: The majority of the patients belonged to the age group of 21-40 years. Among these, elevated PCT values (ranging from 0.05-89.4 ng/mL) were observed in 112 (93.33%) patients. Twelve (10%) patients died during the study period, and all of them had elevated PCT levels. Among these, six developed septic shock with Multiple Organ Dysfunction Syndrome (MODS). Increased leukocyte values, elevated liver enzymes such as Aspartate Aminotransferase (SGOT/AST) and Alanine Transferase (SGPT/ALT), abnormal coagulation profile, and abnormal renal profile with elevated urea and uric acid levels were found to be significantly associated with scrub typhus patients with elevated PCT values. Conclusion: There is a need to address the role of prognostic markers in the management of scrub typhus patients. This may lead to breakthroughs in the field of diagnostic research and help improve the prognosis of these patients.

Introduction: A total of 360 million people worldwide have been reported to suffer from hearing loss. The most common cause of ear infection is otitis media, which can be attributed to bacterial pathogens such as Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus pneumoniae. Aim: To identify the incidence and risk factors associated with multidrug-resistant bacteria causing ear infections at a tertiary care centre in India. Materials and Methods: A retrospective analytical study was conducted in the Bacteriology section of the Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, from January 2021 to January 2023, and analysed in February 2023. A total of 83 ear discharge samples sent to the laboratory were included in the duration of the study and all clinical and laboratory data were extracted from the hospital information system and the laboratory register, respectively. All pathogens were identified using routine biochemicals and Matrix-assisted Laser Desorption/Ionisation- Time of Flight-Mass Spectrometry (MALDI-TOF-MS) assay, and their antibiotic susceptibility testing was performed using the Kirby Bauer Disc Diffusion method. Statistical analysis was performed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) software version 20.0 (SPSS Inc.). The Chi-square test was used for all categorical variables, and the comparison of two means was performed using GraphPad Prism version 9.5.1 (GraphPad Software Inc.), with p-value

Introduction: Human parvovirus B19 (B19V) has an affinity for multiple organs and causes a myriad of clinical diseases depending on the host’s immunological and haematological status. The seroprevalence of human parvovirus B19 has mostly been studied in haematological disorders, but there is still a lack of data on B19V seroprevalence in extra-haematological disorders. Aim: To study the seroprevalence of B19V in haematological and extra-haematological disorders. Materials and Methods: This retrospective observational study was conducted at the Microbiology Laboratory of Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India. Data was collected from September 2017 to September 2020, and data analysis was done from October 2020 to January 2021. A total of 702 serum samples from patients suspected of B19V infection were received over a threeyear duration for parvovirus B19 antibody testing. Of these, 674 serum samples were included in the study as per the inclusion and exclusion criteria. The prevalence of B19V antibodies in different clinical disorders was investigated by collecting patient details like age, gender, underlying clinical disorder, and B19Vspecific Immunoglobulin M (IgM) and IgG antibodies detected by quantitative enzyme immunoassay on all serum samples suspected of B19V infection using Statistical Package for Social Sciences (SPSS) version 25.0 software. The Chi-square test was used to analyse statistically significant variables. Results: B19V-specific IgM and IgG antibodies were detected in 35.7% (241/674) of the serum samples received over a three-year duration. The positivity rate was 94 (13.9%) for IgG, 108 (16%) for IgM, and 39 (5.8%) for both IgG and IgM. The positivity in adults aged 18 years and over (39.6% or 160/404) was statistically significantly higher compared to children aged 17 years and younger (30% or 81/270) (p=0.0109). Among the 241 B19V-positive patients, 126 (52.3%) had haematological disorders, and 115 (47.7%) had extra-haematological disorders. The total positivity of IgG plus IgM antibodies was highest in musculoskeletal and connective tissue disorders (33 (54.1%) and haematological disorders 126 (48.3%). Conclusion: The B19V seroprevalence was relatively low in the present study compared to most serological studies conducted in other regions. The present study provides information on the seroprevalence of B19V in both haematological and extrahaematological disorders simultaneously.

Sphingobacterium multivorum is a Gram-negative bacterium previously classified as a Flavibacterium. It produces non lactose fermenting colonies and is capable of producing oxidase and catalase enzymes. It is found ubiquitously in the environment and has been isolated from food, plants, soil, and aquatic environments, including hospital water supplies. Only a few cases of clinical infections caused by Sphingobacterium multivorum have been reported. Most cases of infection have been demonstrated in immunosuppressed patients. This case report presents the case of a 23-year-old immunocompetent woman with pituitary macroadenoma haemorrhage who developed Sphingobacterium meningitis following neurosurgery and subsequently died from cardiac arrest.

Background: Meningitis can be attributed to bacterial, fungal, or viral agents. In this study, we demonstrate the common bacterial agents causing meningitis along with their antibiotics susceptibility pattern in patients of all age groups. Material and Methods: This retrospective, observational study was carried out in the Department of Microbiology with cerebrospinal fluid (CSF) samples collected from November 2019 to May 2022. We collected 1986 nonrepeat CSF samples from clinically suspected patients of bacterial meningitis, and clinical information about the patients was extracted from the hospital information system. Results: Out of the 1986 CSF samples included in our study, 150 (7.55%) were found to be positive on bacterial culture. Most of our patients were in the age group of 0–20 years. Common clinical manifestations observed in our patients were: high-grade fever, 87 patients (58%); severe headache, 126 patients (84%); neck rigidity, 47 patients (31.3%); altered mental status, 76 patients (50.7%) and photophobia, 83 patients (55.3%). The most commonly isolated bacteria was Acinetobacter species (30%). The mean length of hospitalization (37.76 ± 25.30), the mean total cell count, high levels of protein (mg/dl) and low levels of glucose (mg/dl) of CSF were statistically significant in meningitis caused by multidrug-resistant bacteria. Conclusion: We recognized the spectrum of pathogens causing meningitis at our center along with the antibiotic resistance pattern to guide and facilitate early treatment by primary health care professionals and family medicine practitioners.

Introduction: Bile is deemed a sterile fluid, with the presence of clinical conditions like cholelithiasis, cholecystitis, previous biliary interventions, biliary strictures, and so on, leading to bile stasis, and increases the chances of bacteriobilia. In this study, we recognize the bacterial spectrum of microorganisms isolated from bile samples, diagnostic parameters, and antibiotic sensitivity patterns. Methods: A retrospective observational study was carried out by compiling data from the hospital information system of a tertiary care center from 2021 to 2022 to evaluate biliary infections in patients who underwent surgical procedures related to the biliary tract and associated organs. Results: A total of 234 patients’ bile samples were included in our study. The mean age of patients was 48.04 ± 14.74 years, with more patients below the age of 65 years among those with infected bile samples. One hundred and sixty-three (163/234, 69.66%) patients infected by 209 pathogenic microorganisms were recognized. The most common microorganism isolated was Escherichia coli (83/209, 39.71%), followed by Pseudomonas aeruginosa (37/209, 17.7%). Acinetobacter baumannii and Klebsiella pneumoniae isolate owed to more than 90% penicillin, extended-spectrum beta-lactamase, carbapenem, and fluoroquinolone resistance among all isolates. Length of hospital stay, malignant obstruction, and chronic kidney disease were identified as statistically significant risk factors that lead to the isolation of multi-drug-resistant isolates from bile culture. Conclusion: We recognized the spectrum of pathogens causing biliary tract infections at our center along with the antibiotic resistance pattern to guide and facilitate prompt and appropriate treatment by primary health care professionals and family medicine practitioners.

Background Isepamicin is a 1-N-S-a-hydroxy-b-aminopropionyl derivative of gentamicin B and the spectrum of pathogenic microorganisms covered by it and its effectiveness is similar to that of amikacin except the action of aminoglycoside inhibitor enzymes is ineffectual on it.

Cupriavidus gilardii (C. gilardii) is a Gram-negative, motile, non sporulating, non lactose fermenting bacterium. It was first identified by Coenye et al., and has a complex taxonomy, often being misidentified as Wausteria gilardii, Ralstonia gilardii. It is commonly found in ecosystems containing plants and heavy metal-contaminated soil and is rarely isolated from clinical samples with no clear evidence of its clinical significance. The pathogenic nature of C. gilardii in respiratory ailments, particularly in patients with cystic fibrosis, is still unclear. This case report presents a 19-year-old female with Chronic Kidney Disease (CKD) who developed pneumonia caused by C. gilardii. The report also includes the sensitivity pattern of the bacterium to guide physicians in treating these rare pathogens.

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.

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.

Introduction Burkholderia cepacia complex (BCC) is an emerging pathogen causing nosocomial bloodstream infections (BSIs), and its treatment is challenging due to its multidrug resistance. In India, there is a dearth of data on BSIs caused by BCC, therefore, an updated study is required to know the clinical and microbiological profile of these patients. We aimed to study the clinical epidemiology and antibiotic susceptibility pattern of BCC isolated from blood samples in our hospital. Materials and Methods This observational study was conducted from January 2019 to December 2020 at a tertiary care center in northern India. All the blood cultures were done on an automated blood culture system. All BCC isolates of BSI were identified depending on their morphological properties and biochemical reactions, and underwent the matrix-assisted laser desorption ionization time-of-flight mass spectrometry system to confirm diagnosis. Antibiotic susceptibility testing was done as per Clinical Laboratory and Standards Institute guidelines. Results BCC was isolated from 30 BSI patients over a 2-year period. Sixty-six percent (20/30) of patients had cancer and a majority of them were undergoing chemotherapy. The most common predisposing factors were the use of steroids, immunosuppressive drugs, and chemotherapy (93.3%), central lines (83.3%), use of higher antibiotics (60%), and diabetes mellitus type 2 (60%). The most common species isolated were B. cepacia (64%) and B. cenocepacia (30%). Isolates showed highest sensitivity to minocycline (100%), ceftazidime (73.3%), and meropenem (70%) and the least to ticarcillin–clavulanate. Conclusion BCC is an emerging pathogen causing BSIs, especially in malignancy patients. Minocycline can be a good choice for these bacteria.

Chryseobacterium spp., is non motile, non fermenter, Gram Negative Bacillus (GNB) showing enzymatic activity of catalase, oxidase, and indole production. Chryseobacterium spp. are found widely in the soil and aquatic milieu. It is also capable of surviving in chlorinated water, which can be attributed to the spread of infection in hospital settings hosting profusely immunosuppressed individuals. Newer diagnostic modalities like Matrix-Assisted Laser Desorption Ionisation-Time Of Flight-Mass Spectrometry (MALDI-TOF-MS) and Vitek-2 facilitate early identification and treatment can alleviate the infections caused by them. Present series discusses three cases of Chryseobacterium indologenes (C. indologenes) Urinary Tract Infection (UTI) Case 1- was a 61-year-old hypertensive and diabetic male patient diagnosed with renal failure with pyelonephritis. Case 2- was a female patient of 64-year-old with left upper ureteric calculus. Case 3- was a 31-year-old male patient having left mid ureteric calculus. All the patients were catheterised with a urinary catheter and developed UTI by C. indologenes. C. indologenes infection in UTI patients is uncommon but these cases of complicated UTIs demonstrate C. indologenes as a potential cause of UTI in hospitalised patients using invasive equipment like urinary catheters. As the organism was Multidrug-Resistant (MDR), appropriate antibiotic treatment and accurate identification can alleviate infection by this organism.

Pseudomonas mendocina is a Gram negative bacillus, belonging to the Pseudomonadaceae family. It was first isolated in 1970 from soil and water of Mendoza region in Argentina. Although, it rarely causes infection, 21 cases of infections ranging from infective endocarditis, bacteraemia, meningitis, soft tissue infections and urinary tract infections are reported worldwide mostly among patients with underlying co-morbidities. This report is the first case of pyogenic meningitis due to Pseudomonas mendocina reported from a 1600 bedded teaching hospital in Northern India and second case of Pseudomonas mendocina infection from the Indian subcontinent. The presented case was of a 31-year-old female who was diagnosed for pituitary macroadenoma on Magnetic Resonance Imaging (MRI). She underwent endoscopic endonasal trans-sphenoidal excision of the tumour after two months of diagnosing the tumour following which she developed meningitis. On two consecutive aerobic bacterial culture and identification by Matrix-Assisted Laser Desorption/Ionisation-Time of Flight-Mass Spectrometry (MALDI-TOF-MS), growth of Pseudomonas mendocina was observed. After Antibiotic Sensitivity Testing (AST) the patient was started on Piperacillin-tazobactam and Amoxicillin-clavulanic acid which lead to alleviate her symptoms of meningitis and was discharged after 27 days of hospital stay.

The genus Aerococcus spp. comprise microaerophilic, catalase-negative, Gram-positive cocci that show alpha-haemolytic growth on blood agar. They have a tendency to divide on two planes at a 90° angle, and rapid multiplication leads to the formation of Grampositive cocci in tetrads and irregular clusters. Aerococcus spp. are capable of causing invasive and fatal systemic illnesses, such as endocarditis, bactereamia, arthritis, and meningitis. Due to evolving diagnostic tools, it is now identified as a pathogen in a variety of disorders instead of being considered a contaminant. Most isolates are susceptible to penicillins, but there is increasing resistance to cephalosporins, ciprofloxacin, cotrimoxazole, clindamycin, vancomycin, and tetracycline. Here, authors present a rare case of Aerococcus viridans meningitis in a patient who underwent surgical excision of a left trigeminal Schwannoma, along with the drug susceptibility pattern resistant to most first-line antibiotics used against isolates from Streptococci spp., except doxycycline.

Purpose: Coronavirus disease 2019 (COVID-19) is purely a viral illness which is not affected by the usage of antibiotics, but the risk of development of secondary bacterial infections during the course of respiratory illness or hospitalisation has led to a surge of antibiotic use. Anti-microbial resistance has taken an upward trend to some of the commonly used or over-used antibiotics. The present study was planned to focus on the trends of resistance rates noticed for the common antibiotics, namely, doxycycline, azithromycin, and so on, before and after the advent of this pandemic. Material and Methods: The study was conducted at a tertiary care hospital of North India with 2000 samples, 1000 samples between March 2019 and March 2020 before the COVID pandemic and 1000 samples between April 2020 and April 2021 after the advent of the pandemic. Identification and zones for doxycycline and erythromycin were interpreted as per Clinical and Laboratory Standards Institute guidelines. Results: Among the various samples, pus/aspirated fluids were in majority (47%), followed by blood (29%), respiratory specimens (18%), and urine (6%). On stratifying the various pathogens associated with the treatment of doxycycline and erythromycin, Staphylococcus species were the predominant ones in almost 82% of the cases, followed by Enterococcus (12%) and Streptococcus (6%) species. For doxycycline, the overall sensitivity was noted to be 46% in the year 2019–20 and 31% in the year 2020–21, whereas for erythromycin, the sensitivity was seen as 39% in 2019–20 and dropped down to 26% in 2020–21. Conclusions: The authors noted a dip in the overall sensitivity towards doxycycline and azithromycin. This finding clearly indicates the increasing rates of antibiotic resistance in a developing country such as India during these COVID times. A proper anti-microbial stewardship programme during these times will help to de-escalate the increasing resistance rates and will prove to be of great help to the primary care physicians.

Purpose: Bacterial coinfections are a leading cause of morbidity and mortality during viral infections including corona virus disease (COVID-19). The COVID-19 pandemic has highlighted the need to comprehend the complex connection between bacterial and viral infections. During the current pandemic, systematic testing of the COVID-19 patients having bacterial coinfections is essential to choose the correct antibiotics for treatment and prevent the spread of antimicrobial resistance (AMR). This study was planned to study the prevalence, demographic parameters, comorbidities, antibiotic sensitivity patterns, and outcomes in hospitalized COVID-19 patients with bacterial coinfections. Material and Methods: The COVID-19 patients having bacterial coinfections were selected for the study and analyzed for the prevalence, antibiotic sensitivities, comorbidities, and clinical outcomes. The bacterial isolates were identified and the antibiotic susceptibility testing was performed according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Of the total 1,019 COVID-19 patients screened, 5.2% (n = 53) demonstrated clinical signs of bacterial coinfection. Escherichia coli were the most common isolate followed by Pseudomonas aeruginosa and Klebsiella spp. among the gram-negative bacterial infections. Coagulase-negative Staphylococcus species (CONS) and Staphylococcus aureus were most common among the gram-positive bacterial infections. The antibiotic sensitivity profiling revealed that colistin (99%), imipenem (78%), and fosfomycin (95%) were the most effective drugs against the gram-negative isolates while vancomycin (100%), teicoplanin (99%), and doxycycline (71%) were most potent against the gram-positive isolates. The analysis of the clinical parameters and outcomes revealed that among the COVID-19 patients with bacterial coinfections, the mortality rate was higher (39%) than the control group (17%) (P-value < 0.001). Conclusion: This study reveals the significantly increased rates of bacterial coinfections among COVID-19 patients which may lead to an increase in mortality. This study will guide the physicians at the primary level on the rational and correct usage of antibiotics in such COVID cases. Hence, systematic testing of COVID-19 patients with bacterial coinfections is the need of the hour to decrease the mortality rate and limit the spread of AMR.

Introduction: Infections associated with catheter in the upper urinary tract (CUUT), which include the double-J stent and the percutaneous nephrostomy (PCN) tube, get particularly infected in patients with specific risk factors for developing an infection. Methods: A retrospective observational study was carried out by compiling data from the hospital information system of a tertiary care center from 2019 to 2021 to evaluate infections in patients with catheter in the upper urinary tract. Result: A total of 200 pus samples of double-J stent (96 pus samples) and PCN tube (104 pus samples) were included in our study. Among patients with nephrostomy tube, the most frequently isolated microorganisms were Escherichia coli, followed by Pseudomonas spp. In those with a double-J stent, Pseudomonas aeruginosa, followed by E. coli were the most commonly isolated microorganisms. We found 55.72% of cases of Enterobacteriaceae-producing carbapenemases in patients with a percutaneous catheter. 66.07% of Enterobacteriaceae in patients with double-J and nephrostomy stents are extended-spectrum beta-lactamase-producing bacteria. The percentage of cultures with multiple-drug resistance (MDR) microorganisms was 38.54% in patients with double-J stents and 37.75% in nephrostomy tubes. The presence of prior urinary tract infection (P = 0.010), presence of urinary catheter before admission (P = 0.005), increased time with single urinary catheter in-situ (P < 0.001), and increased length of hospital stay (P = 0.036) were risk factors for isolation of MDR microorganisms. Conclusion: Pseudomonas spp. and Pseudomonas aeruginosa are commonly infecting both the CUUT. E. coli infections are more commonly infecting the nephrostomy tubes. MDR microorganisms are frequent, mainly in patients with prior urinary tract infection, presence of urinary catheter before admission, and prolonged use of a single catheter.

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 β-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.

Introduction: Acinetobacter is a non fermenting, Gram negative bacillus, a causative pathogen of hospital-acquired infections due to its inherent Multidrug-Resistant (MDR) property. It is held responsible for the majority of nosocomial meningitis in patients undergoing neurosurgical procedures. Aim: To identify the clinical characteristics, drug-resistance and mortality rate among the patients suffering from meningitis caused by Acinetobacter baumannii. Materials and Methods: This retrospective, single-centre study was carried out in the Bacteriology section of the Department of Microbiology at Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, from February 2019 to February 2022. A total of 150 Cerebrospinal Fluid (CSF) samples from routine bacterial culture-confirmed patients were included in the study. All clinical data were extracted from the Hospital Information System (HIS). All the isolates were identified by Matrix Assisted Laser Desorption/Ionisation-Time of Flight-Mass Spectrometry (MALDI-TOF-MS) assay and antibiotic sensitivity testing was performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: The study included 150 (7.55%) cases of culture-proven bacterial meningitis among 1986 CSF samples collected from February 2019 to February 2022. There were 45 (30.0%) cases of Acinetobacter meningitis. Thirty-five (77.8%) patients had undergone neurosurgical procedures for the removal of space-occupying lesions from the brain parenchyma. Forty-two (93.3%) isolates were resistant to amikacin and a cumulative resistance of almost 93.3-95.6% was observed among cephalosporins. Fluoroquinolone resistance was observed in 43 (95.6%) patients and carbapenem resistance was observed in 42 (93.33%) isolates. Overall, 12 (26.7%) succumbed to their infections. Conclusion: Acinetobacter meningitis causes delay in the recovery of the patient undergoing intracranial surgery, amounting to a delay in brain parenchyma healing in the case of neurosurgical patients.

Patients undergoing chemotherapy for any malignant disease are at a higher risk of developing central line related blood stream infection, as a result of lack of proper care of the central line used for giving chemotherapy. Here, a case of sepsis by an unusual pathogen Delftia acidovorans is shown in a 29-year-old female patient undergoing chemotherapy for breast cancer with no other related co-morbidities and family history. On investigation, elevated procalcitonin showed presence of bacterial sepsis. Despite of empirical antimicrobial therapy, the patient showed features of continued sepsis. Blood specimens were taken and sent as paired sets of BACTEC blood culture bottles. This was identified as Delftia acidovorans which is rarely known to cause central line related blood stream infection and has a ubiquitous presence and cause infection mostly in immunocompromised patients. Empirical therapy was continued in the patient but could not be revived because of sudden episode of bradycardia. This report highlights the significance of appropriate diagnosis and treatment of such rare pathogen as a causative pathogen for sepsis. In this report, authors also emphasise the need of education of patients and healthcare providers for proper care of any chemoport inserted to avoid incidence of central line associated blood stream infection.

Aerococcus viridans is a rare Gram positive microorganism identified largely as environmental or skin contaminants. With the advent of an increase in the immunosuppressed population due to diabetes, the use of steroids and the Coronavirus Disease 2019 (COVID-19) pandemic, this bacteria caused a variety of infections like bacteraemia, urinary tract infections, and endocarditis. The use of Matrix-Assisted Laser Desorption Ionisation Time-of-Flight Mass-Spectrometry (MALDI-TOF MS), a unique technique of microorganism identification, has placed Aerococci among human pathogens, capable of causing infection among immunocompromised patients. The present case was of a 48-year-old female presented with dry cough, high-grade fever associated with chills and rigors, and generalised body ache and weakness for the past one week. She was a known case of bronchial asthma. She tested positive for COVID-19 and over the course of hospital stay, her BACTEC blood culture performed due to high fever which flagged positive indicated her as a case of Aerococcus viridans bacteraemia. Despite of all the efforts she developed respiratory distress followed by an episode of asystole following which she could not be revived.

Introduction: Levonadifloxacin is a novel antibiotic belonging to the benzoquinolizine subclass of fluoroquinolone with potent activity against Methicillin Resistant Staphylococcus aureus (MRSA) and Quinolone Resistant Staphylococcus aureus (QRSA). Both intravenous levonadifloxacin and its oral formulation have recently been approved in India for the treatment of acute bacterial skin related infections. Aim: To assess the activity of levonadifloxacin against gram positive clinical isolates collected from Intensive Care Units (ICUs) using the disk-diffusion method. Materials and Methods: The present descriptive study where non duplicate isolates of Staphylococcus aureus (S. aureus) and other gram positive isolates from various clinical samples from all Intensive Care Units (ICUs) were collected from June to December 2020 and subjected to levonadifloxacin susceptibility testing (disk diffusion method) as per the Clinical and Laboratory Standards Institute (CLSI) guidelines, 2020. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) software, version 25.0. Results: A total of 142 gram positive clinical isolates collected from all ICUs of the hospital were analysed. These isolates included coagulase negative S. aureus 109 (76.8%), S. aureus 21 (14.8%) and Enterococcus faecalis 12 (8.4%). All the gram positive isolates of the study were susceptible to levonadifloxacin as per the prespecified interpretive criteria identified based on population pharmacokinetic model and Monte Carlo simulation enabled probability of pharmacodynamic target attainment analysis. Conclusion: Results of this in vitro study shows good activity of levonadifloxacin against gram positive isolates including difficult to-treat methicillin resistant staphylococcal isolates collected from ICU patients.

Achromobacter xylosoxidans subspecies denitrificans flourishes in presence of oxygen, commonly isolated from aquatic milieu. It is rarely implicated as the causative agent of endocarditis. It is not known to cause virulent infections in patients but causes severe infections in immunosuppressed patients with underlying co-morbidities. Present report is first case of Achromobacter xylosoxidans prosthetic valve endocarditis from India. This case report is of a 47-year-old male, suffering from Rheumatic Heart Disease (RHD), who presented to the cardiology emergency with a chief complaints of remitting type high-grade fever for two years followed by persistent fever for 10 days. On echocardiography and positively flagged BACTEC blood culture reports, it was diagnosed as a case of Achromobacter xylosoxidans subspecies denitrificans bacteraemia and prosthetic aortic valve endocarditis. Antibiotics were started according to the susceptibility testing but the patient could not complete the course of treatment as he developed dyspnoea and cardiac arrest following which he could not be resuscitated.

Background: Rickettsial infections remain one of the most neglected and underdiagnosed tropical diseases in the developing countries. Scrub typhus can prove to an important diagnosis in pyrexia of unknown origin (PUO) patients and is transmitted by a species of trombiculid mites (“chiggers”). The disease leads to a plethora of symptoms like fever, rash, headache, nausea, abdominal pain, thrombocytopenia, etc. The current study was aimed to assess the seroprevalence as well as other demographic parameters of scrub typhus among patients diagnosed with PUO in the northern part of India. Materials and Methods: This study was undertaken for a period of 3 years from September 2017 to September 2020. Serum samples of suspected cases were tested for IgM Scrub typhus along with other common febrile illnesses like Malaria, typhoid, dengue, leptospirosis, chikengunya, etc. Additional testing for COVID-19 was also planned for samples received after February 2020. Results: The overall seroprevalence of Scrub typhus during the 3 year study period was noted to be 18.6% in the PUO patients. Typhoid was noted in 39.5%, malaria in 9.2%, Dengue in 13.5%, leptospirosis in 4.8%, and chikungunya in 5.3% of the patients. No cause was identified in 9.1% of the PUO cases. 3.9% of the samples were positive by RT-PCR for COVID-19. No mortality was noted in the scrub typhus positive cases. Conclusion: Scrub typhus is an emerging tropical rickettsial disease in the Indian subcontinent. The present study highlights the importance of screening of PUO cases for this important infection as timely institution of simple empirical treatment can prove to be life saving in such positive cases.

Ochrobactrum intermedium (O. intermedium) is a novel emerging gram negative bacillus infecting immunocompromised hosts. It is known for its multidrug resistance and to distinguish it from other species of Ochrobactrum genus by conventional methods, is often difficult. Here, authors report two unusual and interesting cases of bacterial infection due to O. intermedium in a 28-year-old female and 46-year-old male having Coronavirus Disease-2019 (COVID-19) infection. Rapid identification by Matrix Assisted Laser Desorption/Ionisation-Time Of Flight (MALDI-TOF) mass spectrometry and patient’s treatment guided by antibiotic sensitivity yielded in favourable outcome. Present report describes clinical and microbiological characteristics of this rare pathogen and also highlights the need of automated methods for proper identification of such opportunistic pathogens and their unique antibiotic susceptibility profiles.

Leptospirosis is a worldwide zoonotic disease which remains under diagnosed in most of the regions of our country due to the lack of proper diagnostic facility and set up. Diagnosis usually depends on Microscopy,culture and serological tests like ELISA, MAT(Microscopic agglutination test ). MAT is the gold standard diagnostic test but it requires live leptospires and it can only be done in a reference laboratory. Hence, ELISA is the most preferred cost-effective serological method with both sensitivity and specificity of 95%. The Aim of our present study was to evaluate the trends of seroprevalence of leptospirosis from January 2016 to December 2019 and to compare two ELISA kits for the serodiagnosis of Leptospirosis. The study was conducted between January 2016 to December 2019 and 1611 blood samples were collected from clinically suspected cases of leptospirosis. Detection of IgM antibodies to leptospira was done by DRG andRecombilisa (CTK) ELISA kits. Results by both the kits were analysed. Seventy samples were taken as controls from different patients on random basis to prevent any type of biasing. Samples were tested for other co-infections and Demographic parameters were studied. Seroprevalence was estimated to be 4.8% by DRG KIT and 5.5% by Recombilisa CTK kit. Average seroprevalence was noted to be 5.1%. The diagnosis of presumptive and possible Leptospirosis was made in 96(78%) and 27(22%) respectively, by modified Faine’s criteria. The seroprevalence between 2016 to 2019 varied from 0.57 – 1.8 % . The months of July to November of year 2017 noted the highest prevalence. Out of these patients, majority (96%) showed significant improvement during the follow–up period after 2-3 months with empirical treatment. Typhoid was seen as most common co- infection in these patients.

Context Early microbiological diagnosis and treatment of periodontal pathogens is important for successful retention of dental implants. Aims This study aimed to identify and monitor oral bacterial colonization after successful two-piece dental implants. Settings and Design In this study, 50 two-piece dental implant subjects were included and assessed clinically, radiographically, and microbiologically. Methods and Material All the parameters were recorded at various stages after prosthesis placement. In each stage, nonadherent (peri-implant sulcular fluid) and adherent (curetted inner threads) samples were collected. Semiquantitative anaerobic culture of the samples were done in Anoxomat system. Bacterial colonies were first identified by routine microbiological methods and then by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) method. Statistical Analysis All the results were analyzed by appropriate statistical methods (Chi-square, one factor analysis of variance, etc.). Results All the bacterial isolates were identified in the MALDI-TOF MS system with no failure. After implant placement for the nonadherent samples, the frequency (%) of Fusobacterium nucleatum, Prevotella melaninogenica, and Propionibacterium acnes decreased whereas frequency (%) of Escherichia coli, Staphylococcus epidermidis, and Streptococcus mitis increased. For adherent samples, the frequency (%) of E. coli, Enterococcus faecalis, Porphyromonas gingivalis, P. melaninogenica, and Veillonella parvula decreased, whereas frequency (%) of S. mitis and Streptococcus mutans increased. The postimplant mean nonadherent and adherent bacterial load increased with time but not significantly over the periods (p = 0.302 and 0.123, respectively). Conclusion Combination of basic (semiquantitative culture method) and advanced microbiological method (MALDI-TOF MS) can be useful for accurate detection and monitoring of potential pathogens around two-piece dental implants.

Background: Bacterial colonization of dentition in different age groups can impact prognosis in different dental diseases. Latest diagnostic technique such as matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF) is increasingly being used for accurate identification of bacteria. This study was undertaken to evaluate the MALDI-TOF MS technique to identify bacterial pathogens from dental plaques in subjects with primary, mixed, and permanent dentition. Materials and Methods: The study included 150 subjects of different age groups and were divided into three groups - Group A: Subjects with primary dentition (n = 50), Group B: Subjects with mixed dentition (n = 50), and Group C: Subjects with permanent dentition (n = 50). Subgingival dental plaque samples were collected from buccal and lingual surfaces of premolar and molar teeth. Clinical parameters such as gingival index were recorded. Samples were cultured in routine aerobic and anaerobic medium. Bacterial growths were assessed by semiquantitative methods. Bacterial isolates were confirmed by MALDI-TOF MS technique. Results: MALDI-TOF MS detected all the culture-grown bacteria. In primary dentition group, purple and yellow complex bacteria predominated. Streptococcus spp. was the predominant bacteria (51%) followed by Escherichia coli (19%) and Veillonella spp. (19%). In mixed dentition and permanent group also, Streptococcus spp. was predominant (46%) followed by Veillonella spp. (24%) and E. coli(19%). However, in both groups, orange complex bacteria (bridge complex) such as Prevotella nigrescens and red complex bacteria (Porphyromonas gingivalis, 3%) were seen. For majority of bacteria, the load increased with age. Conclusions: The bacterial isolates showed a distinct age-specific colonization. The use of advanced technique such as MALDI-TOF MS is helpful in the detection of periodontal pathogens, and the effective oral health programs can be implemented to minimize the risk of periodontal diseases.

Introduction: Irrational use of antibiotics to treat Urinary Tract Infections (UTI) has led to the development of Multidrug Resistant (MDR) bacteria in both community as well as the hospital settings. Fosfomycin has emerged as a novel therapeutic option to treat these UTI patients along with empirically used routine antibiotics. Aim: To assess the sensitivity, molecular resistance mechanisms and clinical response of fosfomycin along with other urinary antibiotics like nitrofurantoin, colistin, and imipenem. Materials and Methods: It was a cross-sectional observational study conducted from July 2018 to June 2019 in SGPGIMS, Lucknow, India. Stream urine samples of 24,782 patients were collected with clinical suspicion of UTI. The antibiotics were tested by disc diffusion and Minimum Inhibitory Concentration (MIC) methods. Genotypic analysis was done for testing resistance mechanisms in fosfomycin resistant isolates. Statistical tests were performed using Statistical Package for the Social Sciences (SPSS) software for Windows version 14.0. Results: Out of the 24,782 urine samples, 2,776 (11.2%) showed significant growth of pathogens with 334 drug resistant isolates among them. Gram negative bacilli 1846 (66.50%) was the most predominantly isolated pathogen in the cultures. Among the 334 drug resistant specimens, Escherichia coli {124 (37.13%)} were maximum in number. Total 79.6% (266/334) of the isolates were sensitive to fosfomycin including 88.7% (110/124) of E. coli, and 91.3% (105/115) of K. pneumoniae isolates. Colistin showed sensitivity in 87.1% (108/124) of the E. coli isolates; followed by Imipenem in 49.2% (61/124) and nitrofurantoin in 37.1% (46/124) of the isolates. Fos A genes were found to be the most prevalent in Fosfomycin resistant. About 41% of the patients showed favourable outcome and were cured with initiation of treatment as per sensitivity pattern. Conclusion: Fosfomycin has emerged as a safer option in MDR urinary isolates as compared to other urinary antibiotics including colistin. The drug needs to be more widely studied for its possible pharmacokinetics and dynamics as well as it’s possible implications in healthcare settings and patient management.

Pandoraea apista is a novel gram-negative bacillus usually isolated from respiratory specimens of cystic fibrosis patients. Few cases of bacteremia have also been reported due to this rare pathogen. Emergence of multidrug-resistant isolates of this bacillus is of grave concern. Here, we report a very interesting and unusual case of Pandoraea apista bacteremia in a coronavirus disease (COVID)–positive elderly diabetic man suffering from pneumonia. Prompt isolation and antibiotic sensitivity testing guided the patient’s treatment and yielded favorable outcome. The need of automated methods for identification and sensitivity testing limits the reporting of this rare but important pathogen in hospital settings. Detailed research work and studies are needed in this direction to better understand this pathogen and its clinical manifestations for better patient outcome.

Introduction: Despite the advancement in diagnostic modalities of sepsis, it is still a leading cause of morbidity and mortality. Differentiation between sepsis and non-infectious disease states remains a diagnostic challenge. Procalcitonin (PCT) is useful for the diagnosis of sepsis but it varies in cut-off ranges at different clinical settings. The aim of this study was to correlate serum PCT levels with cultures and to evaluate the best cut-off values with high sensitivity and specificity for PCT. Methodology: This prospective study included 305 patients from different medical wards; the patients were classified into group I: controls (n = 46), group II: culture-negative sepsis (n = 76) and group III: culture-positive sepsis (n = 196). Mean p value

Descriptive statistics are an important part of biomedical research which is used to describe the basic features of the data in the study. They provide simple summaries about the sample and the measures. Measures of the central tendency and dispersion are used to describe the quantitative data. For the continuous data, test of the normality is an important step for deciding the measures of central tendency and statistical methods for data analysis. When our data follow normal distribution, parametric tests otherwise nonparametric methods are used to compare the groups. There are different methods used to test the normality of data, including numerical and visual methods, and each method has its own advantages and disadvantages. In the present study, we have discussed the summary measures and methods used to test the normality of the data.

BackgroundIncreasing use of colistin has led to the world-wide emergence of mobile colistin resistant gene (mcr). The present study aimed to identify and characterise mcr and other drug-resistant genes in colistin resistant Klebsiella pneumoniae clinical isolates.MethodsTwenty-two colistin resistant K. pneumoniae were analysed for mcr and other drug-resistant genes, efflux pumps, and virulence genes, and for their biofilm forming ability. Pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST) were performed for all mcr-1 positive isolates. S1-PFGE and Southern hybridisation were performed for localisation of mcr-1 and blaNDM.ResultsNineteen colistin resistant K. pneumoniae harboured mcr-1 and 3 had mgrB disruption. All isolates harboured blaOXA-48-type and ESBL genes; eight strains (five with mcr-1 and three with mgrB disruption) co-harboured blaNDM. Efflux pumps genes AcrAB and mdtK were detected in all 22 and tol-C in 21 isolates. Virulence-related genes entB and irp-1 were detected in all 22, mrkD in 20, and fimH-1 in 18 isolates; 11 isolates were strong biofilm producers. PFGE clustered mcr-1 positive isolates into eight groups based on ≥90% similarity; MLST revealed diverse sequence types, predominant being ST-15 (n = 4) and ST-16 (n = 4). Both mcr-1 and blaNDM were localised on plasmid and chromosome; mcr-1 was present on IncFII type and blaNDM on IncFIB and IncA/C type plasmids.ConclusionsColistin resistance in K. pneumoniae was predominantly mediated by mcr-1. Co-existence of colistin, carbapenem, and other drug-resistant genes along with efflux pumps indicates towards enormous genomic plasticity in K. pneumoniae with ability to emerge as super-spreader of drug-resistance.

BACKGROUND: Carbapenems show excellent activity against resistant uropathogens, and they are the antibiotics of choice for urinary tract infections (UTIs). The choice of carbapenem prescription is strongly influenced by antimicrobial susceptibility testing (AST) report. With the publication of recent AST guidelines by the European Committee on AST (EUCAST), we were curious to evaluate the difference in results between Clinical and Laboratory Standards Institute (CLSI) and the EUCAST guidelines for the interpretation of carbapenems. METHODS: During a period of 1 year, midstream urine specimens received in the laboratory were cultured by conventional techniques and 2932 of them grew significant colony counts of Escherichia coli. Out of them, 501 E. coli isolates which were resistant to at least six first-line antibiotics were further subjected to second-line antimicrobials imipenem and meropenem, reported by E-tests (bioMerieux, France). The E-test results were interpreted by both CLSI 2016 and EUCAST 6.0 (2016) guidelines. Weighted kappa was used to determine absolute agreement, and McNemar’s Chi-square test was used to test the difference in proportions of susceptibility between two methods, respectively. RESULTS: Taking CLSI guidelines as a gold standard, there was 100% sensitivity in a susceptible category by the EUCAST guidelines for both the carbapenems. Weighted kappa showed good and moderate agreement between them for imipenem and meropenem, respectively. However, McNemar Chi-square test in the nonsusceptible category between the two tests was 9.38% and 33.03% for imipenem and meropenem, respectively, and they were highly significant (P < 0.001). Conclusions: A laboratory can follow EUCAST guidelines as well and the guidelines are more useful in urinary concentrated antibiotics such as carbapenems. Further other antibiotics need to be evaluated by both these guidelines.

Coinfection with Salmonella and Leptospira is a rare entity even in regions where both pathogens are endemic. As clinical features are nonspecific and overlapping, it is very difficult to differentiate between these two infections. However, many cases of coinfections of leptospirosis and scrub typhus; dengue and Leptospirosis, typhoid and dengue have been reported but coinfections by Salmonella and Leptospira have been reported rarely. Clinically they should be suspected in endemic areas and here we are presenting such a case. A 30-year-old female presented with chief complaints of loose stools for 10 days, high grade fever and jaundice for three days. CT enterography showed mildly enlarged liver and features of small bowel obstruction. Blood culture was sterile. No improvement was seen with empirical antibiotics. Widal titers were very high and IgM antibodies for Leptospira was positive by Enzyme-Linked Immune Sorbent Assay (ELISA) test in third week of illness. She was started on ceftriaxone 1 gm Intravenous (IV) twice a day as both the infections respond excellently to ceftriaxone. Over next couple of days her conditions improved and she was discharged in stable condition. This case highlights the need for optimal use of microbiological laboratory services and timely intervention to reach a final diagnosis.

Burkholderia cepacia complex consists of 24 species of microorganisms that include B. cepacia, B. multivorans, B. cenocepacia, B. vietnamiensis, B. ambifaria, and many more. It is a ubiquitous microorganism found in the soil and aquatic milieu. The probability of infections in immunocompetent individuals is rare, but an increase in the population of immunocompromised patients in the past decade has attributed to increasing incidence of infections caused by these microorganisms. The most common infections caused by these isolates include bacteremia, pneumonia, genital tract infections, and surgical wound infections. Their potential to cause nosocomial outbreaks in wards of immunocompromised patients is well known. In this case series, we describe three cases of community-acquired Burkholderia vietnamiensis bacteremia in patients suffering from B-cell acute lymphocytic leukemia and their antibiotic sensitivity pattern to guide the treatment of these individuals.

Background Species distribution and antibiotic resistance pattern of Salmonella varies with time and place. Rapid and correct use of antibiotics requires understanding of the distribution and drug resistance patterns. Therefore, we aimed to study the clinical profile of patients along with speciation and antibiogram of Salmonella isolates from blood.