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Levonadifloxacin (intravenous) and alalevonadifloxacin (oral prodrug) are novel antibiotics based on benzoquinolizine subclass of fluoroquinolone, licensed for clinical use in India in 2019. The active moiety, levonadifloxacin, is a broad-spectrum antibiotic with a high potency against methicillin-resistant Staphylococcus. aureus, multi-drug resistant pneumococci and anaerobes.This review, for the first time, critically analyses the antimicrobial susceptibility testing methods, Clinical LaboratoryStandards Institute (CLSI)-quality control of susceptibility testing and breakpoints of levonadifloxacin. Further, the genesis, discovery and developmental aspects as well as therapeutic profile of levonadifloxacin and alalevonadifloxacin are briefly described.In order to aid the scientific and clinician communities with a single comprehensive overview on all the key aspects of levonadifloxacin and alalevonadifloxacin, the present article covers the reference MIC and disk diffusion methods for levonadifloxacin susceptibility testing that were approved by CLSI and the reference ranges for quality control strains published in the CLSI M100 document. The breakpoints of levonadifloxacin were derived in concordance to US FDA, European Committee on Antibiotic Susceptibility Testing (EUCAST) and CLSI approaches. Further, the article provides a brief account of challenges encountered during the discovery stages of levonadifloxacin and alalevonadifloxacin, activity spectrum and safety benefits accruing from structural novelty-linked mechanism of action. Further, the review also covers in vitro and in vivo activities, registrational clinical studies and patient-friendly features of levonadifloxacin/alalevonadifloxacin. Cumulatively, levonadifloxacin has a potential to offer a long awaited new standard-of-care treatment for the resistant Gram-positive bacterial infections.

Background: Various studies reported that Low serum vitamin D has been found to be associated with various types of metabolic illness such as obesity, diabetes mellitus, insulin resistance, cardiovascular diseases including hypertension. Low serum 25 (OH) D levels have been linked to a range of non-skeletal health conditions in adults, including metabolic disorders and cardiovascular diseases. Objective: To determine serum 25 (OH) D concentrations in all study subjects. Methods: This cross-sectional analytical study was carried out to determine serum 25(OH)D concentration in all study subjects. For this study, 90 subjects were recruited after fulfilling the inclusion and exclusion criteria. Study subjects were divided into two groups: 45 subjects with MetS and 45 subjects without MetS. Results: Mean±SD of Age (years), Height (m), Weight (kg), BMI (kg/m2), WC (cm), SBP (mmHg), DBP (mmHg) in Group I and Group II. Subjects with MetS had higher Weight (kg), BMI (kg/m2), WC (cm), SBP (mmHg), DBP (mmHg) than those subjects without MetS. The relationship of BMI, FPG with Vitamin D became significant when FPG entered into model 2. Again, it was evident that Vitamin D was associated with height, BMI and FPG and these relationships remained significant even after TG and HDL-C entered into model 3. Conclusion: In conclusion we can say that low serum vitamin D concentration may predispose to higher BMI, WC, SBP and FPG also low serum vitamin D concentration is negatively correlated with components of MetS (WC, SBP and FPG).

Background: The prevalence of obesity rises gradually worldwide and it is a chronic metabolic disease, which is defined by an excessive accumulation of body fat resulting from an imbalance between energy intake and expenditure. Some studies suggested that the level of serum 25(OH)D was associated with obesity. Vitamin D insufficiency or deficiency is closely associated with chronic diseases, such as tumours, cardiovascular diseases, and diabetes. Vitamin D is fat soluble that can be stored in body fat tissues and excessive body fat can reduce 25(OH) D levels in the blood, especially in obese individuals. Many studies revealed that young women are at a high risk of vitamin D deficiency. Objective: To evaluate the relationship between serum 25(OH)D level and obesity among young women. Methods: This cross-sectional analytical study was carried out in the Department of Biochemistry of Sir Salimullah Medical College & Mitford Hospital, during July 20- June 21. 100 female subjects aged belongs to 19-29 yrs were selected by purposive sampling. Among them 50 women were obese (BMI ≥25 kg/m²) and 50 women were non-obese (BMI< 25 kg/m²). Initial evaluation was done by history taking and anthropometric indices were measured. Here, used student unpaired t-test, chi square test and Pearson's correlation test to determine the association between vitamin D statuses with different variables. Lipid profile assay were carried out by a semi auto biochemistry analyzer and Vitamin D was estimated by immunoanalyzer. SPSS (22) was used for test of significance and p value

Introduction: The COVID-19 pandemic raised a host of challenges to modern medicine. Key amongst these were in diagnostics, as most SARS-CoV-2 assays had been rapidly developed and released under emergency-use authorization with limited validation on clinical samples and secondly, an increased risk of COVID-19 infection to healthcare workers (HCW). There are limited inter-assay comparisons to detect SARS-CoV-2 antibodies in cases with milder symptoms of COVID-19, necessary to evaluate whether assays can detect SARS-CoV-2 antibodies in patients with mild infection. Aim: Therefore this study aimed to evaluate the performance of four chemiluminescence immunoassays and a rapid immunochromatographic assay in 100 rRT-PCR diagnosed-recovered frontline HCW with milder COVID-19 disease and secondly to evaluate the seroprevalence of SARS-CoV-2 infection in the asymptomatic frontline HCW at a multispeciality hospital in Delhi, India. Study Design: Serum and plasma samples were obtained from 100 rRT-PCR diagnosed-recovered frontline HCWs with mild disease working across the hospital, and performance of four common chemiluminescence immunoassays evaluated. Also samples of 505 asymptomatic, frontline HCWs working in hospital, who had not developed or shown any symptoms of COVID-19 infection to date was collected and the seroprevalence of infection was evaluated. Place and Duration of the Study: A study was conducted at BLK Superspeciality Hospital, New Delhi from September to October 2020. Methods: Four chemiluminescence immunoassays [Abbott SARS-CoV-2 IgG (Nucleocapsid), Roche Elecsys® Anti-SARS-CoV-2 Total (Nucleocapsid), Ortho-Clinical Diagnostics: VITROS Anti-SARS-CoV-2 IgG (Spike) and Anti-SARS-CoV-2 Total (Spike)] and a rapid assay [Medsource Ozone Biomedicals] were evaluated in 100 rRT-PCR diagnosed-recovered frontline HCW with mild disease. Also, seroprevalence was studied in 505 asymptomatic, frontline HCW. Results: At manufacturers' thresholds, overall sensitivity for Abbott was 71%, Roche 96%, Ortho (both total and IgG(S) 99% and rapid card 56%. Seroprevalence in asymptomatic frontline HCW was found to be 17.6%, with positivity being higher in the HCW group not facing patients directly compared to direct patient caregivers (P = 0.0034). Conclusion: Assay performance depends on assay design (total IgM & IgG antibodies versus IgG alone), choice of antigen, and time of sample testing from the onset of disease. In our study, Ortho Vitros total-Ab; IgG (Spike), and Roche Elecsys total-Ab (Nucleocapsid) assays were found to have optimal sensitivity. A seroprevalence study in the frontline HCWs at our institute showed that seroprevalence was higher (17.6%) in HCWs in comparison to the community.

Introduction There is limited literature available regarding the prevalence and durability of immune response to infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/coronavirus disease 2019 (COVID-19) in cancer patients. Objective The aim of this study was to analyze the seroconversion rate in cancer patients recovered from SARS-CoV-2 infection. Materials and Methods We retrospectively analyzed antibody levels and seroconversion rates in serum samples from 135 cancer patients who had recovered from SARS-CoV-2 infection. Chemiluminescent immunoassay using Roche Cobas e801 analyzer (Roche Diagnostics, Rotkreuz, Switzerland) was performed to identify Pan Ig antibody against nucleocapsid antigen. Reports of first, third, and sixth month were analyzed. Seroconversion was also compared with health-care workers (HCW) of our institute who had recovered from COVID-19 infection. Results Seroconversion rate in cancer patients was 81.2% at 1 month, 95% at 3 months, and 94.6% at 6 months post reverse transcriptase–polymerase chain reaction positivity. There was no difference in seroconversion rate among different age groups, gender, comorbidities, severity of COVID-19 symptoms, cancer disease status, and treatment with chemotherapy. Seroconversion rate in cancer patients is comparable to HCW (90.4 vs. 96%, p = 0.82) and is durable. Conclusion Humoral response to COVID-19 infection in cancer patients is comparable to general population and sustained. Such responses suggest that cancer patients are likely to benefit from COVID-19 vaccination.

The purpose of our review is to emphasize the impact of effective communication in bringing a behavioral change in prescribers’ habits in absence of mandatory guidelines on usage of antibiotics. The unceasing surge of inappropriate antimicrobial use has resulted in antimicrobial resistance (AMR). It is a fall out of injudicious use by healthcare workers, be it an empiric treatment owing to inadequate diagnosis, inappropriate prescribing behavior attributable to insufficient knowledge and training, or lack of confidence and financial incentives. Patient factors contributing to AMR are self-medication due to over-the-counter drug availability and patients’ attitude. Another vital driver of AMR is the non-therapeutic abuse of food animals. Despite the existence of policies regarding licensing and sale of antibiotics, their implementation is not uniform and regulated. It is observed that conditioning strategies like trainings, audits, and feedbacks affect human behavior and can prove to be an important tool in antimicrobial stewardship program. It has been perceived that mere presence of regulatory framework is not enough but a productive communication with physicians can drive a behavioral change in prescribing antibiotics.

Healthcare-associated infections (HAIs) and rising antimicrobial resistance (AMR) have posed a major challenge in patient care across the globe, more so in lower-middle-income countries (LMICs). Studies have shown that implementation of an effective infection prevention and control (IPC) program reduces incidence of HAI to a large extent. However, implementation of such a program in low-resource setting has many challenges. Research have shown that gaps exist due to absence of political will, trained manpower, and alternate healthcare priorities. With progress in science of healthcare epidemiology and digital communication, opportunities to establish an effective IPC program at minimal cost is possible. In this review, we explore ways the existing challenges can be mitigated in LMICs. In recent times, the UN general assembly along with World Health Organization (2015) and member countries took a resolution to come up with an action plan to tackle the rising threat of AMR by strengthening IPC programs at national level. We reviewed the progress made by the developing countries in their efforts to implement the program.

CONTEXT: Bloodstream infections pose a major health-care burden worldwide. Routine microbiological methods are time-consuming, thereby delaying appropriate treatment. AIMS: The aim of this study is to evaluate the method of direct testing of identification (ID) and antimicrobial susceptibility testing (AST) of positive blood culture bottles by VITEK®2. SETTINGS AND DESIGN: This was a prospective study at a tertiary level hospital. SUBJECTS AND METHODS: One hundred positive BACTEC blood culture bottles with monomicrobial Gram-negative organisms on microscopy were tested in parallel by direct ID/AST as well as conventional method. Results obtained by two methods were compared in terms of ID/AST and turnaround time (TAT). Results: Of the 100 isolates tested, only one was misidentified by the direct method and there was no unidentified isolate. The AST results demonstrated 99.74% categorical and 99.65% essential agreement. Of 1144 organism-antibiotic combinations, there were 0.44% major error, no very major error, or minor error observed. Conclusions: While conventional method is the gold standard, the direct ID/AST methods have demonstrated that it can be successfully utilized to decrease TAT to the final results by 18–24 h, without sacrificing test accuracy. This technique will help to tailor antimicrobial therapy, thereby reducing patient morbidity, mortality, and antibiotic resistance, as well.

Background Levonadifloxacin is a novel antibiotic belonging to the benzoquinolizine subclass of fluoroquinolones with potent activity against MRSA and quinolone-resistant Staphylococcus aureus. IV levonadifloxacin and its oral prodrug alalevonadifloxacin have recently been approved in India for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) including diabetic foot infections. Objectives To investigate the in vitro activity of levonadifloxacin against contemporary clinical isolates collected from multiple tertiary care hospitals across India in the Antimicrobial Susceptibility Profiling of Indian Resistotypes (ASPIRE) surveillance study. Methods A total of 1376 clinical isolates, consisting of staphylococci (n = 677), streptococci (n = 178), Enterobacterales (n = 320), Pseudomonas aeruginosa (n = 140) and Acinetobacter baumannii (n = 61), collected (2016–18) from 16 tertiary hospitals located across 12 states in India, were included in the study. The MICs of levonadifloxacin and comparator antibiotics were determined using the reference agar dilution method and broth microdilution method. Results Levonadifloxacin exhibited potent activity against MSSA (MIC50/90: 0.5/1 mg/L), MRSA (MIC50/90: 0.5/1 mg/L) and levofloxacin-resistant S. aureus (MIC50/90: 1/1 mg/L) isolates. Similarly, potent activity of levonadifloxacin was also observed against CoNS including MDR isolates (MIC50/90: 1/2 mg/L). Against Streptococcus pneumoniae, levonadifloxacin (MIC50/90: 0.5/0.5 mg/L) showed superior activity compared with levofloxacin (MIC50/90: 1/2 mg/L). Among levofloxacin-susceptible Enterobacterales, 80.6% of isolates were inhibited at ≤2 mg/L levonadifloxacin. Conclusions Levonadifloxacin displayed potent activity against contemporary MRSA and fluoroquinolone-resistant staphylococcal isolates, thus offering a valuable IV as well as an oral therapeutic option for the treatment of ABSSSIs. Furthermore, levonadifloxacin exhibited a broad-spectrum activity profile as evident from its activity against streptococci and levofloxacin-susceptible Gram-negative isolates.

Background\ud Low-income and middle-income countries (LMICs) are under-represented in reports on the burden of antimicrobial resistance. We aimed to quantify the clinical effect of carbapenem resistance on mortality and length of hospital stay among inpatients in LMICs with a bloodstream infection due to Enterobacteriaceae.\ud \ud Methods\ud The PANORAMA study was a multinational prospective cohort study at tertiary hospitals in Bangladesh, Colombia, Egypt, Ghana, India, Lebanon, Nepal, Nigeria, Pakistan, and Vietnam, recruiting consecutively diagnosed patients with carbapenem-susceptible Enterobacteriaceae (CSE) and carbapenem-resistant Entero-bacteriaceae (CRE) bloodstream infections. We excluded patients who had previously been enrolled in the study and those not treated with curative intent at the time of bloodstream infection onset. There were no age restrictions. Central laboratories in India and the UK did confirmatory testing and molecular characterisation, including strain typing. We applied proportional subdistribution hazard models with inverse probability weighting to estimate the effect of carbapenem resistance on probability of discharge alive and in-hospital death, and multistate modelling for excess length of stay in hospital. All patients were included in the analysis.\ud \ud Findings\ud Between Aug 1, 2014, and June 30, 2015, we recruited 297 patients from 16 sites in ten countries: 174 with CSE bloodstream infection and 123 with CRE bloodstream infection. Median age was 46 years (IQR 15–61). Crude mortality was 20% (35 of 174 patients) for patients with CSE bloodstream infection and 35% (43 of 123 patients) for patients with CRE bloodstream infection. Carbapenem resistance was associated with an increased length of hospital stay (3·7 days, 95% CI 0·3–6·9), increased probability of in-hospital mortality (adjusted subdistribution hazard ratio 1·75, 95% CI 1·04–2·94), and decreased probability of discharge alive (0·61, 0·45–0·83). Multilocus sequence typing showed various clades, with marginal overlap between strains in the CRE and CSE clades.\ud \ud Interpretation\ud Carbapenem resistance is associated with increased length of hospital stay and mortality in patients with bloodstream infections in LMICs. These data will inform global estimates of the burden of antimicrobial resistance and reinforce the need for better strategies to prevent, diagnose, and treat CRE infections in LMICs.

Invasive Fungal Infections (IFI) are an important complication and constitute significantly to mortality and morbidity, post Hematopoietic Stem Cell Transplant (HSCT). We report a very rare case of fungal laryngitis post HSCT in a 15-year-old girl with Thalassemia major. She received Busulphan, Cyclophosphamide and Antithymocyte Globulin (Bu-Cy-ATG) based conditioning pre Matched Sibling Donor (MSD) transplant and presented on day 10 post-transplant with hoarseness of voice progressing to stridor and respiratory obstruction. CT neck revealed laryngeal edema and she was ultimately diagnosed, by a laryngoscopy biopsy, histopathology and fungal culture to be having invasive fungal laryngitis due to Rhizopus. She responded partially to combination antifungal treatment with amphotericin B and posaconazole, family refused for laryngectomy and she was discharged with a tracheostomy tube in situ. Patient eventually succumbed due to bacterial sepsis. IFI should be considered in the differential diagnosis of unexplained symptoms post HSCT as timely intervention and treatment can save a lot of morbidity and mortality.

Background: Hematopoietic stem cell transplant (HSCT) recipients are particularly prone to bloodstream infections (BSIs). This has been attributed to neutropenia and immune-suppression. Regardless of the improvements made in the management perspective, infection still plays a major role in morbidity and mortality in these patients. It has been related to the rise of multidrug-resistant organisms. Aim: The aim of this study was to determine the pattern of BSIs and the burden of antibiotic resistance in HSCT patients. Materials and Methods: We conducted this retrospective study for 2 years in 438 transplant events among 429 HSCT recipients who developed febrile neutropenia. Paired blood culture samples were collected on the onset of fever. Carbapenem-resistant Enterobacteriaceae (CRE) carriage rate was also determined in 127 patients. Results: BSIs were detected in 131 transplant events, which were classified as mucosal barrier injury laboratory-confirmed BSIs in 61, central line-associated, and other primary BSIs among 35 each. A diverse variety of 145 isolated organisms included Gram-negative and Gram-positive bacteria with 4 Candida species. All the Gram-negative isolates were susceptible to colistin, while 68.83% of CRE was detected. CRE carriage rate was observed in 37.80% of 127 individuals. Vancomycin resistance was noticed in 40% Enterococcus species. The overall mortality rate was 20.05%. Conclusions: Screening for CRE carriage in these patients could help in timely initiation of empirical colistin therapy. However, local epidemiology plays an important role in deciding the empirical antibiotic therapy.

Summary The Ustilaginomycetous basidiomycete yeast, Pseudozyma aphidis has recently been implicated in potentially fatal disorders ranging from subcutaneous mycoses to disseminated infections. Till date a solitary case of P. aphidis fungaemia in a paediatric patient has been reported. We present a case of fungaemia due to P. aphidis in a rhesus factor-isoimmunised, low-birth-weight neonate. The isolate was identified by sequencing the D1/D2 domain of the LSU region. Antifungal susceptibility of the isolate revealed susceptibility to amphotericin B, voriconazole, itraconazole, isavuconazole and posaconazole. It had high minimum inhibitory concentrations of fluconazole and was resistant to flucytosine and echinocandins. Consequently, the patient was successfully treated with intravenous amphotericin B. Although the source of infection could not be traced, as the neonate developed fungaemia on the first day of life, it could possibly be from the maternal urogenital tract or intrahospital transmission. A review of previously published cases revealed that risk factors for invasive Pseudozyma spp. infections were similar to those previously reported for non-albicans Candida spp. Pseudozyma species are underreported due to the difficulty of identifying this rare yeast pathogen by commercial identification systems. Considering that Pseudozyma spp. cause invasive fungal infections globally and are resistant to flucytosine, fluconazole and echinocandins, this pathogen assumes a greater clinical significance.

Isolation of active fraction and characterization of chemosignals from urine have been attempted in several mammalian species in the recent years. The objective of this study was to identify the urinary volatiles across various reproductive stages of buffalo cow, namely, estrus, diestrus, and pregnancy, and in bull, by chemical extraction followed by gas chromatography–linked mass spectrometry (GC-MS). Urine samples were collected from six buffalo cows at two different phases of estrous cycle, namely, estrus and diestrus. Besides, urinary samples were collected from five pregnant buffalo cows (60–75 days after artificial insemination (AI)) and six adult bulls. Thin-layer chromatography was performed as a preliminary test for qualitative comparison of different compounds extracted by organic solvents. Identification of the urinary compounds was carried out in a gas chromatograph (Perkin Elmer, Autosystem XL) linked to a mass spectrometer (Turbomass). The results of GC-MS analysis indicated the presence of 21 compounds with varying molecular weights and retention time, which were further categorized as diestrus-specific, pregnancy-specific, and bull-specific urinary compounds. No compound, however, could be identified as estrus-specific. We concluded that qualitative differences do exist in estrus, diestrus, and pregnant buffalo cow urine and in bull urine, as evidenced by GC-MS.

Melioidosis is endemic in the South Asian regions, like Thailand, Singapore Malaysia and Australia. The disease is more pronounced in the southern part of the country. It is caused by Burkholderia pseudomallei which causes systemic involvement, morbidity and mortality associated with the disease is high. Due to highly varied clinical presentation, and low general awareness this infection is largely underdiagnosed and under reported in our country. Most laboratories in the country still rely on conventional culturing methods with their low sensitivity, adding to the under reporting. To enhance physician awareness we describe here two cases who presented to our institute after months of misdiagnosis.

1, 33, Buffalo Bulletin

As mentioned in literature R. pickettii has been reported to cause respiratory tract infections, meningitis, peritonitis and sepsis [1-4]. Transmission may occur due to contaminated medical devices or solutions generally encountered in health care facilities. R. picketti has been reported to cause outbreaks also [5]. We present three case reports of R. pickettii bacteremia and a brief review of literature. Though a case of bacteriemia has been reported very recently from India [6], this is, to the best of our knowledge, the first case series from India.

Tuberculosis (TB) is a leading infectious disease in India. Diagnosis of TB has always been a problem due to slow rate of growth of Mycobacterium tuberculosis. In this study we have compared the conventional tools for diagnosis of TB with the new Fast Plaque TB TM MATERIAL AND METHODS: Two hundred and twelve clinically suspected cases of TB were enrolled for the study. Three consecutive early morning sputum samples were collected from each patient. Sputum smears were examined after staining with ZN stain and the sputum samples were later subjected to culture and phage assay.It was seen from the study that out of the total 212 cases, 106 were phage positive and 106 were phage negative. Sensitivity of the phage test with respect to AFB smear is 94.34% and specificity of the phage test is 93.88%. A total of 120 specimens grew on LJ media, of which 112 were Mycobacterium tuberculosis, 2 were Mycobacterium Kansasii, 4 were Mycobacterium avium complex and 2 grew Mycobacteriumfortuitum group. Out of these 120 specimens which grew on LJ, 104 were also positive for phage assay. All the 8 Non-Tubercular Mycobacteria were negative by the Fast Plaque Assay. Out of the 92 which were negative on LJ, 2 were positive by phage assay. Sensitivity and specificity of phage assay with respect to growth on LJ was 92.86% and 97.83% respectively.The study showed that phage assay is a rapid, reliable and cost effective method in diagnosing pulmonary tuberculosis from clinical samples.

Burkhloderia pseudomallei has recently gained importance as an emerging pathogen in India. It causes various clinical manifestations like pneumoniae, septicaemia, arthritis, abscess etc. Cases have been reported from Southeast Asia mainly Thailand, Malaysia, Vietnam, etc. In India, few cases have been reported mainly from the southern part of the country. Patient was a 65-year-old male and presented with fever 1 month back, cough and breathlessness for same period, swelling on both ankles from 7 days. B. pseudomallei was isolated from endotracheal secretions, blood cultures, leg wound. He was successfully treated with Imipenem and Doxycycline and put on maintenance therapy now, and is currently doing well.

Objective : To study the antimicrobial (AM) consumption, record the AM sensitivity pattern, and evaluate impact of Reserve AM indent form in the intensive care unit (ICU). Materials and Methods : The study was carried out in medical ICU over 4 months period at a tertiary care hospital. AM consumption was determined by defined daily dose (DDD) per 100 bed days for each month for consecutive 4 months. The average total AM consumption was calculated. The laboratory samples were processed, and the sensitivity pattern was determined. Some of the newer AM were categorised as Reserve and an indent form was made mandatory to be filled up prior to prescription. Results : The total AM consumption was 232 per 100 bed days. The commonly used AM were penicillin with b-lactamase inhibitor (21%) followed by antifungal drugs (13.4%), cephalosporins and macrolides (11.7%) each. The most common organism isolated was Acinetobacter (26.1%) followed by Candida (23.8%) and Pseudomonas (21.4%). The average occupancy index was 0.53, and the average duration of ICU stay was 6 days. The consumption of carbapenems (new AM) and antifungals decreased from 18.8/100 to 10.6/100 and 56.1/100 to 22.1/100 bed days, respectively, after the introduction of indent form. Conclusion : The Reserve AM indent form was helpful in reducing the AM consumption during the study period. The AM indent form can be used as an important tool to combat irrational use, AM resistance and can be implemented in AM stewardship programmes.