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Objectives: The objective of the study is to identify and study the antimicrobial susceptibility pattern of various causative agents of bloodstream infection (BSI) in a tertiary care hospital. Materials and Methods: This was a retrospective observational study conducted from October 2022 to September 2023. Paired blood culture samples were collected aseptically and incubated in BD BACTEC FX-40, a fully automated blood culture system, for 5 days. When the bottle was "flagged positive," gram staining was done, followed by subculture onto Blood agar and MacConkey agar. Species identification and antibiotic susceptibility testing were performed using the VITEK 2 Compact system and interpreted according to Clinical Laboratory Standard Institute guidelines. Statistical analysis: The data were analyzed using the Statistical Package for the Social Sciences version 20.0. Results: 10,449 blood cultures were received during the 1-year study period, out of which 13.2% (1378 samples) showed growth of pathogenic organisms. Gram-negative bacilli (810/1,378, 58.8%) were the most common etiological agents, and Klebsiella pneumoniae was the most predominant pathogen recovered. Candida spp. were recovered in (150/1378, 10.9%) isolates. A high rate of antimicrobial resistance (AMR) was noted, including (26/46, 56.5%) methicillin-resistant Staphylococcus aureus , (9/125, 7.2%) vancomycin-resistant enterococci, and (269/536, 50.2%) carbapenem-resistant enterobacterales. The current study also highlights high resistance among non-fermenting Gram-negative bacteria. Conclusions: Gram-negative bacilli are the most common cause of BSIs in our setup. A high level of AMR is observed among the pathogens. The formulation of an effective antimicrobial stewardship program and its strict compliance is the need of the hour. [ABSTRACT FROM AUTHOR]

The health-care sector has undergone remarkable progress along with experiencing challenges such as escalating antimicrobial resistance. Here, we report the successful management of Sphingomonas paucimobilis bloodstream infection in a postliver transplant patient. The objective of sharing this case report is to create the awareness regarding the possibility of this novel bug implicated in infections in the posttransplant setting. Further, it emphasizes on the utility of breakpoint to Minimum Inhibitory Concentration quotient in tailoring appropriate antibiotic therapy. [ABSTRACT FROM AUTHOR]

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) has a high prevalence in hospital settings in India and imposes a serious economic burden on healthcare resources. Understanding the local prevalence and evolving antimicrobial resistance patterns of MRSA is crucial for guiding effective treatment strategies. This study aims to determine the prevalence, clinico-demographic profile, and antibiotic susceptibility patterns of MRSA and methicillin-susceptible Staphylococcus aureus (MSSA) isolates. Methods: This retrospective study analyzed Staphylococcus aureus isolates collected between June 2021 and May 2023 from blood, pus, sterile body fluids, respiratory, and urine samples at the Microbiology laboratory of Mahatma Gandhi Hospital. Isolates were identified as S. aureus and tested for methicillin resistance using the Vitek 2 Compact system, which employs an advanced colorimetry method for identification and determines the minimum inhibitory concentration (MIC) using a broth microdilution method for antimicrobial susceptibility testing. Results: Of the 481 Staphylococcus aureus isolates analyzed, 264 (55%) were identified as MRSA. Among the MRSA isolates, the most common source was pus/wound infections (59%), followed by bloodstream infections (22%). MRSA isolates showed a susceptibility rate of 56% to gentamicin and 45% to clindamycin, but only 14% to ciprofloxacin. However, 55% of MSSA isolates were resistant to ciprofloxacin. All MRSA isolates were susceptible to daptomycin, teicoplanin, vancomycin, and linezolid. Conclusion: Our findings underscore the need for continuous MRSA surveillance and emphasize tailoring local antibiotic guidelines based on resistance patterns. Targeted antimicrobial stewardship programs and reinforced infection control protocols, especially for pus/wound infections, are crucial to curb the spread of resistant strains. [ABSTRACT FROM AUTHOR]

Background: Carbapenem‑resistant Acinetobacter baumannii (CRAB) is a serious global health challenge. It is increasingly associated with nosocomial infections and outbreaks in healthcare facilities. This study was conducted in a tertiary care teaching hospital in Jaipur to quantitate the burden of CRAB in our setup, examine the clinico‑epidemiological profile of patients infected with this bug, and determine their antibiotic susceptibility pattern. Methods: Clinical specimens collected from patients admitted in various wards and ICUs were processed. Bacterial identification and susceptibility testing were done using standard laboratory techniques and VITEK 2 automated system. Only one isolate per patient was included for study purposes. The data on the sociodemographic and epidemiological profile was collected and analyzed statistically. Results: A total of 4897 clinical samples were received in the department of microbiology during the study period, out of which 1517 exhibited significant growth, sample positivity rate being 31%. Acinetobacter baumannii was the third most common gram‑negative isolate (228/1067; 21.3%). Out of the total 228 A. baumannii isolates, 221 (97%) were carbapenem resistant. The maximum number of CRAB isolates were obtained from endotracheal secretions (103), followed by blood (59). All patients were critically ill and needed intensive care. The antibiotic susceptibility testing of these clinical isolates revealed a high level of resistance (99%) against ceftazidime, meropenem, and imipenem with the least resistance against colistin (2%) and tigecycline (9%). Conclusions: CRAB is an important global pathogen contributing to increased morbidity and mortality in hospitalized patients. Viable treatment options that may be used with success against bugs include minocycline, tigecycline, and polymyxins. [ABSTRACT FROM AUTHOR]

Background: The natural capability to produce offspring is termed as fertility. As the growing world is flourishing with modern means and advances in technology, there is a sharp fall in the birth rate all over. Many developing countries including India are now struggling with this issue. Bacterial infection of the male genitourinary tract is one of the key factors responsible for male infertility. These pathogenic bacteria induce an alteration in semen parameters, such as sperm count, morphology, and motility which are predictors of male fertility potential. Material and Methods: This is a retrospective descriptive observational study and includes culture reports of 388 semen samples of adult men attending the infertility clinics over a 3‑year study period. Sample inoculation was done on culture media plates and incubated for 18–24 h at 37°C. Culture identification and antibiotic susceptibility testing were done using VITEK 2‑automated system. Result: Eighty‑one samples showed growth of single isolate and were further processed. The majority of the patients were 26–30 years of age, followed by 31–35 years. Gram‑positive isolates outnumbered the gram‑negative isolates (58% vs. 42.0%). The antimicrobial susceptibility pattern of gram‑negative isolates showed maximum resistance against third‑generation cephalosporins (70.6%), followed by cotrimoxazole (54.5%) and flouroquinolones (50.0%). Amongst gram‑positive isolates, high degree of resistance was observed against tetracycline (89.4%) and fluoroquinolones (72.3%). Conclusion: Urogenital infections in males have been found to be associated with a reduction in fertility. Though these patients may be completely asymptomatic, these infections are known to reduce the sperm counts and motility. Proper bacteriological profiling of these patients is thus an important part of diagnostic workup. [ABSTRACT FROM AUTHOR]

Diagnosis and management of candiduria in hospitalized patients is often a gray zone for clinicians and microbiologists alike. The presence of Candida in urine could mean anything ranging from contamination and colonization to frank urinary tract infection. This study aims to enhance the understanding of candiduria among critically ill patients admitted in the intensive care unit (ICU). Out of 226 urine samples received in the laboratory from patients admitted in the ICU with an indwelling urinary catheter, 15 were found to have candiduria, prevalence being 6.6%. Various species isolated were Candida tropicalis (40%), Candida albicans (33.33%), Candida lusitaniae (13.33%), Candida parapsilosis (6.66%), and Candida dubliniensis (6.66%). In all patients, candiduria resolved spontaneously upon removal of the catheter. No antifungal was administered, and no concurrent positive blood culture was found in any of these patients. This study emphasizes that simply culturing the organism does not imply clinical significance. Removal or change of catheter must be undertaken once such a report is received from the laboratory. [ABSTRACT FROM AUTHOR]

Achromobacter xylosoxidans is an uncommon nosocomial pathogen known to cause serious infections in immunocompromised patients. Long stays in critical care units often predispose to infection with this bacterium. A female patient, who is a known case of diabetes mellitus type 2, hypertension, and chronic kidney disease, presented to the emergency department with complaints of shortness of breath, generalized swelling, decreased urine output for 7 days, and altered sensorium for 1 day. A. xylosoxidans was isolated from paired blood culture. She was managed according to the antibiotic susceptibility report and was improving when she left against medical advice due to personal issues. The objective of presenting this case report is to stress upon the importance of communication between the microbiologist and the clinician. Embracing automation in microbiology laboratories is essential to identify such novel bacterium in time to achieve clinical and microbiological cures. [ABSTRACT FROM AUTHOR]

The article discusses the role of co-trimoxazole (cot) in current medical practice. Co-trimoxazole is a combination of trimethoprim and sulfamethoxazole that was introduced in the late 1960s as a broad-spectrum antibiotic. It was used to treat various infections, but its use declined due to increasing antimicrobial resistance. However, recent studies have shown that cot may still be effective against certain pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacterales (CRE). The article suggests that further research should be conducted to explore the potential use of cot in combating infectious diseases. [Extracted from the article]

Background and Aim: Ventilator-associated pneumonia (VAP) is considered as a sub-category of healthcare-associated infections and is associated with high morbidity and mortality. Acinetobacter baumannii complex and Klebsiella pneumoniae (K. pneumoniae) are known to be the most important causes. During the last few decades, polymyxins have represented the most commonly used antimicrobial options against multidrug resistant K. pneumoniae. However, in some cases, aminoglycosides were also found to be effective. Materials and Methods: This retrospective observational study was conducted in a tertiary care hospital in Jaipur from June' 2020 to June' 2021. All endotracheal (ET) aspirate samples from the clinically suspected cases of VAP received in microbiology laboratory were processed using the standard procedures and relevant medical records were reviewed. VITEK 2 automated system was used for the bacterial identification and antimicrobial susceptibility testing. Results: Out of 705 ET aspirate samples received during the study period, 467 were found culture positive. Majority 304 (98.1%) were Gram-negative isolates, while only 6 (1.9%) were Gram-positive. 156;51.3% isolates belonged to A. baumannii complex, followed by K. pneumoniae (73;24.0%). Antimicrobial susceptibility profile of 73 K. pneumoniae isolates to aminoglycosides was noted. Out of 73 isolates, 42 were found to be resistant to both gentamicin and amikacin, 12 isolates were sensitive to both, while 19 isolates showed variable susceptibility. Conclusion: K. pneumoniae is an important causative agent of VAP. While polymyxins have an important role in the management of such cases, aminoglycosides need to be given a careful consideration. They can constitute an effective polymyxin sparing regimen, especially for carbapenem-resistant isolates. [ABSTRACT FROM AUTHOR]

Background: The genus Providencia, earlier considered a rare pathogen, is now increasingly recognized as a notorious opportunistic pathogen capable of causing serious nosocomial infections, mainly urinary tract infections (UTIs). Treating these infections is an onerous task given the resistance seen in clinical strains to many currently available antimicrobials. The objective of the present study is to provide an overall view into the prevalence of Providencia spp. causing UTIs, their antibiotic susceptibility pattern, and respective clinical outcomes. Materials and methods: This is a retrospective observational study carried out in a tertiary care teaching referral hospital located in Jaipur, India from March 2021 to May 2021. All Providencia spp. strains isolated from urine samples were included in the study. Data were entered in Microsoft Office Excel worksheet. Results are presented in numbers and percentages. Results: Out of 1,261 urine samples processed in the laboratory during the study period, 426 were culture positive and the majority were gram-negative isolates and included Escherichia coli (46.0%) and Klebsiella spp. (28.0%). Providencia spp. was the fourth most common gram-negative pathogen (6.0%). The median age of patients was 65 years. The male:female ratio was 3:2 and maximum patients belonged to the 30-60-year age-group. Diabetes was the commonest associated comorbidity. All patients had an indwelling urinary catheter. Three (20.0%) patients succumbed to infections. Conclusion: Providencia is an opportunistic pathogen that cannot be neglected due to escalating antibiotic resistance. Effective infection control and antibiotic stewardship policies are required to prevent the development of further antibiotic resistance. [ABSTRACT FROM AUTHOR]

Background The ongoing pandemic of coronavirus disease 2019 (COVID-19) has overwhelmed healthcare facilities and raises an important novel concern of nosocomial transmission of Candida species in the intensive care units (ICUs). Methods We evaluated the incidence and risk factors for development of candidemia in 2384 COVID-19 patients admitted during August 2020–January 2021 in ICUs of 2 hospitals (Delhi and Jaipur) in India. A 1:2 case-control matching was used to identify COVID-19 patients who did not develop candidemia as controls. Results A total of 33 patients developed candidemia and accounted for an overall incidence of 1.4% over a median ICU stay of 24 days. A 2-fold increase in the incidence of candidemia in COVID-19 versus non-COVID-19 patients was observed with an incidence rate of 14 and 15/1000 admissions in 2 ICUs. Candida auris was the predominant species (42%) followed by Candida tropicalis. Multivariable regression analysis revealed the use of tocilizumab, duration of ICU stay (24 vs 14 days), and raised ferritin level as an independent predictor for the development of candidemia. Azole resistance was observed in C auris and C tropicalis harboring mutations in the azole target ERG11 gene. Multilocus sequence typing (MLST) identified identical genotypes of C tropicalis in COVID-19 patients, raising concern for nosocomial transmission of resistant strains. Conclusions Secondary bacterial infections have been a concern with the use of tocilizumab. In this cohort of critically ill COVID-19 patients, tocilizumab was associated with the development of candidemia. Surveillance of antifungal resistance is warranted to prevent transmission of multidrug-resistant strains of nosocomial yeasts in COVID-19 hospitalized patients. [ABSTRACT FROM AUTHOR]

Background: World is in grip of coronavirus disease-2019 (COVID-19) pandemic right now. Majority of studies center around its epidemiological and clinical characteristics. Information regarding secondary bacterial infections is limited. This retrospective observational study was done to determine the prevalence and characteristics of bloodstream infections in COVID-19 patients admitted in a tertiary care center in Jaipur. Materials and methods: All blood cultures received from COVID-19 positive patients admitted in designated COVID care ICUs and wards were included in the study. A predesigned pretested questionnaire was used to collect relevant data. Blood cultures were done using BD BACTEC™ FX40, and identification and antimicrobial susceptibility testing of isolates were done by VITEK® 2 COMPACT. Results: One thousand five hundred seventy-eight (1578) COVID-19 positive patients were admitted in center during 5-month study period from whom 158 blood cultures were received. Out of these, 15 (9.4%) were positive. Median age of patients with positive blood culture was 54 years and included 10 males and 5 females. Ten (67%) patients needed intensive care in ICU. Significant correlation of blood culture positivity was found with parameters like ICU admission, presence of an indwelling device, underlying comorbidity, raised biochemical markers, and adverse clinical outcome. Conclusions: Incidence of bloodstream infections is low for COVID-19 patients. Antibiotic prophylaxis needs to be used with caution, and prompt discontinuation should be done based on clinical judgment. [ABSTRACT FROM AUTHOR]

Aims & Objective: This study was conducted to determine the knowledge, attitude and practices regarding BMW management among medical undergraduates. It was descriptive, questionnaire based cross sectional study. Methods: 180 students were evaluated for BMWM knowledge. The study was conducted in two parts first pre training session and post training session. Results: Significant improvement was observed in post training session answers supporting the aim of the study and training sessions were welcomed in future. Conclusions: Such trainings should also be made a compulsory feature in all courses which have any associations to healthcare settings. All health care workers should be trained for BMWM before their postings in hospitals or the site of BMW origination to improve their knowledge regarding BMWM. [ABSTRACT FROM AUTHOR]

Presence of Bush class C enzymes in uropathogenic strains of Klebsiella pneumoniae & E. coli resistant to extended spectrum cephalosporins is an emerging threat to clinical therapeutics. These resistant strains result in considerable treatment failure and cannot be detected by routine antibiotic sensitivity screening methods. An effort was therefore made to study AmpC beta lactamase production in E. coli and Klebsiella pneumoniae strains causing UTI. A total of 126 E. coli and 49 K. pneumnoniae strains isolated from urine samples were selected for study out of which AmpC beta lactamase production was seen in 23% E. coli (29 isolates) and 18% K. pneumoniae (49 isolates). The susceptibility of AmpC beta lactamase producers to Imipenem, Nitrofurantoin and Amikacin was found to be 100%, 92% and 80% respectively. Thereby the present study emphasizes the importance of monitoring and control of usage of extended spectrum cephalosporins.