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Background: Women with normal cervical cytology, who are infected with high-risk HPV type, have an approximately 100-fold increased risk of developing cervical cancer compared with uninfected women. Present study was conducted to study seroprevalence of Human Papilloma Virus by ELISA method in female patients attending in Gynecology OPD of in a tertiary care hospital. Present study was cross- Material and Methods: sectional study, observational study, conducted female patients clinically suspected of having HPV infections like bleeding per vagina, irregular menstruation, pain in lower abdomen or post-coital bleeding or had any abnormal ndings on per vaginal examination. Among 160 Results: patients, majority of were from age group 31-40 years (39.38%), married (88.75 %), married at 18-20 years age (54.36 %), had parity of 2-4 (83.75%). All females had gynecological problems followed by women who were smoker ( 33.13 %), suffering from STD's (29.37 %), had alcohol drinking habit (25 %), had multiple sexual partner (5 %) and family history of cervical cancer (2.5 %). The patients who used homemade napkins had a highest seroprevalence of HPV 68.18% followed by patients who are suffering from STD's (63.83 %), had a family history of cervical cancer (50 %), women who used to smoke (37.7 %), drink (25 %), had multiple sex partners (25 %) and the least number seropositivity was among patient who had gynecological problems 23.12%. The sero-prevalence among patients for HPV was 23.12%. Conclusion: The prevalence increased with early marriages, high parity, and middle socio-economic status group. So, our study will guide for planning and implementation of governmental HPV infection control measures and the consequences of infection around the world. ELISA method is an important diagnostic method in future in HPV infection detection as it has several advantages over other existing diagnostic methods in respect of early detection, reliability, cost effectiveness and patients compliance as blood can be easily accessible.

Background: Cervical cancer is the commonest cancer amongst Indian women and the second most common cancer in the women worldwide. Persistent infection with high-risk HPV (HR-HPV) is the most important risk factor for cervical cancer precursors and invasive cervical cancer. Present study was conducted to study prevalence of Human Papilloma Virus (HPV) & correlation of PAP smear in clinically suspected cases of HPV. Present study was prospective, observational study, conducted in female pa Material and Methods: tients clinically suspected of having HPV infections like bleeding per vagina, irregular menstruation, pain in lower abdomen or post-coital bleeding or had any abnormal ndings on per vaginal examination. In the present study, majority of patients were in age group Results: 31-40 years (39.38%), married (88.75%), were married at 18-20 years age (54.36%) & had parity of 2-4 (83.75%). The patients who used homemade napkins had a highest seroprevalence of HPV (68.18 %), followed by patients who are suffering from STD's (63.83%), family history of cervical cancer (50%), women who used to smoke (37.7%). It was observed that serological test and PAP smear was positive among 03 patients with 34 false positive tests. Comparison between ELISA and cytological study showed that ELISA test was better, and nding was statistically signicant; p value

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.

Healthcare-associated infections (HAIs) are one of the most common adverse events in patient care that account for substantial morbidity and mortality. We evaluate the existing Infection Prevention and Control (IPC) practices in hospitals participating in the nationally representative HAI Surveillance network.This cross-sectional survey was conducted in 23 hospitals across 22 states of India from October-2015 to September-2018 in the HAI surveillance network. The World Health Organization (WHO) IPC core components assessment tool for health-care facility level (IPCAT-H) was adapted from IPC assessment tool developed by US Centers for Disease Control and Prevention (US CDC) under the Epidemiology and Laboratory Capacity (ELC) Infection Control Assessment and Response (ICAR) Program. Mann-Whitney U test was used to calculate the significant difference between scores (P.05).Amongst the participating hospitals, 7 were private sectors and 16 were public health care facilities. Infection IPCAT-H average score per multimodal strategy was less than 50% for programmed IPC activities (45.7); implementation of health care workers (HCWs) immunization programme (43.5%); monitoring and evaluation component (38.30%).There is potential for improvement in Human Resources, Surveillance of HAIs as well as Monitoring and Evaluation components.

Health-care-associated infections (HAIs) cause significant morbidity and mortality globally, including in low-income and middle-income countries (LMICs). Networks of hospitals implementing standardised HAI surveillance can provide valuable data on HAI burden, and identify and monitor HAI prevention gaps. Hospitals in many LMICs use HAI case definitions developed for higher-resourced settings, which require human resources and laboratory and imaging tests that are often not available.A network of 26 tertiary-level hospitals in India was created to implement HAI surveillance and prevention activities. Existing HAI case definitions were modified to facilitate standardised, resource-appropriate surveillance across hospitals. Hospitals identified health-care-associated bloodstream infections and urinary tract infections (UTIs) and reported clinical and microbiological data to the network for analysis.26 network hospitals reported 2622 health-care-associated bloodstream infections and 737 health-care-associated UTIs from 89 intensive care units (ICUs) between May 1, 2017, and Oct 31, 2018. Central line-associated bloodstream infection rates were highest in neonatal ICUs (20 per 1000 central line days). Catheter-associated UTI rates were highest in paediatric medical ICUs (4·5 per 1000 urinary catheter days). Klebsiella spp (24·8%) were the most frequent organism in bloodstream infections and Candida spp (29·4%) in UTIs. Carbapenem resistance was common in Gram-negative infections, occurring in 72% of bloodstream infections and 76% of UTIs caused by Klebsiella spp, 77% of bloodstream infections and 76% of UTIs caused by Acinetobacter spp, and 64% of bloodstream infections and 72% of UTIs caused by Pseudomonas spp.The first standardised HAI surveillance network in India has succeeded in implementing locally adapted and context-appropriate protocols consistently across hospitals and has been able to identify a large number of HAIs. Network data show high HAI and antimicrobial resistance rates in tertiary hospitals, showing the importance of implementing multimodal HAI prevention and antimicrobial resistance containment strategies.US Centers for Disease Control and Prevention cooperative agreement with All India Institute of Medical Sciences, New Delhi.For the Hindi translation of the abstract see Supplementary Materials section.

Introduction. As the world was still recovering from the 2020 pandemic, the devastating impact of Covid-19 driven by the Delta variant shook the world in 2021. As the second wave was declining, there was an unusual surge in Covid-19 positive cases by the end of 2021 which led to global concern about the change in virus characteristics. Hypothesis/gap statement. Whole genome sequencing is critical for understanding a rapidly progressing pandemic. Aim. To provide an insight into the major differences encountered in the changing characteristics between the second and third waves of the pandemic at a tertiary care hospital in India. Methods. A retrospective observational cohort analysis was conducted on Covid-positive patients during the second wave of the Covid-19 pandemic (from March 2021 to April 2021) and the third wave of the Covid-19 pandemic (from December 2021 to January 2022). Results. Out of 303 Covid-19 positive cases, 52 samples were tested by whole genome sequencing during the second wave and 108 during the third wave. A decline of 18.5 % was observed in the case fatality rate from the second wave to the third wave. There was a 5 % decline in the number of patients admitted with ARDS and a 16.3 % decline in the number of patients with co-morbidities. In total, 51.9 percent of cases were due to the Delta variant during the second wave and 95 percent due to the Omicron variant during the third wave. We found that 36.5 % of Covid-positive patients during the second wave had been vaccinated compared to 40 % in the third wave. Conclusion. Whole genome sequencing of clinical samples from a wide range of individuals during a viral epidemic will enable us to develop a more rapid public health response to new variants and identify the required vaccine modifications more quickly.

The study revealed the differential ability of cefepime/taniborbactam and cefepime/zidebactam in tackling carbapenemase-producing Indian clinical isolates that also harbored additional mechanisms of resistance. NDM-expressing E. coli with 4-amino-acid insert in PBP3 are predominately resistant to cefepime/taniborbactam, while the β-lactam enhancer mechanism-based cefepime/zidebactam showed consistent activity against single- or dual-carbapenemase-producing isolates including E. coli with PBP3 inserts.

Introduction Healthcare associated infections (HAIs) are prevalent and difficult to treat worldwide. Most HAIs can be prevented by effective implementation of Infection Prevention and Control (IPC) measures. A survey was conducted to assess the existing IPC practices across a network of Indian Hospitals using the World Health Organization designed self-assessment IPC Assessment Framework (IPCAF) tool. Methods This was a cross sectional observation study. Thirty-two tertiary care public and private facilities, part of the existing Indian HAI surveillance network was included. Data collected was analysed by a central team at All India Institute of Medical Sciences (AIIMS), New Delhi, a tertiary care hospital of India. The WHO questionnaire tool was used to understand the capacity and efforts to implement IPC practices across the network. Results The overall median score of IPCAF across the network was 620. Based on the final IPCAF score of the facilities; 13% hospitals had basic IPC practices, 28% hospitals had intermediate and 59% hospitals had advanced IPC practices. The component multimodal strategies (CC5) had the broadest range of score while the component IPC guidelines had the narrowest one. Conclusion Quality improvement training for IPC nurses and healthcare professionals are needed to be provided to health facilities.

Poster session 1, September 21, 2022, 12:30 PM - 1:30 PM Objectives Nosocomial candidiasis is associated with a mortality rate of over 60% while the attributable mortality rate is 49%. The present study was to determine the magnitude and risk factors in patients with candidemia at a tertiary care hospital with speciation and antifungal susceptibility of pathogenic Candida isolates. Methods The present study was a prospective, cross-sectional, observational study, conducted at a tertiary care hospital for a period of 1 year after approval from Institutional ethics committee. It included a total of 150 patients of all age groups, admitted to hospital for ˃48 h and diagnosed as proven Candidemia with isolation of Candida species from at least two blood culture samples or from a clinically significant single blood culture sample. A thorough history and clinical characteristics of each patient was noted. Blood was collected and processed as per standard protocol. Pathogenic Candida species were identified and their antifungal susceptibility testing was performed by disk diffusion method as per the standard method. The antifungal discs used were fluconazole (25 μg), itraconazole (10 μg), voriconazole (1 μg), and amphotericin B (100 units). Results were analyzed statistically using SPSS statistics 20. Results Candida species was isolated as the pathogen in 24/150 (16%) of clinically suspected cases of candidemia. Candida species isolated were non-albican Candida (NAC) species, mainly C. glabrata 11/24 (45.83%) followed by C. parapsilosis 8/24 (33.33%), and C. tropicalis 5/24 (20.83%). Candida species was isolated as the pathogen, predominantly in patients of age group 0-10 years [15/24 (62.5%)]. Majority of Candida species were isolated from patients who had prolonged ICU stays. Among 24 patients of proven candidemia, 2 (8.33%) patients were from NICU, 10 (41.6%) from PICU, and 3 (12.5%) from MICU. Other important risk factors observed in the present study were, recent major abdominal surgery, malignancy, and mechanical ventilation, each accounting for 2/24 (8.33%) cases. The resistance pattern of isolates of Candida species to antifungals showed that C. glabrata showed 100% resistance to fluconazole, 63.6% to itraconazole, and 45.4% to voriconazole. C. tropicalis showed 80% resistance to fluconazole, 60% to itraconazole, and 40% to voriconazole. Candida parapsilosis showed 87.5% resistance to fluconazole, 62.5% to itraconazole, and 37.5% to voriconazole. All three isolated pathogenic Candida spp. showed 100% susceptibility to amphotericin B. Mortality observed in present study was 7/24 (29.7%). A total of 5/7 patients were from ICU. Conclusion Non-albican Candida (NAC) species, mainly C. glabrata, C. tropicalis and C. parapsilosis were the causative agent of candidemia, seen to predominantly affect 0-10 year age group. Infections caused by Candida species remain a significant problem in ICU. An increase in resistance to azoles is a challenge to its empirical and prophylactic use. This necessitates the usage of antifungals, only on the basis of antifungal susceptibility patterns of the pathogenic isolates.

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM Introduction The epidemiology of invasive candidiasis (IC) is dynamically changing, given the increasing population of susceptible hosts, use of indwelling medical devices (IMD), and environmental factors. The presence of an IMD is one of the most important risk factors for persistent infection due to the possibility of biofilm formation. The biofilm cells are significantly less susceptible to antifungal drugs and are able to evade the host immune system, serving as a nidus for reinfections. Objectives Methods A total of 100 Candida isolates from patients with suspected invasive candidiasis were tested for the production of biofilm. Based on clinical history, 62% of the isolates were found to be clinically significant, while 38% represented commensals or colonizers. Species identification was done on the basis of germ tube test, CHROMagar, Dalmau plate technique, and carbohydrate fermentation and assimilation tests, and VITEK 2. Four isolates that failed to be identified by conventional methods were subjected to MALDI-TOF MS. Biofilm production was detected and graded by visual (test tube) and spectrophotometric (microtiter plate) methods. Results Non-albicans Candida (NAC) were the predominant clinically relevant isolates recovered from cases of IC (71%), while C. albicans was most commonly associated with colonization (68.4%). Among the NAC isolates, C. tropicalis was the most common isolate (23%) followed by C. glabrata (11%), C. krusei (8%), C. parapsilosis (6%), C. lusitaniae (2%), C. kefyr (2%), C. rugosa (2%), C. guilliermondii (1%), and C. famata (1%) (Fig. 1). A total of 55% of the Candida isolates produced biofilm. Biofilm positivity in clinically relevant isolates was found to be significantly higher than commensals/colonizers (P Conclusion Our study demonstrated a paradigm shift from C. albicans to NAC with the isolation of C. tropicalis from a large number of cases, highlighting the growing importance of this pathogen. The knowledge about local epidemiological trends of Candida spp. is important to guide therapeutic choices. Moreover, clinically relevant Candida spp. were found to possess a greater ability to produce biofilms than commensals or colonizers. These findings are unique as previous studies haven't differentiated between biofilms formed by commensal Candida populations and those related to infections. This study highlights that biofilm production should be considered a relevant biologic variable while treating patients with invasive candidiasis, particularly those who fail to respond to antifungal therapy.

Objectives: COVID-19 is highly contagious, and health care workers are at high risk of being infected. We carried out a rapid survey to estimate the proportion of HCWs who are serologically positive for SARS-CoV-2 in the Lokmanya Tilak Municipal General Hospital, Mumbai, India. Material and Methods: After the consent of the hospital authorities, volunteers were asked to report at a special booth set up in the hospital between May 1, 2020, and May 16, 2020. After consent, each worker was administered a questionnaire using a handheld computer which had questions on symptoms in the past 30 days, place of posting (COVID designated area or other), work category (doctor/nurse/others), use of personal protective equipment, smoking, comorbidity, and exposure followed by a test for COVID-19 using the STANDARD Q COVID-19 IgM/ IgG Duo Test of SD Biosensor. We estimated weighted seroprevalence with 95% confidence limits after adjusting for the work category. We calculated the adjusted odds ratio (aOR) using logistic regression with seropositivity as an outcome variable and others as independent variables. Results: The final sample included 501 and 1051 subjects working in the COVID area and non-COVID area, respectively, covering 35% of the total staff of the hospital. Overall, 6.9% (95% CI of 5.7–8.2) of the hospital staff was serologically positive for SARS-Cov-2, similar in the COVID area –5.7 (3.8–8.1) and non-COVID area –7.2 (5.7–9.0). Age more than 50 years (aOR 2.65; 1.45–4.85) and being in others work category 2.84 (1.34–6.02) were identified as significant predictors of being seropositive. Only 10% of the subjects reported COVID-like illness in the past 1 month. Conclusion: The overall modest prevalence of infection among the health care workers, especially non-doctors and nurses, and similarity of prevalence in COVID and non-COVID area staff indicate the possibility of non-hospital source of infection.

Objective: To determine the sensitivity and specificity of three Malaria rapid antigen detection tests(RDTs) .To study the sensitivity of the RDTs in relation to parasitic index . Materials and Methods: The study was conducted at a tertiary care hospital. Peripheral smear were prepared and stained.Parasite index was calculated. Three rapid antigen detection tests ; Optimal – IT, Paramax-3 and QDx malaria PAN/PF were tested. Results: Sensitivity for Optimal – IT was highest (98.47%). QDx malaria PAN/Pf gave highest specificity (97%). All the three RDTs gave sensitivity of 100% at a parasitic index of more than 100 parasites per µl. Sensitivity of Optimal – IT and QDx malaria PAN/Pf for P falciparum and P vivax was 100% and 88.88% respectively at a parasitic index of 51-100 parasites/ µl. Conclusion: Malaria RDTs are a good diagnostic tool in health care set ups where quick results are desired and expert microscopy is not available.

Sonam Vijay,1 Nitin Bansal,1 Brijendra Kumar Rao,2 Balaji Veeraraghavan,3 Camilla Rodrigues,4 Chand Wattal,5 Jagdish Prasad Goyal,6 Karuna Tadepalli,7 Purva Mathur,8 Ramanathan Venkateswaran,9 Ramasubramanian Venkatasubramanian,10 Sagar Khadanga,11 Sanjay Bhattacharya,12 Sudipta Mukherjee,13 Sujata Baveja,14 Sujatha Sistla,15 Samiran Panda,1 Kamini Walia1 1Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India; 2Institute of Critical Medicine, Sir Ganga Ram Hospital, New Delhi, India; 3Department of Clinical Microbiology, Christian Medical College, Vellore, India; 4Department of Microbiology, PD Hinduja Hospital, Mumbai, Maharashtra, India; 5Department of Clinical Microbiology, Sir Ganga Ram Hospital, New Delhi, India; 6Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, India; 7Department of Microbiology, All India Institute of Medical Sciences, Bhopal, India; 8Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India; 9Department of Medicine, JIPMER, Pondicherry, India; 10Department of Infectious Diseases, Apollo Hospital, Chennai, Tamil Nadu, India; 11Department of Medicine, All India Institute of Medical Sciences, Bhopal, India; 12Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India; 13Department of Critical Care Medicine, Tata Medical Center, Kolkata, West Bengal, India; 14Department of Microbiology, Lokmanya Tilak Municipal General Hospital, Mumbai, India; 15Department of Microbiology, JIPMER, Pondicherry, IndiaCorrespondence: Kamini WaliaDivision of Epidemiology and Communicable Diseases, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, IndiaEmail waliakamini@yahoo.co.inPurpose: Critically ill coronavirus disease 2019 (COVID-19) patients need hospitalization which increases their risk of acquiring secondary bacterial and fungal infections. The practice of empiric antimicrobial prescription, due to limited diagnostic capabilities of many hospitals, has the potential to escalate an already worrisome antimicrobial resistance (AMR) situation in India. This study reports the prevalence and profiles of secondary infections (SIs) and clinical outcomes in hospitalized COVID-19 patients in India.Patients and Methods: A retrospective study of secondary infections in patients admitted in intensive care units (ICUs) and wards of ten hospitals of the Indian Council of Medical Research (ICMR) AMR surveillance network, between June and August 2020, was undertaken. The demographic data, time of infection after admission, microbiological and antimicrobial resistance data of secondary infections, and clinical outcome data of the admitted COVID-19 patients were collated.Results: Out of 17,534 admitted patients, 3.6% of patients developed secondary bacterial or fungal infections. The mortality among patients who developed secondary infections was 56.7% against an overall mortality of 10.6% in total admitted COVID-19 patients. Gram-negative bacteria were isolated from 78% of patients. Klebsiella pneumoniae (29%) was the predominant pathogen, followed by Acinetobacter baumannii (21%). Thirty-five percent of patients reported polymicrobial infections, including fungal infections. High levels of carbapenem resistance was seen in A. baumannii (92.6%) followed by K. pneumoniae (72.8%).Conclusion: Predominance of Gram-negative pathogens in COVID-19 patients coupled with high rates of resistance to higher generation antimicrobials is an alarming finding. A high rate of mortality in patients with secondary infections warrants extra caution to improve the infection control practices and practice of antimicrobial stewardship interventions not only to save patient lives but also prevent selection of drug-resistant infections, to which the current situation is very conducive.Keywords: COVID-19, secondary infections, antimicrobial resistance, hospital acquired infections, antibiotics

Introduction: Diphtheria is an acute, highly infectious and previously endemic disease. Due to the vaccine preventable nature of the disease and initial steady decline, not much attention had been given towards this disease. Recent increase in the number of clinically suspected and laboratory confirmed cases of diphtheria have been observed in our laboratory. Aims and objectives: To study the status of resurgence of the disease in a tertiary care hospital of Mumbai. Materials and methods: 76 throat swabs and 1 slough material from 57 clinically suspected cases of diphtheria over a period of one and a half year from July 2018 to December 2019 were obtained and were processed for microscopy and culture for Corynebacterium species by standard microbiological techniques. Results: Eighteen (23.37%) out of 77 samples yielded Corynebacterium species on culture. Out of 57 suspected patients, 11 were culture confirmed diphtheria (19.29%). None of the patients were less than 5 years of age, 55% were between 5 and 9 years and 45% were above 10 years of age with a total female preponderance of 64%. The immunization status was unclear in 27% cases. All the smear and/or culture positive cases were informed immediately to the clinicians so that the patients could be transferred to the Infectious disease hospital for further management. Conclusion: The study has shown an increase in the number of Diphtheria cases in a metropolitan city, which is a cause of concern in healthcare. There is also a shift in age to older children (> 5 years). The study also highlights the need for confirmation of toxin production to facilitate early information to the treating clinicians.

Introduction: Diagnosing Central line associated bloodstream infection (CLABSI) and Central line Related local infections (CRLI) involves doing central line tip culture. The routine method which is followed in every laboratory is the semiquantitative roll plate method. However, the use of a quantitative flush method will add a further advantage, as it may detect endoluminal microorganisms more easily which helps in diagnosing blood stream infections due to central line. Materials and Methods: A prospective study was carried out in MICU of tertiary care hospital. Semiquantitative roll over technique and quantitative flush technique was followed to process central line catheter in patients suspected of CRLI and CLABSI. Results: Of 210 samples processed from patients forty seven patients (47) were diagnosed with CRLI and seven (7) with CLABSI. Semiquantitative technique had superiority in diagnosing local infections whereas flush technique had superiority in diagnosing blood stream infections. Conclusion: Both Semiquantitative and flush techniques are recommended for processing central line catheters for diagnosing CRLI and CLABSI. Early CLABSI can be missed sometimes in samples from ICU patients who have associated comorbid conditions. Thus those laboratories where only semiquantitative roll over technique is followed, quantitative flush technique is recommended which aids in diagnosing CLABSI which can be missed by roll over technique. Keywords: Central line associated bloodstream infections (CLABSI), Central line related local infections (CRLI), Intensive care unit (ICU), Semiquantitative roll over, Quantitative flush technique. Introduction Central line catheter associated bloodstream infection (CLABSI) remains one of the leading causes of nosocomial acquired bacteremia in ICUs leading to increased mortality, whereas Central line related local infections (CRLI) leads to increased morbidity and hospital stay in turn increasing cos

Context: Acute viral hepatitis (AVH) is predominantly caused by hepatitis A virus (HAV) and hepatitis E virus (HEV), the prevalence of which varies in different geographical regions. Aims: This study aimed to determine the prevalence of HAV and HEV infections in patients with AVH, the rate of HAV-HEV co-infection and the prevalence of HEV infection among pregnant women with hepatitis. Settings and Design: It was a retrospective observational study conducted over 3 years from January 2015 to December 2017, after obtaining clearance from the institutional ethics committee. Subjects and Methods: A total of 675 serum samples were collected from patients with a clinical diagnosis of AVH, between January 2015 and December 2017. The study population included outdoor and hospitalised patients between 3 and 70 years of age who presented with signs and symptoms of hepatitis. The presence of IgM anti-HAV and IgM anti-HEV antibodies in serum were assessed by enzyme-linked immunosorbent assay. Statistical Analysis Used: Chi-square test. Results: The prevalence of HAV, HEV and HAV-HEV co-infection was found to be 6.96%, 9.63% and 2.07%, respectively. Among males, this was 7.3%, 8.8% and 2.6%, respectively and in females 6.7%, 10.2% and 1.7%, respectively. However, these differences in the prevalence rates were of no statistical significance. The prevalence of HEV infection in pregnant women with hepatitis was 9.4%. HAV and HEV infections showed a seasonal trend with predominance during summer and rainy seasons (May to September). Conclusions: A higher seroprevalence of HEV as compared to HAV together with a co-infection rate of 2.07% mandates screening for HEV in all suspected cases of acute hepatitis, particularly pregnant women in whom the outcomes of HEV infection are poor. Health and civic authorities should make necessary efforts to counter epidemic or outbreak situations, thus reducing morbidity, mortality and economic burden.

Background India is among the nations reporting substantial healthcare burden linked to pneumococcal infections. Nafithromycin is a novel lactone ketolide antibiotic, which recently entered Phase 3 development in India for the indication of community-acquired bacterial pneumonia (CABP). Objectives To assess the in vitro activity of nafithromycin against serotyped invasive and non-invasive Streptococcus pneumoniae isolates, collected from nine medical centres across India. Methods A total of 534 isolates of S. pneumoniae were collected during 2015–20 and serotyped as per CDC protocol. A subset of erythromycin-non-susceptible S. pneumoniae (n = 200) was screened for the presence of erm(B) and mef(A/E) genes. A subset of MDR isolates (n = 54) were also subjected to MLST. The MICs of antibiotics were determined by the reference agar-dilution method (CLSI). Susceptibilities of the comparators were interpreted as per CLSI criteria. Results Fifty-nine distinct serotypes were identified among the 534 isolates. Among erythromycin-non-susceptible isolates, erm(B) and mef(A/E) genes were found in 49% and 59% strains respectively, while MLST showed clonal diversity. Azithromycin (67.6% non-susceptible) and clindamycin (31.8% non-susceptible) showed limited activity. Penicillin (for non-meningitis) or quinolone non-susceptibility was low ( Conclusions Indian pneumococcal isolates show poor susceptibilities to macrolides, in concordance with the global trend. Nafithromycin overcomes erm as well as mef-mediated macrolide resistance mechanisms expressed individually or concurrently in S. pneumoniae. This study supports continued clinical development of nafithromycin for pneumococcal infections including CABP.

Background Cytokine storm triggered by Severe Coronavirus Disease 2019 (COVID-19) is associated with high mortality. With high Interleukin -6 (IL-6) levels reported in COVID-19 related deaths in China, IL-6 is considered to be the key player in COVID-19 cytokine storm. Tocilizumab, a monoclonal antibody against IL-6 receptor, is used on compassionate grounds for treatment of COVID-19 cytokine storm. The aim of this study was to assess effect of tocilizumab on mortality due to COVID-19 cytokine storm. Method This retrospective, observational study included patients of severe COVID-19 pneumonia with persistent hypoxia (defined as saturation 94% or less on supplemental Oxygen of 15 L per minute through non-rebreathing mask or PaO2/FiO2 ratio of less than 200) who were admitted to a tertiary care center in Mumbai, India, between 31st March to 5th July 2020. In addition to standard care, single Inj. Tocilizumab 400 mg was given intravenously to 151 consecutive COVID-19 patients with persistent hypoxia, from 13th May to 5th July 2020. These 151 patients were retrospectively analysed and compared with historic controls, ie consecutive COVID-19 patients with persistent hypoxia, defined as stated above (N = 118, from our first COVID-19 admission on 31st March to 12th May 2020 i.e., till tocilizumab was available in hospital). Univariate and multivariate Cox regression analysis was performed for identifying predictors of survival. Statistical analysis was performed using IBM SPSS version 26. Results Out of 269 (151 in tocilizumab group and 118 historic controls) patients studied from 31st March to 5th July 2020, median survival in the tocilizumab group was significantly longer than in the control group; 18 days (95% CI, 11.3 to 24.7) versus 9 days (95% CI, 5.7 to 12.3); log rank p 0.007. On multivariate Cox regression analysis, independent predictors of survival were use of tocilizumab (HR 0.621, 95% CI 0.427–0.903, P 0.013) and higher oxygen saturation. Conclusion Tocilizumab may improve survival in severe COVID-19 pneumonia with persistent hypoxia. Randomised controlled trials on use of tocilizumab as rescue therapy in patients of severe COVID-19 pneumonia with hypoxia (PaO2/FiO2 less than 200) due to hyperinflammatory state, are warranted.

Viruses have been shown to modify the clinical picture of several autoimmune diseases, including type 1 diabetes, systemic lupus erythematosus (SLE), rheumatoid arthritis and multiple sclerosis. Viral infections have also been considered as a possible trigger for autoimmune disorders like myositis through myositis specific antibodies. Dermatomyositis is an acquired inflammatory myopathy which is relatively rare with incidence of 9.3 per 1 million persons. Usually we come across 1-2 patients of dermatomyositis per year, amongst 800-1000 new patients in our tertiary care rheumatology services. A surge in the incidence was noted this year during the months of April-August of 2020, the period coinciding with the occurrence of corona virus (COVID-19) pandemic in the city of Mumbai, the total number of cases encountered being five in a span of six months. The following case series includes five such cases with review of available literature on virus-triggered autoimmunity with special reference to SARS-CoV-2 and the challenges of immunosuppression during this pandemic.

Introduction Candida species are a leading cause of infections in immunocompromised hosts. Usage of indwelling medical devices provides ample opportunity for Candida biofilms to set up a nidus for infection that is not easily amenable to conventional antifungal therapy. Materials and Methods A total of 100 Candida isolates from patients with suspected candidiasis were tested for production of biofilm. Based on clinical history, 62% of the patients were found to have clinically significant infection with Candida while in 38% of the patients, Candida isolates represented commensals. Biofilm production was detected and graded by visual (test tube) and spectrophotometric (microtiter plate) methods. Results Fifty five percent of the Candida isolates produced biofilm. Biofilm producing abilities of clinically significant isolates (80%) was found to be significantly higher than commensals (20%). Biofilm positive Candida isolates were most commonly obtained from blood (34.5%). Biofilm production in non-albicans Candida (67.9%) was found to be significantly higher than C. albicans (38.6%). Majority of the biofilm positive Candida isolates produced Grade 2 (moderate) biofilm. Candida tropicalis accounted for maximum biofilm production comprising 20% Grade 4, 53.8% Grade 3 and 50% Grade 2 biofilm. Concordance in grading between the two methods was observed in 72.7% of the isolates. Spectrophotometric method was found to be more sensitive than visual method for detection of Candida biofilm. Conclusion The importance of studying Candida biofilms is to ascertain new therapeutics and techniques to manage these infections clinically and improve the outcome as these are associated with high morbidity, mortality and resistance to antifungal drugs.

Background: Healthcare-associated infections (HAIs) are a major global threat to patient safety. Systematic surveillance is crucial for understanding HAI rates and antimicrobial resistance trends and to guide infection prevention and control (IPC) activities based on local epidemiology. In India, no standardized national HAI surveillance system was in place before 2017. Methods: Public and private hospitals from across 21 states in India were recruited to participate in an HAI surveillance network. Baseline assessments followed by trainings ensured that basic microbiology and IPC implementation capacity existed at all sites. Standardized surveillance protocols for central-line–associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) were modified from the NHSN for the Indian context. IPC nurses were trained to implement surveillance protocols. Data were reported through a locally developed web portal. Standardized external data quality checks were performed to assure data quality. Results: Between May 2017 and April 2019, 109 ICUs from 37 hospitals (29 public and 8 private) enrolled in the network, of which 33 were teaching hospitals with >500 beds. The network recorded 679,109 patient days, 212,081 central-line days, and 387,092 urinary catheter days. Overall, 4,301 bloodstream infection (BSI) events and 1,402 urinary tract infection (UTI) events were reported. The network CLABSI rate was 9.4 per 1,000 central-line days and the CAUTI rate was 3.4 per 1,000 catheter days. The central-line utilization ratio was 0.31 and the urinary catheter utilization ratio was 0.57. Moreover, 3,542 (73%) of 4,742 pathogens reported from BSIs and 868 (53%) of 1,644 pathogens reported from UTIs were gram negative. Also, 1,680 (26.3%) of all 6,386 pathogens reported were Enterobacteriaceae. Of 1,486 Enterobacteriaceae with complete antibiotic susceptibility testing data reported, 832 (57%) were carbapenem resistant. Of 951 Enterobacteriaceae subjected to colistin broth microdilution testing, 62 (7%) were colistin resistant. The surveillance platform identified 2 separate hospital-level HAI outbreaks; one caused by colistin-resistant K. pneumoniae and another due to Burkholderia cepacia. Phased expansion of surveillance to additional hospitals continues. Conclusions: HAI surveillance was successfully implemented across a national network of diverse hospitals using modified NHSN protocols. Surveillance data are being used to understand HAI burden and trends at the facility and national levels, to inform public policy, and to direct efforts to implement effective hospital IPC activities. This network approach to HAI surveillance may provide lessons to other countries or contexts with limited surveillance capacity.Funding: NoneDisclosures: None

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: Despite the advent of modern neurosurgical techniques, new antibiotics, and modern imaging techniques, infection after ventriculoperitoneal (VP) shunt insertion and/or ventriculostomy is still a serious issue. Aim: The aim of this work was to study bacteriological profile and antimicrobial susceptibility pattern of cerebrospinal fluid shunt infections in infants and children. Materials and Methods: A total of 90 patients under the age of 12 years undergoing cerebrospinal fluid shunt procedures were included. The CSF shunt fluid, external ventricular drain (EVD), shunt tube tip specimens were processed as per standard microbiological techniques. The organisms isolated were subjected to antimicrobial susceptibility using the Kirby–Bauer disk diffusion method. Results: Of 20 infected patients 10 (50%) were culture positive. Most common organisms isolated were Acinetobacter baumannii 03 (30%) followed by Enterococcus faecalis 2 (20%). Two isolates of A. baumannii and one isolate of Klebsiella pneumoniae showed carbapenem resistance, which were sensitive to colistin. All Gram-positive isolates were sensitive to vancomycin and linezolid. Reinfection was found only in one (8.33%) patient. In 12 (60%) infected cases with shunt failure, revision of shunt was done. The shunt related mortality in this study was 1.11%. Conclusion: Most common organisms isolated were A. baumannii followed by E. faecalis. Carbapenem resistance was noted in these isolates which were sensitive to colistin. All Gram-positive isolates were sensitive to vancomycin and linezolid.

To identify, if Dornic acid test done on human milk bank sample is as effective as doing routine culture, both pre and post pasteurization. The authors analyzed 477 samples, both pre and post pasteurization. Dornic acid measurement was performed by using N/9 NaOH and titrated to get dornicity of the sample. Senstivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) at different Dornic acid levels were calculated. To find diagnostic power of this study, ROC curve was prepared. Dornic acid for paired pre and post pasteurization were noted and analysed for statistical significance. A significant growth was seen in 21% (98/477) samples with coagulase negative staphylococci and gram negative organisms being the major contaminants seen prior to pasteurization. In the index study, Dornic acidity ≥4°D had a sensitivity of 98% but very low specificity of just over 10%. However, 8°D had 92% specificity and acceptable sensitivity of 72% in comparison to gold standard microbiological criteria, making it a good test for analyzing the quality of milk before pasteurization. Dornic acid test at 8°D has a very high specificity with acceptable sensitivity in comparison to dornicity at 4°D. It can be used as a simple method to select better quality of milk sample prior to pasteurization.

BACKGROUND: Antibiotic resistance is a global problem in the hospitals as well as in the community. Selection pressure exerted by overuse of antimicrobial agents is the commonest predisposing factor of development of resistance. Problems faced are especially with Methicillin Resistant Staphylococcus aureus (MRSA), Vancomycin Resistant Enterococci (VRE) and Multidrug resistant Gram-negative bacilli (MDR-GNB). AIMS: A study was undertaken to find out the prevalence of all bacteria isolated in this hospital from different specimens, which are resistant to first line antibiotics and their antimicrobial susceptibility pattern with higher antibiotics during a six-month period. MATERIAL AND METHODS: All isolates from different specimens were processed by standard techniques and identified by standard biochemical tests. Antibiotic susceptibility was performed on Mueller Hinton Agar (MHA) by Kirby-Bauer Disc Diffusion Method (KBDDM), according to CLSI guidelines. Those resistant to first line antibiotics were further tested for higher antibiotics. For Extended Spectrum β-lactamse (ESBL) detection, double disc synergy method was carried out for all Gram-negative bacilli. RESULTS: Out of 2987 bacteria grown, 904 (30.3%) were multidrug resistant bacteria. Resistance to first line antibiotics was 83.4% and resistance to all higher antibiotics tested was 16.6%. Sixty percent of Staphylococcus aureus was MRSA and all were sensitive to vancomycin. Prevalence of VRE was 5.3%. Carbapenem resistant Pseudomonas aeruginosa and Acinetobacter species were 19.1% and 9.8% respectively and 10.1% of Klebsiella species was carbapenem resistant. CONCLUSIONS: This study highlights the extensive problem of antibiotic resistance encountered in this hospital. Thus, prudent and appropriate uses of antibiotics are required to reduce the emergence of resistance. Each hospital should also have its own antibiotic policy based on the susceptibility pattern of bacteria at a particular time, which should be reviewed as and when required. Rational antibiotic use and effective infection control practices can go a long way in preventing the development of antibiotic resistance.

Eumycetoma due to Madurella mycetomatis is of worldwide occurrence. It usually presents with signs of tumefaction, sinuses and grains which are the hallmarks in diagnosis of the disease. The present case was an eight year old boy admitted with moderate swelling of the forearm with a discharging sinus. The swelling had developed over a four month period. He gave history of trauma one year back to the site. He also had fever for two months. Imaging studies showed large cystic lesions in the bone. On surgical exploration it was observed that a large mass of compacted black grains (5cm X4cm) was filling the space between the radius and ulna bones. A mycological examination of the black grains revealed fungal hyphae and culture showed growth of Madurella mycetomatis. An extensive surgical debridement and voriconazole treatment for 6 weeks relieved the clinical symptoms but there was little radiological improvement. This case represents a rare presentation of mycetoma with a rapid progression of the disease over a few months, not commonly seen with eumycotic agents. The young age of the patient and the site were unusual findings. The external signs were mild and disproportionate to the extensively destructive disease seen underneath. These findings highlight the importance of an early diagnosis to prevent the devastation caused by this relentless infection which may be especially challenging in cases like this which present with unusual features.

Introduction: The production of Metallo-β-lactamases (MBLs) is one of the resistance mechanisms of Pseudomonas aeruginosa and Acinetobacter species. There is not much Indian data on the prevalence of MBLs in burns and surgical wards. Materials and Methods: A total of 145 non-duplicate isolates of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter species, isolated from pus/wound swabs and endotracheal secretions from burns and surgical wards, were tested for MBL production by modified ethylene diamine tetra acetic acid (EDTA) disc synergy and double disc synergy tests. Results: Prevalence of MBLs was 26.9% by both the above tests. All MBL-positive isolates were multidrug resistant. Only 6.06% (2/33) P.aeruginosa and 16.67% (1/06) Acinetobacter species were susceptible to piperacillin-tazobactam and netilmycin, respectively. These patients had multiple risk factors like >8 days hospital stay, catheterization, IV lines, previous antibiotic use, mechanical ventilation, etc. Graft application and surgical intervention were significant risk factors in MBL-positive patients. Overall mortality in MBL-positive patients was 34.21%. Conclusion: Emergence of MBL-producing Pseudomonas aeruginosa and Acinetobacter species in this hospital is alarming, which reflect excessive use of carbapenems and at the same time, pose a therapeutic challenge to clinicians as well as to microbiologists. Therefore, a strict antibiotic policy and implementation of proper infection control practices will go a long way to prevent further spread of MBLs. Detection of MBLs should also become mandatory in all hospitals.

Introduction: Physicians and microbiologists have long recognized that the presence of living microorganisms in the blood of a patient carries with it considerable morbidity and mortality. Hence, blood cultures have become critically important and frequently performed test in clinical microbiology laboratories for diagnosis of sepsisObjectives: To compare the conventional blood culture method with the lysis centrifugation method in cases of sepsis.Materials and Methods: Two hundred nonduplicate blood cultures from cases of sepsis were analyzed using two blood culture methods concurrently for recovery of bacteria from patients diagnosed clinically with sepsis – the conventional blood culture method using trypticase soy broth and the lysis centrifugation method using saponin by centrifuging at 3000 g for 30 minutes.Results: Overall bacteria recovered from 200 blood cultures were 17.5%. The conventional blood culture method had a higher yield of organisms, especially Gram positive cocci. The lysis centrifugation method was comparable with the former method with respect to Gram negative bacilli. The sensitivity of lysis centrifugation method in comparison to conventional blood culture method was 49.75% in this study, specificity was 98.21% and diagnostic accuracy was 89.5%. In almost every instance, the time required for detection of the growth was earlier by lysis centrifugation method, which was statistically significant. Contamination by lysis centrifugation was minimal, while that by conventional method was high. Time to growth by the lysis centrifugation method was highly significant (P value 0.000) as compared to time to growth by the conventional blood culture method.Conclusion: For the diagnosis of sepsis, combination of the lysis centrifugation method and the conventional blood culture method with trypticase soy broth or biphasic media is advocable, in order to achieve faster recovery and a better yield of microorganisms.

Introduction: Saksenaea erythrospora is a recently described species that has been reported in two human cases of cutaneous infection. The present case is, to the best of our knowledge, the first with invasive infection of the sinuses by this fungus and the first report of its isolation from India. Case presentation: A 44-year-old woman was diagnosed with a pre-septal cellulitis and pansinusitis. She was non-diabetic and did not have any other co-morbidity. The patient underwent emergency endoscopic endonasal debridement for right pansinusitis with right orbital nerve decompression and left-sided functional endoscopic sinus surgery. A right orbital exenteration was performed to prevent further spread of the infection. Debrided material from the orbit grew S. erythrospora, the identity of which was confirmed by molecular techniques. The infection spread subcutaneously to the cheek and neck. The patient was treated with intravenous amphotericin B, to which she responded favourably. Conclusion: S. erythrospora can cause rhinosinusitis and appears to have a propensity for subcutaneous spread. The fungus is present in the environment in India. Treatment with amphotericin B was successful in our case.

Introduction: Diarrhea is a frequent complication observed in patients with hematologic cancer. The normal fecal micro flora changes in chemotherapy-induced diarrhea, which shows a higher proportion of aerobic and oxygentolerant bacteria. Hence the causative bacterial pathogens maybe different than the usual etiology. Objectives: Therefore, the objective of the study was to find outthe etiology of diarrhea in children suffering from hematological malignancy and who are on chemotherapy. Material and Methods: A retrospective study was carried out on patients in hematologic unit of pediatric ward over a period of one and half years at a tertiary care hospital in Mumbai. A total of 55 stool samples from patients of hematological malignancy who presented with diarrhea, were included in this study. The samples were processed as per standard techniques and the bacterial pathogens were identified by standard biochemical tests. Results: Growth of pathogenic bacteria was seen in 15 (27.27%) stool samples, of which 13 patients had acute lymphatic leukemia(ALL) and only two patients had acute myeloid leukemia (AML). Among 15 growths, 11 grew Pseudomonas aeruginosa, two grew Morganella morganii and one each grew Aeromonas hydrophila and Klebsiella pneumoniae. Conclusion: Organisms usually considered as non pathogenic may cause disease in immunocompromised patients. Stool specimens of all leukemic patients suffering from diarrhea and on chemotherapy, should be sent routinely for culture, so as to find out the exact cause of diarrhea.

Due to inconsistent clinical presentations and the lack of a rapid, sensitive and specific test, tuberculous meningitis (TBM) is particularly difficult to diagnose. The present study was carried out to determine the utility of the polymerase chain reaction (PCR) using INS primers in the diagnosis of TBM and to compare the efficacy of two different DNA extraction protocols. Fifty-seven cerebrospinal fluid (CSF) samples from suspected cases of meningitis -- 30 definitive/possible TBM and 27 non-TBM -- were processed for microscopy, culture and PCR. Results of computer tomographic (CT) scan findings were noted. The results of smear, culture and PCR were compared using culture and/or clinical response to treatment as the gold standard. The sensitivity of microscopy, culture, CT scan and PCR was 3.3%, 26.7%, 60.0% and 66.7%, respectively. PCR following QIAmp DNA extraction had a sensitivity of 66.7% compared to PCR following a DNA extraction protocol based on the use of cetyl trimethyl ammonium bromide (CTAB) (50%). PCR was positive in all culture-positive CSF samples using either extraction method. PCR is a rapid and sensitive technique; above all, it can diagnose tuberculous meningitis at a very early stage.