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Balaji Veeraraghavan,1 Dhanasekhar Kesavelu,2 Bijesh Yadav1 1Christian Medical College, Vellore, Tamil Nadu, 632004, India; 2SS Child Care, Mogappair, West Chennai, 600037, IndiaCorrespondence: Balaji Veeraraghavan, Christian Medical College, Vellore, Tamil Nadu, 632004, India, Tel +919442210555, Email vbalaji@cmcvellore.ac.inAbstract: Gut microbiota starts colonizing from birth and reach the adult gut microbial profile by around three years of age. There are scarce data on the gut microbial profiles of Indian infants. Moreover, there are insufficient data comparing the types of gut microbiota in Indian and Western infants, at different stages of their growth between 0 and 24 months. Also, with increasing globalization, infants of one country of origin are born in another country or travel to another country during infancy. Hence, these infants are exposed to changing environment and food practices that often causes dysbiosis or imbalance in the healthy gut microbiota profile. Dysbiosis has been linked, directly or indirectly, with many neurodevelopmental, gastrointestinal, respiratory, and other health issues. Early probiotic supplementation is associated with the return to the gut microbiota profile to a healthy state at one year and beyond. The changing global scenarios warrant the availability of a probiotic that can be used across nations. However, this is possible only if the gut microbiota profile of Indian and Western infants is similar enough to encourage the use of same probiotic in both populations. Hence, a systematic literature search was carried out to assess if the microbiota profile of the Indian and Western infants was comparable. This systematic review included 29 studies (10 Indian and 19 Western) and found that despite some differences, the gut microbiota of Indian and Western infants aged 0– 24 months are largely similar, with implications for probiotic supplementation.Keywords: gut microbiota, Indian, Western, 0.24 months, infants

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

Abstract Background Typhoid fever causes nearly 110,000 deaths among 9.24 million cases globally and disproportionately affects developing countries. As a control measure in such regions, typhoid conjugate vaccines (TCVs) are recommended by the World Health Organization (WHO). We present here the protocol of a cluster randomised vaccine trial to assess the impact of introducing TyphiBEV® vaccine to those between 1 and 30 years of age in a high-burden setting. Methods The primary objective is to determine the relative and absolute rate reduction of symptomatic, blood-culture-confirmed S. Typhi infection among participants vaccinated with TyphiBEV® in vaccine clusters compared with the unvaccinated participants in non-vaccine clusters. The study population is residents of 30 wards of Vellore (a South Indian city) with participants between the ages of 1 and 30 years who provide informed consent. The wards will be divided into 60 contiguous clusters and 30 will be randomly selected for its participants to receive TyphiBEV® at the start of the study. No placebo/control is planned for the non-intervention clusters, which will receive the vaccine at the end of the trial. Participants will not be blinded to their intervention. Episodes of typhoid fever among participants will be captured via stimulated, passive fever surveillance in the area for 2 years after vaccination, which will include the most utilised healthcare facilities. Observers blinded to the participants’ intervention statuses will record illness details. Relative and absolute rate reductions will be calculated at the end of this surveillance and used to estimate vaccine effectiveness. Discussion The results from our trial will allow countries to make better-informed decisions regarding the TCV that they will roll-out and may improve the global supplies and affordability of the vaccines. Trial registration Clinical Trials Registry of India (CTRI) CTRI/2022/03/041314. Prospectively registered on 23 March 2022 ( https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=62548&EncHid=&userName=vellore%20typhoid ). CTRI collects the full WHO Trial Registration Data Set.

Byline: W. Rose, B. Veeraraghavan, B. George Sir, Bloodstream infections (BSIs) in children with febrile neutropenia are a major source of morbidity and mortality.[sup][1] Guidelines have evolved for the use [...]

Over the last three decades, successful implementation of the diphtheria vaccination in the developed and developing countries has reduced the infections caused by the toxigenic strains of Corynebacterium diphtheriae, but a concomitant increase in the invasive infections due to the nontoxigenic strains was seen. In addition, the recent reports on the emergence of nontoxigenic toxin gene-bearing strains, having the potential to revert back to toxigenic form poses a significant threat to human beings. Besides infections caused by C. diphtheriae, the emergence of the respiratory, cutaneous and invasive infections by related pathogenic Corynebacterium species like C. ulcerans and C. pseudotuberculosis, complicate the diagnosis and management of infection. These observations together with the widespread prevalence of diphtheria in the vaccine era, necessitates the strengthening of the epidemiological surveillance and laboratory diagnosis of the pathogen. This review provides the overview of the advantages and limitations of different molecular methods and the role of MALDI- TOF in the laboratory diagnosis of Diphtheria. The contribution of next generation sequencing technology and different genotyping techniques in understanding the pathogenicity, transmission dynamics and epidemiology of the C. diphtheriae is discussed. [ABSTRACT FROM AUTHOR]

The profile of the intestinal microbiota is known to be altered in malnourished young children in low- and middle-income countries. However, there are limited studies longitudinally evaluating the intestinal microbiota in malnourished young children in resource-limited settings over the first two years of life. In this longitudinal pilot study, we determined the effect of age, residential location, and intervention on the composition, relative abundance, and diversity of the intestinal microbiota in a representative sample of children under 24 months of age with no diarrhea in the preceding 72 h in the urban and rural areas of Sindh, Pakistan nested within a cluster-randomized trial evaluating the effect of zinc and micronutrients on growth and morbidity (ClinicalTrials.gov Identifier: NCT00705445). The major findings were age-related with significant changes in alpha and beta diversity with increasing age. There was a significant increase in the relative abundance of the Firmicutes and Bacteroidetes phyla and a significant decrease in that of the Actinobacteria and Proteobacteria phyla (p < 0.0001). There were significant increases in the relative abundances of the major genera Bifidobacterium, Escherichia/Shigella and Streptococcus (p < 0.0001), and no significant change in the relative abundance of Lactobacillus. Using the LEfSE algorithm, differentially abundant taxa were identified between children in the first and second years of age, between those residing in rural and urban areas, and those who received different interventions at different ages from 3 to 24 months. The numbers of malnourished (underweight, wasted, stunted) or well-nourished children at each age, in each intervention arm, and at urban or rural sites were too small to determine if there were significant differences in alpha or beta diversity or differentially abundant taxa among them. Further longitudinal studies with larger numbers of well-nourished and malnourished children are required to fully characterize the intestinal microbiota of children in this region.