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Introduction: In India, multiple antibiotic resistances are rapidly growing in the bacterial population with a rising threat to public health. To overcome the effect of extended-spectrum beta-lactamases (ESBL), Metallo beta-lactamases (MBL) and carbapenemaseproducing organisms, very few antibiotics are effective; the need of the hour is a new antibiotic or drug combination. Various studies suggested that antibiotic adjuvant therapies can be an alternate approach to curb the rate of drug resistance in microorganisms. A new antibiotic combination of ceftriaxone+ sulbactam+ EDTA (CSE) has recently been proposed to tackle MDR organisms. Aim: To evaluate the in-vitro efficacy of a new antibiotic adjuvant entity CSE, among the Vitek-2 (Biomerieux, France) confirmed Multidrug Resistant (MDR) strains isolated from specimens of Intensive Care Unit (ICU) patients. Materials and Methods: A cross-sectional descriptive study was conducted on a total of 100 consecutive MDR organisms isolated from specimens of ICU admitted patients in NRI general hospital and super specialty care centre in Guntur district, Andhra Pradesh, India. Bacterial growth on the medium was identified using an automated Vitek-2 system using gram negative and gram positive identification card and Antimicrobial Susceptibility Testing (AST) cards. The isolates were identified as ESBL, MBL, AmpCbeta-lactamase, and carbapenemases producing organisms and tested for sensitivity to CSE drug-using Epsilometer (E)-test strips with Minimum Inhibitory Concentrations (MIC) gradient of 0.016-256 µg/mL, and interpreted as sensitive, and resistant based on breakpoints. A descriptive statistical analysis was done by calculating the frequencies of the variables. Results: The more prevalent MDR pathogens were Escherichia coli (36%), Pseudomonas aeruginosa (18%), Klebsiella pneumoniae (15%), and Proteus species (10%). Among Escherichia coli MDR isolates, 16.7% were ESBL+MBL producing and 83.3% were carbapenemase-producing with good susceptibility to CSE 86.7% and 83.3% respectively. Among Pseudomonas aeruginosa 83.3% of ESBL+MBL and carbapenemase-producing organisms were susceptible to CSE. Overall, 88% of MDR strains were sensitive and 12% were resistant to novel CSE combinations among 100 MDR isolates. Conclusion: The novel antibiotic-adjuvant combination CSE is highly effective (88% susceptibility) against ESBL/MBL, AmpC, and carbapenemase-producing MDR bacteria. The enhanced susceptibility may be due to the synergistic effect of all three molecules in the combination. [ABSTRACT FROM AUTHOR]

Introduction: In India, multiple antibiotic resistance are rapidly growing in the bacterial population with a rising threat to public health. To overcome the effect of extended-spectrum beta-lactamases (ESBL), Metallo beta-lactamases (MBL) and carbapenemase-producing organisms, very few antibiotics are effective, the need of the hour is a new antibiotic or drug combination. Various studies suggested that antibiotic adjuvant therapies can be an alternate approach to curb the rate of drug resistance in microorganisms. A new antibiotic combination of ceftriaxone+sulbactam+Ethylene Diamine Tetra Acetic Acid (EDTA) (CSE) has recently been proposed to tackle Multidrug Resistant (MDR) organisms. Aim: To evaluate the in-vitro efficacy of a new antibiotic adjuvant entity CSE, among the Vitek-2 (Biomerieux, France) confirmed MDR strains isolated from specimens of Intensive Care Unit (ICU) patients. Materials and Methods: A cross-sectional descriptive study was conducted on a total of 100 consecutive MDR organisms isolated from specimens of ICU admitted patients in NRI general hospital and super specialty care centre in Guntur district, Andhra Pradesh, India from January 2021-May 2021. Bacterial growth on the medium was identified using an automated Vitek-2 system using Gram negative and Gram positive identification card and Antimicrobial Susceptibility Testing (AST) cards. The isolates were identified as ESBL, MBL, AmpC-beta-lactamase, and carbapenemases producing organisms and tested for sensitivity to CSE drug-using Epsilometer (E)-test strips with Minimum Inhibitory Concentrations (MIC) gradient of 0.016-256 μg/mL, and interpreted as sensitive, and resistant based on breakpoints. A descriptive statistical analysis was done by calculating the frequencies of the variables. Results: The more prevalent MDR pathogens were Escherichia coli (36%), Pseudomonas aeruginosa (18%), Klebsiella pneumoniae (15%), and Proteus species (10%). Among Escherichia coli MDR isolates, 16.7% were ESBL+MBL producing and 83.3% were carbapenemase-producing with good susceptibility to CSE 86.7% and 83.3%, respectively. Among Pseudomonas aeruginosa 83.3% of ESBL+MBL and carbapenemase-producing organisms were susceptible to CSE. Overall, 88% of MDR strains were sensitive and 12% were resistant to novel CSE combinations among 100 MDR isolates. Conclusion: The novel antibiotic-adjuvant combination CSE is highly effective (88% susceptibility) against ESBL/MBL, AmpC, and carbapenemase-producing MDR bacteria. The enhanced susceptibility may be due to the synergistic effect of all three molecules in the combination.

Purpose: This study was conducted to estimate the prevalence of metallo-β-lactamases (MBL)-producing Pseudomonas aeruginosa isolates obtained from various clinical samples and to compare the diagnostic strength of different phenotypic MBL-detection tests and also to know the performance of ethylene diamine tetraacetic acid (EDTA) disk potentiation test (PT) which is the least studied. Materials and Methods: This study included 160 nonconsecutive isolates of P. aeruginosa collected over a period of 1-year. Resistance to carbapenems and ceftazidime was used for screening of isolates. Positively screened isolates were further subjected to five different MBL detecting phenotypic tests-MBL Epsilometer test (E-test), combined disk test (CDT), double-disk synergy test (DDST), EDTA disk PT using four cephalosporins and modified Hodge test (MHT). MBL E-test was considered as gold standard for MBL detection. Results: Based on the screening criteria for MBL production, 66 isolates were screened positive. The prevalence of MBL producing isolates of P. aeruginosa was 15% (24/160) based on E-test result. MHT showed the highest sensitivity (87.5%), followed by CDT (79.2%), while specificity was highest for DDST (100%), followed by PT (95.2%). Out of 24 MBL producers, 15 isolates (62.5%) were resistant to both imipenem (IPM) and meropenem. Conclusion: The early detection of MBL-producing P. aeruginosa may help inappropriate antimicrobial therapy and avoid the development and dissemination of these strains. Hence, routine detection of MBL production in P. aeruginosa should be undertaken. We recommend that all IPM and/meropenem-resistant P. aeruginosa isolates should be routinely screened for MBL production using CDT and the positive isolates may further be confirmed by MBL E-test or PCR. EDTA disk PT had low sensitivity.

Purpose: This study was conducted to estimate the prevalence of metallo-β-lactamases (MBL)-producing Pseudomonas aeruginosa isolates obtained from various clinical samples and to compare the diagnostic strength of different phenotypic MBL-detection tests and also to know the performance of ethylene diamine tetraacetic acid (EDTA) disk potentiation test (PT) which is the least studied. Materials and Methods: This study included 160 nonconsecutive isolates of P. aeruginosa collected over a period of 1-year. Resistance to carbapenems and ceftazidime was used for screening of isolates. Positively screened isolates were further subjected tofive different MBL detecting phenotypic tests-MBL Epsilometer test (E-test), combined disk test (CDT), double-disk synergy test (DDST), EDTA disk PT using four cephalosporins and modified Hodge test (MHT). MBL E-test was considered as gold standard for MBL detection. Results: Based on the screening criteria for MBL production, 66 isolates were screened positive. The prevalence of MBL producing isolates of P. aeruginosa was 15% (24/160) based on E-test result. MHT showed the highest sensitivity (87.5%), followed by CDT (79.2%), while specificity was highest for DDST (100%), followed by PT (95.2%). Out of 24 MBL producers, 15 isolates (62.5%) were resistant to both imipenem (IPM) and meropenem. Conclusion: The early detection of MBL-producing P. aeruginosa may help inappropriate antimicrobial therapy and avoid the development and dissemination of these strains. Hence, routine detection of MBL production in P. aeruginosa should be undertaken. We recommend that all IPM and/meropenem-resistant P. aeruginosa isolates should be routinely screened for MBL production using CDT and the positive isolates may further be confirmed by MBL E-test or PCR. EDTA disk PT had low sensitivity. [ABSTRACT FROM AUTHOR]

To assess the pattern of antimicrobial resistance of Helicobacter pylori isolates from peptic ulcer disease patients of Chandigarh, Delhi, Lucknow, Hyderabad and Chennai in India, and to recommend an updated anti- H. pylori treatment regimen to be used in these areas. Two hundred and fifty-nine H. pylori isolates from patients with peptic ulcer disease reporting for clinical management to the Post Graduate Institute of Medical Education and Research, Chandigarh; All India Institute of Medical Sciences, New Delhi; Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow; Deccan College of Medical Sciences and Allied Hospitals, Hyderabad; and hospitals in Chennai in collaboration with the Dr ALM Post Graduate Institute of Basic Medical Sciences were analyzed for their levels of antibiotic susceptibility to metronidazole, clarithromycin, amoxycillin, ciprofloxacin and tetracycline. The Epsilometer test (E-test), a quantitative disc diffusion antibiotic susceptibility testing method, was adopted in all the centers. The pattern of single and multiple resistance at the respective centers and at the national level were analyzed. Overall H. pylori resistance rate was 77.9% to metronidazole, 44.7% to clarithromycin and 32.8% to amoxycillin. Multiple resistance was seen in 112/259 isolates (43.2%) and these were two/three and four drug resistance pattern to metronidazole, clarithromycin, amoxycillin observed (13.2, 32 and 2.56%, respectively). Metronidazole resistance was high in Lucknow, Chennai and Hyderabad (68, 88.2 and 100%, respectively) and moderate in Delhi (37.5%) and Chandigarh (38.2%). Ciprofloxacin and tetracycline resistance was the least, ranging from 1.0 to 4%. In the Indian population, the prevalence of resistance of H. pylori is very high to metronidazole, moderate to clarithromycin and amoxycillin and low to ciprofloxacin and tetracycline. The rate of resistance was higher in southern India than in northern India. The E-test emerges as a reliable quantitative antibiotic susceptibility test. A change in antibiotic policy to provide scope for rotation of antibiotics in the treatment of H. pylori in India is a public health emergency. [ABSTRACT FROM AUTHOR]