The documentation of lead toxicity (plumbism) dates back to the times when man learnt its various applications. This versatile heavy metal is non-degradable and its ability to get accumulated in the body that goes undiagnosed, makes it a serious environmental health hazard. Lead is now known to affect almost every organ/tissue of the human body. With irreversible effects on neurobiological development of young children and foetus, its toxicity has lasting implications on the human life. Outlining the symptoms, diagnosis and treatment therapy for lead poisoning, the present review elaborates the pathophysiological effects of lead on various organs. This will be of immense help to the health professionals so as to inculcate a better understanding of the lead poisoning which otherwise is asymptomatic. With chelation therapy being the classic path of treatment, new strategies are being explored as additive/adjunct therapy. It is now understood that lead toxicity is completely preventable. In this regard significant efforts are in place in the developed countries whereas much needs to be done in the developing countries. Spreading the awareness amongst the masses by educating them and reducing the usage of lead following stricter industry norms appears to be the only roadmap to prevent lead poisoning. Efforts being undertaken by the Government of India and other organisations are also mentioned.

Integrons by means of horizontal gene transfer carry multidrug resistance genes (MDR) among bacteria, including E. coli. The aim of this study was to determine the antibiotic resistance profiles and the genes associated with them, to gain insights in the distribution of phylogroups, prevalence, and characterization of class 1, 2 and 3 integrons among Enteropathogenic E. coli (EPEC) isolates, from children upto 5 years of age from Delhi and National Capital Region (NCR), India. A total of 120 E. coli isolates, including 80 from diarrheagenic E. coli (cases) and 40 from healthy isolates (controls) were recruited in this study. After isolation of E. coli, screening for EPEC was done by conventional multiplex PCR. Antibiotic suseptibility test was performed using disk diffusion method and further confirmed by minimum inhibitory concentration (MICs) by E-test. The presence and characterization of integrons and antimicrobial resistance genes were performed by PCR and DNA sequencing. Phylogeny determination was carried out by quadruplex PCR. EPEC strains were found in 64 of the 80 diarrheagenic cases, out of which 38 were MDR. In the 40 healthy controls, 23 were found to be EPEC strain, out of which only 2 were MDR. Amongst 80 diarrheagenic cases, class 1 integron were observed in 43 isolates, class 2 integron in 12 isolates and 9 isolates were found with co-existence of both. Similarly, in healthy controls; class 1 integron in 9 and class 2 integron in 7 isolates were observed with co-existence in 3 isolates. None of the isolates included class 3 integron. The dfr was the most commonly identified gene cassette within the integron-positive isolates. Phylogenetic studies showed considerable representation of phylogroup B2 in both diarrheagenic cases and healthy controls. This study reiterates the importance of class 1 integron predominantly for acquisition of antibiotic resistance genes among EPEC isolates. Furthermore, it also ascertains the possible association between multidrug resistance and presence of integrons. Approximately 91% of isolates were easily assigned to their respective phylogroups. Assessment of the relationship between antibiotic resistance and dominant phylogroups detected was also attempted. This study also highlights the increased burden of antimicrobial resistance in healthy controls.

Background & objectives: The increasing prevalence of extended-spectrum β-lactamases (ESBLs) has abated therapeutic options worldwide. This study was undertaken to investigate the molecular profile and resistance patterns of ESBLs among clinical isolates of Escherichia coli and Klebsiella pneumoniae at four tertiary care centres in India. Methods: Clinical isolates of E. coli and K. pneumoniae were collected from the All India Institute of Medical Sciences (AIIMS), New Delhi; the Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry; Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh and Christian Medical College (CMC), Vellore, over one and a half year period. Antimicrobial susceptibility was determined by Kirby-Bauer disc diffusion method. ESBLs were confirmed phenotypically, and multiplex PCR was performed to identify genes for β-lactamases ( bla TEM , bla SHV , bla OXA-1 , bla CTXM-1 , bla CTXM-2 , bla CTXM-9 and bla CTXM-15 ). Results: Among 341 E. coli isolates collected during the study period, 171 (50%) harboured bla TEM , 145 (43%) bla OXA-1 , 70 (21%) bla CTXM-1 , 19 (6%) bla SHV and four (1%) harboured bla CTXM-2 . Phenotypically, combined disc test detected ESBL production in 98/298 (33%) E. coli . Among 304 K. pneumoniae isolates, 115 (38%), 89 (29%), 83 (27%), 64 (21%) and two (0.6%) harboured bla TEM , bla OXA-1 , bla CTXM-1 , bla SHV and bla CTXM-2 , respectively. Combined disc test (CDT) detected ESBL production in 42 per cent K. pneumoniae . Most of the bla CTXM-1 positive isolates were also bla CTXM-15 positive. The carbapenem susceptibility ranged from 56 to 88 per cent for E. coli and from 20 to 61 per cent for K. pneumoniae . Antibiotic sensitivity patterns showed that colistin (CST) was the most sensitive drug for both E. coli (271/274, 99%) and K. pneumoniae ...

Background: Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are increasingly common; however, predicting which patients are likely to be infected with an ESBL pathogen is challenging, leading to increased use of carbapenems. To date, five prediction models have been developed to distinguish between patients infected with ESBL pathogens. The aim of this study was to validate and compare each of these models, to better inform antimicrobial stewardship. Methods: This was a retrospective cohort study of patients with gram-negative bacteremia treated at the South Texas Veterans Health Care System over 3 months from 2018 to 2019. We evaluated isolate, clinical syndrome, and score variables for the five published prediction models/scores: Italian “Tumbarello”, Duke, University of South Carolina (USC), Hopkins Clinical Decision Tree, and Modified Hopkins. Each model was assessed using the receiver-operating-characteristic curve (AUROC) and Pearson correlation. Results: 145 patients were included for analysis, of which 20 (13.8%) were infected with an ESBL E. coli or Klebsiella spp. The most common sources of infection were genitourinary (55.8%) and gastrointestinal/intraabdominal (24.1%) and the most common pathogen was E. coli (75.2%). The prediction model with the strongest discriminatory ability (AUROC) was Tumbarello (0.7556). Correlation between prediction model score and percent ESBL was strongest with Modified Hopkins (R2=0.74). Conclusions: In this veteran population, the Modified Hopkins and Duke prediction models were most accurate in discriminating between gram-negative bacteremia patients when considering both AUROC and correlation. However, given the moderate discriminatory ability, many patients with ESBL Enterobacteriaceae (at least 25%) may still be missed empirically.

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Introduction: Urinary tract infection (UTI) is a common complication after kidney transplant,prevalence ranging from 35 to 79%,associated with graft loss and increased healthcare cost 1. Beta-lactam antibiotics are the most frequently prescribed antimicrobial in the United States and worldwide 2. Nowadays ESBL(Extended-spectrum beta-lactamases) producing organism has become a major cause of concern causing antibiotic resistance 3,4 Very little data is available for antibiotic resistance pattern in developing world & further studies are needed in this area.The aim of this study is to determine the incidence of UTI and causative organisms,antibiotic susceptibility and resistance pattern over last four years. Methods: This is a retrospective observational-single center study conducted at PSRI Hospital, New Delhi.Post renal transplant patients between January 2015-July 2018 who had symptomatic UTI and urine culture positive were taken as subjects.The minimum follow up period of 3 months post transplant was taken as inclusion criteria.All the patients after transplant received triple immmunosuppression which included Tacrolimus, Mycophenolate and Steroids according to center protocol.Urine culture was performed with manual semi-quantitative technique & further identification & antimicrobial susceptibility testing was done using VITEK2.0 compact (Biomerieux,France).Antibiotics were prescribed according to their sensitivity report. ESBL positive organisms were defined as resistance to 3rd generation cephalosporins including ceftazidime.The data was entered in MS EXCEL spreadsheet & analysis was done using SPSS version 21.0.Statistical tests applied are Chi-Square test & Kaplan-Meier survival analysis curve.p value of < 0.05 was considered statistically significant. Results: A total of 91 episodes of UTI were identified in 66 subjects out of 211 urine samples processed.Incidence of infections were more common in initial 3 months(41.7%) following transplant possibly due to higher immunosuppression during this period.Growth of Gram Negative in 87(95.60%) & Gram positive in 4(4.40%) patients with Escherichia coli(57.1%) being the commonest followed by Klebsiella pneumoniae(28.5%),Pseudomonas(6.5%),Enterococcus spp.(3.3%) and Enterobacter (1.1%)(Table 1).Incidence of ESBL positive infection increased from 19.23% in 2015 to 34.62% in 2018.Resistance to antibiotics increased over last four years Example Amikacin(from 23% to 43%),Levofloxacin(from 61% to 82%),Ceftazidime(from 18% to 21%) & Meropenem(from 28% to 51%)(Picture).Even resistance to higher antibiotics such as Colistin which was not there in 2015 but was present in 2018(10%)(Picture).Kaplan-Meier curve showed that Infection free survival rates were better in 2015(66%) when compared with 2018(57%)

Introduction: The morbidity and mortality of the COVID-19 pandemic have disproportionately burdened Hispanic populations in the United States. While health equity research is typically conducted in populations where Hispanics are the minority, this project analyzes COVID-19 racioethnic transmission trends over the first 6 months of the pandemic within a large majority-minority city in South Texas. Methods: Patients diagnosed with COVID-19 across inpatient, emergency department, and outpatient settings of a large county health system were included in a clinical registry. For 4644 COVID-19-positive patients between March 16 and August 31, 2020, demographic and clinical data were abstracted from the registry. Race/ethnicity trends over time were compared for patients with and without COVID-19 diagnoses. Logistic regressions identified predictors of inpatient diagnosis by age, race/ethnicity, and testing delay. Results: The proportion of patients with COVID-19 identifying as Hispanic increased rapidly during the pandemic's first months: from 55.6% in March to 85.7% in June. A significantly greater proportion of patients identified as Hispanic within the COVID-19 cohort compared to other diagnoses cohort. Testing delay was 11.6% longer for Hispanic patients, with each day of testing delay associated with 7% increased odds of inpatient COVID-19 diagnosis. Conclusion: These findings highlight the disproportionate impact of COVID-19 on Hispanic populations even within a majority-minority community. In the United States, Hispanic persons are more likely to work frontline jobs, live in multigenerational homes in poverty, and be uninsured. The burden of COVID-19 cases within Bexar County's largest hospital system reflects this systemic inequity. Identifying racioethnic health disparities supports efforts toward mitigating structural factors that predispose minority groups to illness and death.