Modern diagnostic and therapeutic procedures including advanced surgeries, organ transplants, and immunotherapy are pillared by antimicrobial therapy. Parallel to the rising incidence of infectious diseases, the menace of antimicrobial resistance (AMR) emerged worldwide. Developing countries are facing the brunt in epidemic proportions due to huge population, substandard housing, overcrowding, rapid unplanned urbanization, deterioration in water and waste management systems, strained public health infrastructure, and limited resource allocation to healthcare. Simultaneously, AMR has adversely affected the outcome of military injuries. The rising problem of AMR is discouraging the development of newer antimicrobials by the pharmaceutical industry. There has been a considerable impetus towards concept development; however, the magnitude of the problem overshadows the progress made towards the control of AMR worldwide. There is a dire need to identify this threat, develop concerted multipronged strategy, develop infrastructure, foster expertise, and take coordinated and urgent steps to tackle the serious public health challenge. An intensified commitment needs to be taken up on a war footing at individual, local, national, regional, and international levels. This article discusses the overall concept for developing countries.
A B ST R AC T Introduction: Enteric-fever is a major public-health problem in developing countries emerging as multidrug-resistant, Nalidixic-acid resistant and extremely drug-resistant Salmonella (Pakistan, 2016), has intensified the use of WHO watch/reserve group antimicrobials such as azithromycin and meropenem. Methods: This ambispective-study was conducted on 782 non-repeat blood-culture isolates of S. Typhi, S. Paratyphi A and S. Paratyphi B obtained from 29,184 blood cultures received at a 1000-bedded tertiary-care hospital of North-India from 2011-2017. Identification and antibiograms were obtained by Vitek-2 compact and Kirby-Bauer's disc diffusion with resistance to ampicillin, chloramphenicol and cotrimoxazole being labeled as multidrug-resistant. Decreased ciprofloxacin-susceptibility and ciprofloxacin-resistance were defined as MIC 0.125-0.5 and >1 µg/ml. Results: S. Typhi and S. Paratyphi A in a ratio of 3.9:1 were seen between July-September predominantly distributed between 6-45 year age group. Resistance to co-trimoxazole, chloramphenicol, ceftriaxone and azithromycin was 6.1%, 13.8%, 16.1 and 5.78% respectively. Multidrug-resistant S. typhi and S. paratyphi A were 2.73% and 1.91% respectively. Conclusion: Enteric-fever is a major public-health problem in India. Emergence of multidrug-resistant, Nalidixic-acid resistant and extremely-drug resistant Salmonella mandates ongoing surveillance for targeted empirical therapy and containment of spread. Repeated epidemics call for water, sanitation, hygiene and vaccination strategies to sustain herd-immunity. K E Y WO R D S antimicrobial resistance; enteric fever; multidrug-resistant Salmonella
Introduction: Curvularia is an emerging dematiaceous/melanized/phaeoid hyphomycete causing ocular curvulariosis including keratomycosis, conjunctivitis, dacryocystitis, sino-orbital cellulitis, and endophthalmitis. Curvularia ketatomycosis may be associated with satellite stromal infiltrates, immune rings, Descement's folds, iriditis, and endothelial plaque. Surgical trauma followed by delayed tissue healing may render cornea susceptible to invasion by exogenous air-dispersed conidia from environment. Cases Presentation: Curvularia lunata keratomycosis occurred in 2 military veterans after phacoemulsification and intraocular lens implantation without any history of trauma. Topical 5% natamycin was effective for treatment resulting in minimal residual scar. Complete recovery and uneventful 1-year follow-up period was observed. Conclusions: Seven out of 30 Curvularia species are emerging as opportunistic human pathogens from being primary phytopathogens. With increasing ocular surgeries in the diabetic populace amongst general population including military veterans, a high index of clinical and microbiological suspicion is required for optimal diagnosis of emerging pathogens in post-operative keratomycosis.
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