The antibiotic era started in the 1940s and changed the profile of infectious diseases and human demography. The burgeoning classes and numbers promised much and elimination of this major cause of human (and animal) morbidity appeared possible. Bacterial antibiotic resistance which was observed soon after antibiotic introduction has been studied extensively. Diverse mechanisms have been demonstrated and the genetic basis elucidated. The resilience of the prokaryote ecosystems to antibiotic stress has been realized. The paper presents these subjects briefly to afford an overview. The epidemiology of antibiotic resistance is dealt with and community practices in different countries are described. The role of high antibiotic usage environments is indicated. The implication of the wide use of antibiotics in animals has been pointed out. Steadily increasing antibiotic resistance and decreasing numbers of newer antibiotics appear to point to a post-antibiotic period during which treatment of infections would become increasingly difficult. This article attempts to review the global antimicrobial resistance scene and juxtaposes it to the Indian experience. The prevalence in India of antibiotic resistance among major groups of pathogens is described. The factors that determine the prevalent high antibiotic resistance rates have been highlighted. The future research activity to ensure continued utility of antibiotics in the control of infections has been indicated.

Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen in India, and up to 70% methicillin resistance has been reported from hospitals in various parts of India. Hospitals use phenotyping for the most part, and molecular genotyping is not done. Here we report on the genotyping of 82 single-patient isolates from two hospitals in Bangalore, South India, for the first time. Most of the strains possessed type III or IIIA staphylococcal cassette chromosome (SCCmec) cassettes, and we did not detect strains with type I, IA, or II cassettes. Most isolates also contained the type III cassette chromosome recombinase (ccr) AB region. Multilocus sequence typing (MLST) and staphylococcal protein A (spa) typing of a selected number of isolates have been carried out. Although most isolates that were chosen for MLST and spa typing had the same patterns, they were quite diverse in their pulsed-field gel electrophoresis (PFGE) patterns. PFGE, MLST, and spa typing of the Indian strains revealed that they are related to the previously described Hungarian and Brazilian clones.Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen causing pyogenic, disseminated, and toxinmediated infections (7,18,20). MRSA bacteremia is associated with significantly higher mortality than is known for methicillin-susceptible S. aureus bacteremia (6). Genotyping data from large international studies have shown that a few clones of MRSA are responsible for the spread of the disease in various parts of the world (4,8,18). Methicillin resistance among S. aureus isolates has reached phenomenal proportions in Indian hospitals, with some cities reporting that up to 70% of the strains are resistant to methicillin (2). About 40 to 50% of S. aureus strains isolated from the burn and trauma wards in hospitals in and around Bangalore, India, are resistant (13). For the present study, clinical isolates have been collected from two major hospitals in the city of Bangalore. Many of these MRSA strains are multidrug resistant, and they are characterized only phenotypically at present. The discriminatory power of most of the phenotypic methods is restricted and ambiguous (10, 21). Molecular typing methods have in the last few years paved the way for sophisticated techniques to track the source and transmission route of bacterial pathogens in hospital outbreaks and have also helped in establishing epidemiological investigations comparing strains across continents (1, 4, 23). Pulsed-field gel electrophoresis (PFGE) has been shown to be highly discriminatory in analyzing hospital outbreaks and tracking genetic changes which occur in a relatively short time, while multilocus sequence typing (MLST) is more suitable for studying long-term genetic variations (5,8,16,24). The aim of this study was to characterize the Indian isolates by PFGE, MLST, and spa typing techniques, which would aid in controlling hospital outbreaks, epidemiological studies, and comparison with international strains. MATERIALS AND METHODS Hospitals.St. Joh...

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Importance There is no concrete evidence on the burden of TB among the tribal populations across India except for few studies mainly conducted in Central India with a pooled estimation of 703/100,000 with a high degree of heterogeneity. Objective To estimate the prevalence of TB among the tribal populations in India. Design, participants, setting A survey using a multistage cluster sampling design was conducted between April 2015 and March 2020 covering 88 villages (clusters) from districts with over 70% tribal majority populations in 17 States across 6 zones of India. The sample populations included individuals ≥15 years old. Main outcome and measures Eligible participants who were screened through an interview for symptoms suggestive of pulmonary TB (PTB); Two sputum specimens were examined by smear and culture. Prevalence was estimated after multiple imputations for non-coverage and a correction factor of 1.31 was then applied to account for non-inclusion of X-ray screening. Results A total of 74532 (81.0%) of the 92038 eligible individuals were screened; 2675 (3.6%) were found to have TB symptoms or h/o ATT. The overall prevalence of PTB was 432 per 100,000 populations. The PTB prevalence per 100,000 populations was highest 625 [95% CI: 496–754] in the central zone and least 153 [95% CI: 24–281] in the west zone. Among the 17 states that were covered in this study, Odisha recorded the highest prevalence of 803 [95% CI: 504–1101] and Jammu and Kashmir the lowest 127 [95% CI: 0–310] per 100,000 populations. Findings from multiple logistic regression analysis reflected that those aged 35 years and above, with BMI <18.5 Kgs /m2, h/o ATT, smoking, and/or consuming alcohol had a higher risk of bacteriologically positive PTB. Weight loss was relatively more important symptom associated with tuberculosis among this tribal populations followed by night sweats, blood in sputum, and fever. Conclusion and relevance The overall prevalence of PTB among tribal groups is higher than the general populations with a wide variation of prevalence of PTB among the tribal groups at zone and state levels. These findings call for strengthening of the TB control efforts in tribal areas to reduce TB prevalence through tribal community/site-specific intervention programs.

Evaluation of polyarthritis in 110 patients in civilian and armed force life revealed 89 with rheumatoid arthritis (RA). In the Indian population, RA seems milder and confined to the joints. A substantial number of male patients appeared to share features with spondylarthritis, often in HLA-B27 positive individuals.