Background:As the use of colistin to treat carbapenem-resistant Gram-negative infections increases, colistin resistance is being increasingly reported in Indian hospitals.Materials and Methods:Retrospective chart review of clinical data from patients with colistin-resistant isolates (minimum inhibitory concentration >2 mcg/ml). Clinical profile, outcome, and antibiotics that were used for treatment were analyzed.Results:Twenty-four colistin-resistant isolates were reported over 18 months (January 2014-June 2015). A history of previous hospitalization within 3 months was present in all the patients. An invasive device was used in 22 (91.67%) patients. Urine was the most common source of the isolate, followed by blood and respiratory samples. Klebsiella pneumoniae constituted 87.5% of all isolates. Sixteen (66.6%) were considered to have true infection, whereas eight (33.3%) were considered to represent colonization. Susceptibility of these isolates to other drugs tested was tigecycline in 75%, chloramphenicol 62.5%, amikacin 29.17%, co-trimoxazole 12.5%, and fosfomycin (sensitive in all 4 isolates tested). Antibiotics that were used for treatment were combinations among the following antimicrobials-tigecycline, chloramphenicol, fosfomycin, amikacin, ciprofloxacin, co-trimoxazole, and sulbactam. Among eight patients who were considered to have colonization, there were no deaths. Bacteremic patients had a significantly higher risk of death compared to all nonbacteremic patients (P = 0.014).Conclusions:Colistin resistance among Gram-negative bacteria, especially K. pneumoniae, is emerging in Indian hospitals. At least one-third of isolates represented colonization only rather than true infection and did not require treatment. Among patients with true infection, only 25% had a satisfactory outcome and survived to discharge. Fosfomycin, tigecycline, and chloramphenicol may be options for combination therapy.

Background:The (1,3)-β-D-glucan assay (BDG) is recommended for the early diagnosis of invasive candidiasis (IC).Methods:Records of 154 critically ill adults with suspected IC, on whom BDG was done, were analyzed. Patients were divided into three groups: Group A (confirmed IC), Group B (alternative diagnosis or cause of severe sepsis), and Group C (high candidal score and positive BDG [>80 pg/mL] but without a confirmed diagnosis of IC).Results:Mean BDG levels were significantly higher in Group A (n = 32) as compared to Group B (n = 60) and Group C (n = 62) (448.75 ± 88.30 vs. 144.46 ± 82.49 vs. 292.90 ± 137.0 pg/mL; P < 0.001). Discontinuation of empiric antifungal therapy based on a value <80 resulted in cost savings of 14,000 INR per day per patient.Conclusion:A BDG value of <80 pg/ml facilitates early discontinuation of empirical antifungal therapy, with considerable cost savings.

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Cerebral phaeohyphomycosis is an infection caused by a number of dematiaceous fungi, characterised by the presence of melanised hyphae in the invaded tissue. Cladophialophora bantiana is the most common species affecting the humans, which has a predilection for causing the central nervous system infections resulting in high mortality. We hereby report a success story of two cases of brain abscess caused by C. bantiana who were treated with surgical source reduction and voriconazole therapy.

Aims: To study the epidemiology and clinical presentation of Scrub typhus in Southern India. Study design:  Observational study Place and Duration of Study: Apollo Hospital, Chennai, India, between January 2010 and December 2011. Methodology: This is an observational study of 182 patients from a tertiary care center between January 2010 and December 2011. Cases of scrub typhus were defined by a positive IgM scrub typhus ELISA, compatible clinical features and negative workup for other pathogens. Epidemiological data and clinical data were collected from the records for the study purpose. Results: Fever (100%), headache (69.7%) and cough (47.8%) were the predominant presenting symptoms. The majority (85.7%) of cases were during the period from July to December in both the years, corresponding to the monsoon in South India. 62% of cases were from urban areas and 47.3 % of cases required admission to the critical care unit. An eschar was present in 46.7% of cases and 97.3% of the cases improved with therapy. All patients received either doxycycline or azithromycin or a combination of both as therapy. Defervescence was seen within 72 hours in 98.5% of patients.  Conclusion: Scrub typhus is a re-emerging disease in South India. It should be considered in the differential diagnosis of acute undifferentiated febrile illness even in urban areas in all age groups, especially during the monsoon season. Careful search for an eschar is important. Treatment with doxycycline or azithromycin is effective. The mortality rate is expected to be high if untreated, so we suggest that these antibiotics be part of initial empiric therapy whenever the disease is in the differential diagnosis in all severely ill patients awaiting diagnostic results.