Increased incidence of multidrug resistant (MDR) Gram negative infection has resulted in high rates of morbidity and mortality. Klebsiella pneumoniae is one of the commonest MDR pathogens causing bacteraemia with limited therapeutic options such as colistin and tigecycline. Present study focused on molecular characterisation of MDR K. pneumoniae from bloodstream infection and their clinical outcome. A total of 115 K. pneumoniae from January 2015 to September 2016 were included in the study which comprised of phenotypically identified ESBL and carbapenem resistant (CR) isolates. Multiplex PCR was performed for detection of resistance genes encoding β-lactam resistance. This includes bla, bla, bla, bla, bla, bla, bla, bla, bla, bla, bla, bla, bla and bla. Co-expression of bla, bla and bla was predominant with 64% (74/115) prevalence. CTX-M-1 was the variant produced by all the isolates producing CTX-M. AmpC was uncommon, seen in 5% of the isolates (6/115). Among the carbapenemases co-expression of bla and bla was observed in 28% (32/115) and bla in 19% (22/115) and bla in 13% (15/115). bla was absent. Overall mortality was observed to be 57% (64/113) and mortality among CR K. pneumoniae (Kp) was 68% (50/73). The antibiotics that were administered for treatment of CRKp were colistin in 90% (66/73) and tigecycline in 7% (5/73) and in 99% combined with meropenem (72/73). Prevalence of community acquired and nosocomial infections were 5% (4/73) and 95% (69/73) respectively among CRKp. Minocycline and meropenem susceptibilities were comparable and hence minocycline can be a carbapenem sparing agent. The resistance to β-lactam antibiotics is steadily increasing and are plasmid mediated, their containment in healthcare setting is a challenge.

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Rickettsial infections and Q fever are a common cause of acute febrile illness globally. Data on the role of climate and altitude on the prevalence of these infections in lacking from Southern India. In this study, we determined the sero-prevalence of scrub typhus (ST), spotted fever (SF), murine typhus (MT) and Q Fever (QF) in 8 eight geographical regions of North Tamil Nadu by detecting IgG antbodies using ELISA. Totally we tested 2565 people from 86 localities. Among the 27.3 % positives, approximately 5% were IgG positive for two or more infections. Seroprevalence to rickettsioses and Q fever was highest for individuals from rural areas and increased with age (>30 years). Those in the Nilgiris highlands (wetter and cooler) and Erode, which has the most land under irrigation, demonstrated the least exposure to rickettsioses and Q fever. Lowland plains (AOR: 8.4-22.9; 95% CI: 3.1-55.3) and highland areas upto 1000 metres (AOR: 6.1-10.3; 95% CI: 2.4-23.9) showed the highest risk of exposure to scrub typhus. For spotted fever, the risk of exposure was highest in Jawadhi (AOR:10.8; 95% CI: 2.6-44.3) and Kalrayan (AOR:16.6; 95% CI: 4.1–66.2). Q fever positivity was most likely to be encountered in Salem (AOR: 5.60; 95% CI: 1.01 – 31.08) and Kalrayan hills (AOR:12.3; 95% CI:2.9 – 51.6). Murine typhus risk was significant only in Thiruvannamalai (AOR:24.2; 95% CI: 3.3 – 178.6). Based on the data generated it seems that rickettsial infections and Q fever prevalence is low in areas which receive rainfall of ≥150 cm/yr, with average minimum and maximum temperatures between 15-25 C and elevation in excess of 2000 metres. It is also low in low land and irrigated lands with dry climate. These preliminary findings need to be validated by conducting active surveillance in these areas.