IntroductionDiarrhea is a common complication of acquired immune deficiency syndrome (AIDS), occurring in almost 90% of AIDS patients in developing countries like India. The present study was aimed to determine the prevalence and microbiological profile of pathogens associated with diarrhea in human immunodeficiency virus (HIV) positive patients and their relation to CD4 counts.Materials and methodsForty-five successive HIV-positive patients, 27 with diarrhea (study group) and 18 without diarrhea (control group), were included in the three-month study. The HIV infection was confirmed by three different antibody detection tests. The stool samples were collected on two consecutive days and were examined for parasites by microscopy using wet mount and modified Ziehl-Neelsen stain. They were examined for bacteria by Gram stain and conventional Ziehl-Neelsen stain and were inoculated on appropriate culture media. The isolates were identified by standard biochemical tests, followed by antibiotic susceptibility testing using the Kirby-Bauer disc diffusion method.Results Twenty-four pathogens were detected in diarrheal HIV-positive patients, including 14 parasites (58.33%), seven bacteria (29.17%), and three fungi (12.50%). Isospora sp. was the most common parasite (25.9%) followed by Cryptosporidium sp. (14.8%). Other parasites included Cyclospora sp., Strongyloides stercoralis, and Entamoeba histolytica (3.7% each).​ Escherichia coli (18.5%) was the most common bacterial isolate, of which, 80% were Enterotoxigenic E. coli (ETEC) while 20% were Enteropathogenic E. coli (EPEC). Other isolates included Shigella flexneri and Mycobacterium tuberculosis (3.7% each). The isolates were sensitive to furazolidone (94.11%), chloramphenicol (76.47%), and gentamicin (52.94%). The isolates from diarrheal patients showed resistance to norfloxacin (5.88% vs. 50%, p<0.05) as compared to those from non-diarrheal patients. The diarrheal HIV-positive patients had lower mean CD4 counts (202.6 cells/µL), as compared to those without diarrhea (239.28 cells/µL).Conclusion Isospora sp. is the most common parasite and Escherichia​ coli is the most common bacterium associated with diarrhea in HIV patients. The antibiotic sensitivity patterns should be monitored regularly to detect resistance to commonly used drugs. The prevalence of organisms in a region, various clinical manifestations, sensitivity patterns of isolates, and relation with CD4 count should be considered while instituting therapy in HIV patients with diarrhea.

Background: As infection is a major cause of morbidity and mortality in neonates, early diagnosis and prompt treatment can prevent its serious consequences. The present study was conducted to determine the prevalence of infections in neonatal intensive care unit (NICU) of a tertiary care hospital and to study their risk factors, causative organisms and antimicrobial susceptibility pattern.Methods: Appropriate samples were collected from all neonates with clinical signs and symptoms of infections. Isolation of microorganisms, their identification and antimicrobial susceptibility was done according to standard microbiological techniques.Results: Among 1210 neonates admitted in the NICU, 393 (32.4%) were clinically suspected infections. The prevalence of Septicemia, Pneumonia, and Meningitis were 6%, 1.5%, 0.7% respectively. The predominant organisms causing neonatal infection were Gram negative bacteria followed by fungi and Gram positive bacteria. Among Gram negative bacteria, the antimicrobial resistance was highest for third generation Cephalosporins [Ceftazidime (81.1%), Cefotaxime (60.3%)]. In Gram positive bacteria highest resistance was observed for Penicillin and Ampicillin (91.3%). Methicillin resistance was observed in 91.6% of Coagulase negative Staphylococci (CoNS). All isolates of Candida parapsilosis were sensitive to Fluconazole, Voriconazole but resistant to Amphotericin B. Predominant risk factors were low birth weight (87.7%) and prematurity (75%). Maternal risk factors were pregnancy induced hypertension (13.4%) and premature rupture of membranes (PROM) (10.1%). The case fatality rate was 20.7%.Conclusions: There is a need of strict infection control measures and rational antibiotic policy to reduce the economic burden of hospital and community due to neonatal infections.

Background Levonadifloxacin is a novel antibiotic belonging to the benzoquinolizine subclass of fluoroquinolones with potent activity against MRSA and quinolone-resistant Staphylococcus aureus. IV levonadifloxacin and its oral prodrug alalevonadifloxacin have recently been approved in India for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) including diabetic foot infections. Objectives To investigate the in vitro activity of levonadifloxacin against contemporary clinical isolates collected from multiple tertiary care hospitals across India in the Antimicrobial Susceptibility Profiling of Indian Resistotypes (ASPIRE) surveillance study. Methods A total of 1376 clinical isolates, consisting of staphylococci (n = 677), streptococci (n = 178), Enterobacterales (n = 320), Pseudomonas aeruginosa (n = 140) and Acinetobacter baumannii (n = 61), collected (2016–18) from 16 tertiary hospitals located across 12 states in India, were included in the study. The MICs of levonadifloxacin and comparator antibiotics were determined using the reference agar dilution method and broth microdilution method. Results Levonadifloxacin exhibited potent activity against MSSA (MIC50/90: 0.5/1 mg/L), MRSA (MIC50/90: 0.5/1 mg/L) and levofloxacin-resistant S. aureus (MIC50/90: 1/1 mg/L) isolates. Similarly, potent activity of levonadifloxacin was also observed against CoNS including MDR isolates (MIC50/90: 1/2 mg/L). Against Streptococcus pneumoniae, levonadifloxacin (MIC50/90: 0.5/0.5 mg/L) showed superior activity compared with levofloxacin (MIC50/90: 1/2 mg/L). Among levofloxacin-susceptible Enterobacterales, 80.6% of isolates were inhibited at ≤2 mg/L levonadifloxacin. Conclusions Levonadifloxacin displayed potent activity against contemporary MRSA and fluoroquinolone-resistant staphylococcal isolates, thus offering a valuable IV as well as an oral therapeutic option for the treatment of ABSSSIs. Furthermore, levonadifloxacin exhibited a broad-spectrum activity profile as evident from its activity against streptococci and levofloxacin-susceptible Gram-negative isolates.

Background: Staphylococcal spp. are recognized as one of the most frequent causes of biofilm associated infections. In routine microbiology laboratories, standard method for testing antibiotic susceptibility is Kirby-Bauer disc diffusion method and minimum inhibitory concentration (MIC) which determine the antibiotic susceptibilities in planktonic phase. However, isolates capable of producing biofilm exist in biofilm state. Thus,antibiotics prescribed based on routine methods fail to eradicate biofilms thereby causing persistent infection and possible treatment failure. Thus, this work was designed to study prevalence of biofilm producing staphylococci, its resistance profile and to perform MIC versus MBIC (Minimum biofilm inhibitory concentration) in representative biofilm positive isolates.Methods and materials: 335 clinical isolates of staphylococci included in the study were screened for biofilm formation phenotypically by Congo red agar (CRA) and Tissue culture plate method (TCPM) followed by detection of biofilm genes (icaAD,aap,atlE) by PCR. Antibiotic susceptibility testing was done for biofilm positive isolates. MIC versus MBIC testing was performed for representative biofilm positive isolates for cefoxitin and vancomycin. MIC was done by broth microdilution and MBIC testing was performed using Calgary Biofilm Device. Results were interpreted according to CLSI guidelines,2015.Results: 77/335 (30%) staphylococcal isolates were biofilm positive of which S.haemolyticus (n = 35, 45.5%) was predominant followed by S. aureus (n = 27, 35.1%) and S.epidermidis (n = 15, 19.5%). By CRA, 22 (28.6%) isolates produced black colonies after 24 hours. By TCPM, 4 (5.2%), 1 (1.3%) & 49 (63.6%) isolates showed strong, moderate and weak biofilm production respectively. Overall, 77 isolates harboured biofilm genes (47aap,15atlE,15aap+atlE,5icaAD+aap+atlE).43/77 (55.8%)isolates were methicillin resistant. Highest resistance was found towards ciprofloxacin (74%) followed by erythromycin (70.1%),cotrimoxazole (65%) and pristinamycin (65%) respectively. MIC and MBIC were compared for 25 representative biofilm positive isolates. Cefoxitin MIC and MBIC ranged between 2-1024 g/mL and 8-2048 g/mL respectively. Vancomycin MIC and MBIC ranged between 0.5-8 g/mL and 2-512 g/mL respectively. Both cefoxitin and vancomycin MBIC values were 2-64 folds higher than their respective MIC. Conclusion:The present study documents biofilm producing capability in 30% of isolates. The antibiotic sensitivities of organisms in planktonic phase tested by MIC were significantly higher than for the same organism in their biofilm state as tested by MBIC. The results of the study questions the use of vancomycin as last resort antibiotic for biofilm-associated staphylococcal infections.

Influenza-like illness (ILI) and acute respiratory infection (ARI) are common presentations during winter, and indiscriminate antibiotic use contributes significantly to the emerging post-antibiotic era. Although viral agents causing ILI are predominant, they are indistinguishable from the bacterial agents based on the clinical features alone. The present study was aimed at determining the bacterial agents associated with ILI and their susceptibility pattern during a study done in a community setting in Pune during a surveillance of ILI between March 2013 to November 2016.Throat swabs from 512 suspected ILI cases were processed, and organisms were identified by the standard conventional method. An antimicrobial susceptibility testing was done as per the Clinical Laboratory Standard Institute (CLSI) guidelines.The patients comprised 238 males and 274 females with the majority (38.7%) in the age group of ≤10 years. Bacteria could be isolated from 9.8 % of the patients. The predominant bacteria included beta-hemolytic Streptococcus (42%) followed by group G Streptococcus (30%) and group A Streptococcus (20%).All organisms were sensitive to Penicillin except two isolates of Staphylococcus aureus (50%). Tetracycline (98.8%) and ciprofloxacin (87%) were the next most effective drugs. Overall resistance was observed for erythromycin (37%) and co-trimoxazole (32%).

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Background: Enteric fever is a global disease. In India, Enteric fever is endemic with Salmonella enterica serovar typhi being the predominant etiological agent. Due to changing antimicrobial resistance patterns, knowledge of local epidemiology, antimicrobial resistance pattern helps in the initiation of appropriate empiric therapy. Methodology: A prospective study on Salmonellae isolated from blood and stool specimens over an 8 year period was conducted. Antimicrobial susceptibility was done as per The Clinical & Laboratory Standards Institute (CLSI) guidelines. Serotyping was done by using commercial antisera and later confirmed at Central Research Institute, Kasauli. Results: Out of 52 salmonellae, 43 (82.6%) were from blood and 8 (15.3%) from stool and 1 (1.9%) from pus specimen. We observed a change in spectrum and susceptibility pattern of salmonellae the 8 year study period.

Background: Typhoid fever remains to be a major public health problem even in the present advanced era. With the emerging antimicrobial resistance in typhoid fever, there are very few options to treat typhoid fever. As there is no new antibiotic in the horizon, there is a need to know the actual use of available antibiotics. So, to know the actual practices of antibiotics in the treatment of typhoid fever we designed the current study in a tertiary care hospital.Methods and materials: All the children who met the case definition including clinical and laboratory parameters of 38-degree Fahrenheit fever lasted for at least three days were included in the study. This was an observational study. In the hospitalized patients the antibiotics given were measured as days of therapy per 1000 patient days and in OPD as per the antibiotic were prescribed.Results: Out of total 167 children who met the inclusion criteria, 42 were admitted while125 were treated from OPD. Based on antimicrobial susceptibility ceftriaxone was given to total 37 patients with mean duration of treatment being 6 days. The mean duration of fever was 9.5 days at the time of presentation. Boys constituted 75% and 56% of patients enrolled as in-patients and OPD, respectively. S. Typhi was etiological agent in 68% followed by S. Paratyphi A in 32%. Duration of fever for IgM positive patients was 3-45 days with mean 10.2 days.. An additional antibiotic was needed in 6 patients due to clinical non response. Conclusion:It can be concluded from the present study that ceftriaxone and cefixime form the first line of antibiotic treatment. Although all the isolates were sensitive to ceftriaxone and cefixime but increasing MIC for ceftriaxone is a cause of concern.In our settings use of second antibiotic in case of clinical non response even after 48-72 h of the use of first-line drug needs more study.