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Antimicrobial susceptibility was done as per CLSI guidelines (2019) for amoxicillin, chloramphenicol, co-trimoxazole, ciprofloxacin, ceftriaxone and azithromycin. B Background: b Antimicrobial resistance in enteric fever is a major therapeutic challenge and there is a need to monitor the pattern of resistance to the antityphoidal agents and detection of molecular mechanisms of resistance. [Extracted from the article]

A 6-year study on the treatment of typhoid fever in children from India - Are we running out of options? So, to know the actual practices of antibiotics in the treatment of typhoid fever we designed the current study in a tertiary care hospital. 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. [Extracted from the article]

B Background: b Emerged antimicrobial resistance in typhoidal salmonellae has left us with a limited treatment options for enteric fever. The concept of ECOFFs was introduced by EUCAST as a way of distinguishing bacteria without resistance (wild type, WT) from those with acquired resistance (Non wild type, NWT). [Extracted from the article]

Lipoarabinomanan (LAM) antigen which is secreted actively by Mycobacteria at the diseased site and in urine of the infected patient serves as an attractive biomarker to diagnose Tuberculosis (TB). Given the limitations of current diagnostic modalities for Pleural TB which the second most common form of extrapulmonary TB in India, current study evaluated LAM's potential to serve as a point-of-care test to diagnose pleural TB. A pleural fluid specimen was subjected to LAM antigen detection using the lateral flow assay (LAM-LFA; make - Alere/Abott diagnostics) in addition to biochemical and microbiological assays, in a cross-sectional study on suspected pleural TB patients attending a tertiary care hospital in Chhattisgarh, India. The LAM-LFA test was also performed on an early morning urine sample from the same patient. LAM-LFA results were compared to microbiological reference standards/MRS (defined as Pleural TB confirmed by Mycobacterial culture or CBNAAT) and composite reference standards/CRS (Definite plus Probable TB – Clinico-radiologically diagnosed). Out of 170 evaluable subjects, 26 had Definite TB, 22 had Probable TB, and 122 had No TB. When compared to MRS and CRS, pleural LAM-LFA testing was found to be less sensitive (61.54% & 45.83%) with poor PPV (57.14% & 78.57%) but more specific (91.67% & 95.08%) with good NPV (92.96% & 81.69%). Except for having higher specificity (97.2% and 98.3%, respectively, against MRS and CRS), urinary LAM-LFA performed worse than pleural LAM-LFA. When the subgroup of patients with significant ADA levels (ROC derived cut off value = 40 IU/ml) was studied, the specificity and PPV of pleural LAM detection increased to 100% each. Detection of LAM antigen by LFA directly from pleural fluid performed fairly accurate in diagnosing pleural TB and was highly predictive of the disease in a selected cohort of patients making it a valuable POCT. [ABSTRACT FROM AUTHOR]

Cefiderocol is a siderophore cephalosporin and recently FDA-approved drug possessing potent activity against carbapenem-resistant gram-negative bacilli (CR-GNB) (Enterobacterales, and Nil-fermenter) due to its modified structure, iron-chelation mechanism, stability to hydrolysis by nearly all β-lactamases (including Metallo beta-lactamases and AmpC), overcoming capacity against efflux pump overexpression and porin channels mutations. This is the first study from India evaluating in-vitro susceptibility of Cefiderocol against CRGNBs. A prospective observational study was conducted at a tertiary care hospital in India during 2021-2022. CR-GNB isolates from patients with bloodstream infection, urinary tract infection, and pneumonia were tested for Cefiderocol in-vitro susceptibility using broth microdilution technique (BMD) as per CLSI 2022 guideline. Two Acinetobacter baumanii (AB) isolates observed resistant to Cefiderocol (MIC>32mg/ml) were further analysed by whole genome sequencing (WGS). Forty CR-GNB isolates were tested for BMD [5: Escherichia coli (EC), 7: Pseudomonas aeruginosa (PA), 13: Klebsiella pneumoniae (KP) and 15: Acinetobacter baumanii (AB)]. The susceptibility of EC, PA, KP and AB against Cefiderocol was observed as 60%, 43%, 100%, and 13.3% respectively. Approximately, 20% of EC isolates and 28.5% of PA isolates showed intermediate susceptibility using BMD. All the AB isolates from respiratory specimens were observed resistant to Cefiderocol (MIC > 32mg/ml). On WGS analysis, the two resistant AB isolates were found to harbour bla PER-7 in combination with bla OXA-23/ bla NDM- 1 along with other carbapenemase genes bla OXA-66 & bla OXA-68. In our study, Cefiderocol was found to have potent in-vitro activity against K. pneumoniae , in comparison to other CR-GNB. Higher resistance was seen in A. baumanii isolates, which might be attributed to the synergistic effect of PER-7 type of beta-lactamases in presence of bla OXA-23 and bla NDM-1 gene. [ABSTRACT FROM AUTHOR]