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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]

Background: Corneal blindness is a major public health problem in India and infections constitute a major cause, second only to cataract. The purpose of this study was to identify the specific organisms responsible for suppurative keratitis, and to determine the risk factors predisposing to suppurative keratitis in Vadodara, Gujarat. Methods & Materials: All patients with suspected suppurative corneal ulceration presenting between 1st January 2014 to 30th November 2014 to Ophthalmology department at S.S.G. Hospital,Vadodara were evaluated. The corneal scrapings were performed for cultures and smears by using standard protocols and information pertaining to risk factors was recorded. Results: In the 11 months period, 66 patients with suspected corneal ulceration were evaluated. Corneal cultures were found to be positive in 33 (50%) patients. Of the 66 patients, 19 (28.70%)were diagnosed as bacterial keratitis and 14(21.30%) as fungal keratitis. The most common fungal pathogen isolated was Aspergillus spp, representing (42%) of all positive fungal cultures, followed by Candida albicans (21%). The predominant bacterial pathogen isolated wasStaphylococcus aureus representing(31.57%)of all positive bacterial cultures, followed by Pseudomonas spp (21.07%). Conclusion: Suppurative keratitis is one of the leading causes of blindness in rural India and most often occurs due to superficial corneal trauma, accounting for 84.84% of culture positive cases. In patients of corneal trauma with vegetative matter which was the most common traumatic agent,78.57% developed fungal keratitis whereas 36.84% developed bacterial keratitis (total of 64.28%). Aspergillus spp was responsible for most of the fungal infections and Staphylococcus aureus accounted for the majority of bacterial infections. It is imperative to know the local etiology of keratitis in a particular region particularly if diagnosis is going to be reliant on clinical signs for the prompt treatment of suppurative keratitis. This study helps in finding the most prevalent microorganisms in this region. [ABSTRACT FROM AUTHOR]

Background: Antibiotic resistance in enteric fever continues to pose major therapeutic challenge with increase in ciprofloxacin resistance. Azithromycin has been used to treat enteric fever as an alternate treatment option without any guidelines for laboratory interpretation. In 2015 issue CLSI has added breakpoints for testing azithromycin susceptibility in typhoidal Salmonellae. We aimed to assess the prevalence of resistance to azithromycin in S. Typhi and S. Paratyphi A in a collection of strains to characterize the mechanisms underlying resistance. Methods & Materials: A total number of 224 S. Typhi and S. Paratyphi A isolates were available in the cryopreservated stock which were isolated from the patients presented with enteric fever during 1990 to 2015. Antimicrobial susceptibility testing was done by disk diffusion method as per CLSI 2015 and MICs were determined by E test method as per manufacturer's guidelines (AB Biodisk, Sweden). For molecular chaeacterization of azithromycin resistance, PCR detection was done to screen for the presence of genes responsible for azithromycin resistance i.e, ereA, ereB, ermB, mefA, mphA, mphB and mphD from plasmid and genomic DNA. Sequence analysis was done to detect mutations in acrR, rlpD and rlpV from genomic DNA. Results: It was observed that 96.11% of the isolates were susceptible to azithromycin using disk diffusion method. There was a linear trend observed with time in azithromycin susceptibility (X² = 5.240, P value <0.02). The MIC 50 and MIC 90 values were 6 and 12μg/ml respectively while the resistance breakpoint is ≥16μg/ml. There was no acquired gene for macrolide resistance in plasmid or genomic DNA of any isolate and DNA sequences of acrR, rlpD and rlpV genes did not show any mutations. Total use of azithromycin in pediatric population was only 13,125 mg given to 16 patients in 2014-15. Conclusion: Azithromycin is a good promising agent against typhoid fever on the basis of MIC distribution in India at present. More studies are required to study the use of azithromycin in complicated infections as at present it is being used only for uncomplicated cases. [ABSTRACT FROM AUTHOR]

Background: Salmonella enterica ser. Typhi is the causative agent of the clinical condition called typhoid fever that results after an incubation period of 10 to 15 days following infection. The main line of treatment of typhoid fever includes antibiotics such as fluoroquinolones and aminoglycosides; however, several studies have reported decreased susceptibilities of fluoroquinolones among Salmonella spp isolated from human infections. Thus, this necessitates the studies to explore alternative or adjunct therapeutic agents. Methods & Materials: In this study we isolated and screened the antimicrobial potential of 92 vaginal lactic acid bacteria from healthy women against S. enterica ser. Typhi MTCC 733 by using agar gel diffusion assay. Further, the susceptibility of S. enterica to various antibiotics and the synergistic activity of the culture supernatant (CS) of the isolate 12a along with antibiotics was determined by using Kirby Bauer disk diffusion and chequerboard titration methods, respectively. Results: The isolate no. 12a, identified as Enterococcus spp. by using physico-chemical characterisation showed broad spectrum antimicrobial activity against many Gram-negative pathogens including S. enterica MTCC733. The antimicrobial activity of the CS of 12a was proteinaceous in nature and lost its activity on treatment with pepsin, proteinase K and papain. The minimum inhibitory concentration of the CS was 2133 AU/ml and was stable over a wide pH range of 3-11. Further, the antimicrobial activity of the CS was lost at 100°C; 1 hr treatment. The susceptibility of S. enterica to various antibiotics was determined and it showed reduced susceptibilities to many fluoroquinolones and aminoglycosides. Chequerboard titration assay showed that CS of 12a synergised antimicrobial activities of the antibiotics belonging to the classes fluoroquinolones, aminoglycosides and β-lactam against S. enterica. Conclusion: In conclusion, the study indicates the potential of the probiotic strains of enterococci as adjunct therapeutic agent against resistant forms of S. enterica. [ABSTRACT FROM AUTHOR]

B Conclusion: b Using bioinformatics tools 7 common antigenic proteins in both the organisms were obtained which generated 20 Tc and 8 Th cell epitopes after analysis and a DNA vaccine was designed. NetCTL, self-epitope analysis and epitope cluster analysis reduced Tc cell epitopes to 20 and Th cell epitopes to 8. [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]