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Abstract Background Indiscriminate and widespread use of antibiotics has resulted in emergence of many antibiotic-resistant organisms. Antibiotic administration during pregnancy is mostly avoided, unless there is compelling medical condition. We hypothesized that the uropathogens isolated from pregnant women would be more susceptible to antibiotics compared to those isolated from nonpregnant women, thus will be helpful in formulating separate empiric guideline for pregnant women based on the resistance pattern. Methods This was a prospective cross-sectional study conducted over a period of 2 years in which females with the clinical diagnosis of either cystitis or asymptomatic bacteriuria during pregnancy were included from the community settings. Uropathogen species and their antimicrobial resistance pattern were compared between the pregnant and nonpregnant groups. After accounting for centre-to-centre variation and adjusting for age and socio-economic status, the adjusted odds ratio for antibiotic resistance was calculated and compared between pregnant and nonpregnant women using logistic regression analysis. Results A total of 1758 women (pregnant: 43.3%; nonpregnant: 56.6%) were screened in the study over a period of 2 years, out of which 9.3% (163/1758) were having significant bacteriuria. Escherichia coli and Klebsiella pneumoniae were the two commonest uropathogen in both the groups; their prevalence being 83.6% in pregnant women and 85.2% in nonpregnant women, respectively. Resistance against ampicillin, cefixime, cefoxitin, ceftazidime, ceftriaxone and amoxicillin-clavulanic acid were found significantly lower in the pregnant women compared to nonpregnant. After adjusting the age and socio-economic status accounting for centre-to-centre variation, the odds of resistance for cefixime, amoxicillin-clavulanic acid and co-trimoxazole were found lower and statistically significant among the pregnant women group. Conclusions The antimicrobial resistance was significantly higher among the community-dwelling nonpregnant women compared to pregnant women in case of few antibiotics. The study highlighted the need of building local antibiogram that could help to initiate the empirical treatment and thus prevent emergence of antimicrobial resistance.

Introduction: Scrub typhus is a common but neglected cause of Acute Febrile Illness (AFI) in India. Under diagnosis of this severe disease with protean manifestations, can negatively influence the treatment and outcome. Early laboratory diagnosis by appropriate means is therefore important. In addition, as antigenically diverse variants of Orientia tsutsugamushi (O.tsutsugamushi) are known to exist and evolve, information regarding the strain types is also crucial. Aim: To know the clinical spectrum, laboratory diagnosis by different modalities, outcome and strain variation of scrub typhus in Southern India. Materials and Methods: A prospective cross-sectional study was conducted in a Tertiary Care Hospital in Bengaluru, Southern India from June 2015 to May 2017. Hundred clinically suspected cases of scrub typhus (rickettsioses) were enrolled. Serum and EDTA (Ethylenediaminetetraacetic acid) blood samples were subjected to serodiagnosis for scrub typhus and Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) respectively. Strain characterisation was done by Microimmunofluorescence (MIF), PCR-RFLP and phylogenetic analysis. Patients were followed-up for four weeks. Data was entered in Microsoft Excel spreadsheet and analysed using Statistical Package for the Social Sciences (SPSS) software. Results: Laboratory evidence of scrub typhus was showed by 38% of the cases. Seropositivity was more in comparison to PCR. Paediatric preponderance and seasonal trend was evident. Strain typing showed presence of different strain types, with no correlation between clinical features and strain types. PCR-RFLP results correlated well with phylogeny, while MIF results did not match. All the patients responded to doxycycline, except for 12% who succumbed. Conclusion: Different strain types of O. tsutsugamushi are known to cause scrub typhus in Southern India. PCR-RFLP can be a useful preliminary tool for strain typing in resource poor settings, where phylogenetic analysis is not possible. Early diagnosis and treatment helps in improved outcome.