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Most bacteria and fungi are capable of producing biofilms, enabling them to thrive in nature on distinct surfaces. Biofilm formation stands out as one of the most prominent virulence mechanisms that contribute to the infection’s chronicity by functioning as a defense against antimicrobials and host immune systems. Microbial isolates capable of generating biofilms have been discovered to possess higher resistance to frequently administered antifungal drugs. In this research study, 91 Candida isolates from Vulvovaginal Candidiasis (VVC) patients were tested for biofilm development. Candida species were identified, and clinical isolates were tested for antifungal susceptibility (AST). Three methods were used to screen the isolates: the Congo agar method (CRA), the visual tube method (VT), and the Microtitre plate method (MTP). Nearly 60% of the 91 clinical isolates tested were recognized as Non-Albicans Candida (NCAC) species. Itraconazole resistance was shown to be the highest in clinical isolates, followed by Amphotericin B resistance. There were 11(12.09%) isolates that formed strong biofilms, 35(38.46%) isolates that formed moderate biofilms, and 45(49.45%) isolates that formed no biofilm. Because there is a growing incidence of NCAC in the study, it is critical to speciate the Candida species as NCAC are more resistant to routinely used azole medicines. Furthermore, a spike in the prevalence of biofilm producers has been reported, implying greater pathogenicity and antifungal resistance.

In recent years, the rapid growth in Antimicrobial resistance (AMR) has become a global concern. Essential oils derived from plants that include bioactive components with proven antioxidative and antibacterial activities could be a potential solution to arrest this problem. In this study, antibacterial activities of DoTERRA essential oils such as Onguard, Clove, Teatree, Lavender and Eucalyptus were evaluated with Indian essential oils against clinical pathogenic bacteria. The GC-MS study revealed that cineole, terpinene, eucalyptol, and eugenol were the most prevalent bioactive components in these essential oils. The purity of the essential oils was confirmed with zeta potential and white light absorption spectrophotometer and shows that the Zeta potential of all the essential oils ranges from -51.4 to 0 mV. Using agar well diffusion and Micro broth dilution procedures, the antimicrobial activity of essential oils of clove, lavender, tea tree, eucalyptus, and On-Guard (combined) was assessed against several multi-drug-resistant bacteria. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of essential oils in aqueous and micellar solutions were determined by Micro broth dilution techniques. The most effective antibacterial essential oils were clove, tea tree, and On guard (a blended essential oil with a predominance of Limonene and Eugenol). The current research could result in development of formulas that contain micelle or colloid suspensions of whole essential oils such as clove, On-Guard, or Tea-Tree oil to aid in antimicrobial treatment.

To study the correlation between quantitative Hepatitis B DNA and HBeAg positivity among HBsAg positive patients in a tertiary care hospital. To detect HBsAg, HBeAg levels by CMIA (Chemiluminescent microparticle immunoassay). To perform quantitative Hepatitis B virus DNA assay using Real Time Polymerase Chain Reaction. The study took place between July and December 2022 for 6 months. Sixty four patients were included in the study for whom HBsAg was positive by CMIA and for whom HBeAg (detected by CMIA) and Hepatitis B Virus DNA by quantitative Real Time PCR was performed. Of the 64 HBsAg reactive patients, the ‘e’ antigen of Hepatitis B virus was positive in six patients. In all the six HBeAg positive patients, HBV DNA was detected with a range of 78-10,288 IU/ml with 66% having levels more than 2000 IU/ml and requiring treatment. Among the 58 patients who were negative for the ‘e’ antigen of Hepatitis B virus, the Hepatitis B Viral DNA was detected in 27 patients with a range of 10-1,76,000 IU/ml, with 21% of patients having levels more than 2000 IU/ml. HBeAg is a good serological test to detect viral replication. However, it alone might not be sufficient as quantitative HBV DNA levels are more accurate and it does identify more patients who may require treatment.

Human leukocyte antigens (HLA) are genetically derived proteins in the major histocompatibility complex. They help distinguish “self” and “non-self” antigens and are essential in interacting with the immune cells inside the body. The present research work examines the prevalence of HLA-B27 among patients suspected of Spondyloarthritis (SpA), which has also been correlated with Interleukin-17/23 Inflammatory Markers and other clinical manifestations and was carried out between August 2017 to January 2021. The patient’s blood samples were collected and tested for HLA-B27 and Interleukin-17/23 inflammatory markers. Among 289 SpA patients, 60% (172) were males, and 40% (117) were females, with a ratio of 1.5:1. Ankylosing Spondylitis (65.1%) was found to be the most prevalent subgroup of SpA among the patients, closely followed by reactive arthritis (21%), psoriatic arthritis (10.7%), undifferentiated spondyloarthritis (2.1%), and inflammatory bowel disease with associated arthritis (1%). HLA-B27 was found to be positive in 54% (156) out of 289 patients. Normal IL-17 ranges were seen in 42% of HLA-B27- positive patients, while increased IL-17 was seen in 58% of the population with positive HLA-B27 cases. IL-23 was found within normal ranges in 40% of positive HLA-B27 cases, while it was found to be increased in 60% of the positive HLA-B27 positive subjects. We concluded that HLA-B27 was found to be positive among more than half of the patient population with SpA. The early detection of HLA-B27 may aid in changing lifestyle to prevent Spondyloarthritides.

UTI is one of the most common infections requiring antibiotic treatment and hospitalization. The rising trend in multidrug resistance to commonly used antibiotics has reduced the therapeutic options for treating these infections. Reexploring older antibiotics like nitrofurantoin and fosfomycin provide treatment options and help combat resistance. This prospective study was conducted in the Department of Microbiology, SRM Medical College Hospital and Research Center, from July 2021 to February 2022. The study included only clean catch midstream urine isolates of Escherichia coli and Klebsiella pneumonia from hospitalized patients and outpatients. Standard microbiological procedures were used to process the urine samples. Direct gram stain and conventional biochemical reactions were performed to identify the isolates. The antimicrobial susceptibility testing was carried out by the Kirby Bauer disk diffusion method and Minimum Inhibitory Concentration by E- test gradient method for fosfomycin. MIC for nitrofurantoin was determined by Micro Broth Well Dilution according to CLSI guidelines 2021. Among 150 urine samples, Escherichia coli 107 (71.3%) was higher than Klebsiella pneumonia 43 (29%). Carbapenemase production was seen in 58 (63.04%) isolates by the Kirby Bauer disc diffusion method. Among the 58 positive carbapenemase producers, E. coli was found to be 33 (56.8%), and Klebsiella pneumonia was 25 (43.1%). Fosfomycin susceptibility rates by E test were reported to be high in Escherichia coli, ranging from 0.5-1mg/L. Klebsiella pneumonia was less susceptible to fosfomycin ranging from 16-32mg/L. Only 7(21%) isolates of Escherichia coli showed MIC of 1-4µg/ml to nitrofurantoin by broth microdilution. 21 (63.63%) isolates of Escherichia coli and 11(44%) isolates of Klebsiella pneumonia were reported to have an intermediate category with MIC of 8-32µg/mL. A higher MIC of 64- > 256µg/ml was shown by 5 (15.15%) isolates of Escherichia coli and 14 (56%) isolates of Klebsiella pneumonia. Older medications may resurface as useful therapeutic choices as resistance to current treatment options grow.

Klebsiella is a pathogen that causes a significantly high number of community-acquired and hospital-acquired infections, with infections being one of the leading causes of death in ICU patients worldwide due to increasing antibiotic-resistance and a lack of therapeutic options. A total of 230 Klebsiella spp. were collected from various clinical samples. After initial identification, the drug-resistant strain was subjected to standard Clinical Laboratory and Standards Institute methods such as Kirby–Bauer disc diffusion. All isolates were screened and confirmed for ESBL/AmpC β-lactamase/carbapenemase production. The isolated Klebsiella spp. were found to be K. pneumonia (89%), K. oxytoca (6.5%), and K. aerogenes (4.5%). Among the 230 isolates, 80 (34.7%) isolates were found to be ESBL producers via screening; of these, 53 (23.5%) were verified by a confirmatory test. Moreover, 115 isolates (50%) were screened as AmpC producers; of these, 23 isolates (10%) were verified by a confirmatory test. Carbapenemase producers accounted for 69 (30%) isolates, identified by screening; 25 (10.86%) were verified by a confirmatory test. ESBL producers accounted for the majority of Klebsiella spp. isolates, followed by carbapenem and AmpC producing strains.

The prevalence of multidrug-resistant gram-negative bacilli has increased worldwide. Critical care areas of most hospitals use carbapenem antibiotics for the empirical treatment of gram-negative bacterial (GNB) infections. In the last decade, there have been reports of the detection of carbapenem-resistant Enterobacterales (CRE). This rise in the spread of CRE presents a great challenge in the treatment of GNB infections and poses a serious threat to global health. To detect the burden of CRE and to characterize CRE, we used three phenotypic methods for the detection of carbapenemase enzymes. Using conventional aerobic bacterial culture methods, 150 Enterobacterales strains were isolated from various clinical samples. Identification of CRE was performed using multiple phenotypic detection methods, such as the Kirby Bauer disc diffusion method for meropenem (10 mcg) using the CLSI 2021 interpretation for meropenem, modified Hodge test (MHT), Carba NP test, and modified carbapenem inactivation method (mCIM) test. A total of 150 Enterobacterales strains were isolated over a period of 1 year. Among these, 66/150 (44%), 63/150 (43%), 64/150 (43%), and 65/150 (43%) were identified as CRE using the Kirby Bauer disc diffusion method, MHT, mCIM test, and Carba NP test, respectively. The sensitivity and specificity of MHT, mCIM, and Carba NP tests within 95% CI were 93.94%/100%, 96.97%/100%, and 98.48%/100%, respectively. The positive and negative predictive values of MHT, mCIM, and Carba NP tests were 100%/95.45%, 100%/97.67%, and 100%/98.82%, respectively. The accuracies of the MHT, mCIM, and Carba NP tests were 97.33%, 98.67%, and 99.33% respectively indicating a high burden of carbapenem resistance in Enterobacterales. Therefore, given the current statistics of carbapenem resistance, use of carbapenem as empiric treatment in the intensive care units of hospitals may not be beneficial. Identification of carbapenem resistance can help in the initiation of appropriate antimicrobial therapy. This study compares the accuracy and efficiency of Carba NP, mCIM, and MHT in detecting carbapenem-resistant Enterobacterales.

Every country had to make several difficult decisions in the initial phase of the Coronavirus (COVID-19) pandemic to allocate resources for COVID testing. Decisions on who should be tested for COVID-19 testing are extremely vital for pandemic preparedness. In this article, we highlight the need for prioritization of testing resources including direct-to-consumer testing methods, ethical dilemmas involved in obligatory testing, and testing of refugees and immigrants.

Antimicrobial resistance has emerged as a major danger to contemporary medicine around the world. Carbapenems are the highest class of B-lactam drugs which are considered as the most effective and safest antibiotics available. Increasing spread of carbapenemases has been noted across the world which restricts treatment options. The aim of this study was to determine the incidence of carbapenem resistant genotypic pathways in a tertiary care hospital. 130 clinical strains of Enterobacteriaceae were subjected to Kirby-Bauer disk diffusion tests and genotypic methods (PCR) for the identification of the genes NDM, VIM, and OXA-48. Carbapenem resistance was detected in 30% of the isolates by phenotypic methods. These 37 isolates on being subject to PCR showed OXA-48 followed by VIM and NDM as the most frequently isolated genotypes. All isolates had multiple genes encoding carbapenem resistance. Carbapenemases resistance is on the rise and is associated with multi drug resistance pattern. To minimize spread and initiate early appropriate therapy, early detection of carbapenem resistance is essential. Molecular methods remain gold standard for detection.

Prior to the Severe Acute Respiratory Syndrome Coronavirus Disease 2 (SARS-CoV-2) pandemic, the rise in antimicrobial resistance was a major source of concern in public health. However, due to the novelty of SARS-CoV-2 infection during the pandemic, antibiotics were administered prior to laboratory testing for secondary gram-negative bacteria (SGNB) in order to avoid or reduce the occurrence of SGNB infection. The purpose of this study was to investigate the etiology, prevalence, and antimicrobial susceptibility pattern of gram-negative bacteria (GNB) isolated from SARS-CoV-2 positive patients. Respiratory and blood samples were collected from confirmed SARS-CoV-2 positive patients. They were subsequently cultured and bacterial isolates identified according to standard microbiological protocols. Antimicrobial susceptibility testing (AST) was performed and interpreted according to Clinical & Laboratory Standards Institute (CLSI) 2021 guidelines. A total of sixty-four non-repetitive GNB were isolated from respiratory samples and twenty-two GNB from blood samples. K. pneumoniae was the major cause of SGNB, followed by Acinetobacter species. K. pneumoniae had over 60% resistance to β-Lactam combination agents, cephalosporin, and the carbapenem group of antibiotics. In the current study, we observed that K. pneumoniae was the major cause of SGNB and had high resistance to the antimicrobial agents. Hence, it is important that the epidemiology and susceptibility patterns of circulating organisms causing SGNB infection are always monitored to inform clinical treatment and decrease the occurrence of antibiotic-resistant bacteria.

Viridans streptococci are important causative organism of infective endocarditis, which is a disease having long-lasting effects among the patients who live with the disease as well as those who are cured. Infective endocarditis due to viridans streptococci generally usually affects persons with structural heart disease and is also associated with intravascular prosthetic devices. After the onset of bacteremia with the pathogenic viridans streptococci, vegetation is formed in one or more heart valves. The diagnosis of infective endocarditis due to viridans streptococci is difficult to establish in patients with underlying risk factors and it involves the correlation of microbiological (in-vitro growth of viridans streptococci), clinical, and echocardiography results (modified Duke criteria). The common microorganisms are Staphylococcus spp., Enterococcus spp followed by viridans streptococci. The details of viridans streptococci causing infective endocarditis were reviewed in detail. Viridans streptococci possess a challenge in identification up to its species level and which helps in the identification of the source of infection as well as treating the infection.

Strongyloidiasis is a neglected parasitic disease caused by the intestinal parasite, Strongyloides stercoralis. Most patients with strongyloidiasis are asymptomatic, but few present with varied clinical manifestations such as cutaneous, gastrointestinal, pulmonary, and disseminated disease. It creates a diagnostic dilemma and undue delay in the diagnosis of patients. We report the case of a 79-year-old male who presented with fever and abdominal pain due to strongyloidiasis with no history of immunosuppression. The infection resolved entirely on treatment with ivermectin.

Human leukocyte antigens (HLA) are gene products found in the major histocompatibility complex, aiding in differentiation of “self” from “non-self” antigens, and is crucial for the communication between immune cells of the human body. HLA-B27, in specific, has a strong interrelation with different types of Spondyloarthritis (SpA). The aim of this study is to study the frequency of HLA-B27 in suspected Spondyloarthritis patients presenting with axial and peripheral joint involvement, who attended our tertiary care centre from August-2017 to January-2021. Patients fulfilling Assessment of Spondyloarthritis International Society (ASAS) criteria for Spondyloarthritis were included in the study, and were further classified into Spondyloarthritis sub-groups. Blood samples were collected for CRP and ESR tests along with HLA-B27 detection by RT-PCR method. Magnetic resonance imaging was done for sacroiliac joints in patients with lower back pain. Analysis of 289 samples of SpA patients revealed 156 (54%) to be HLA-B27 positive and 133 (46%) to be HLA-B27 negative. There were 98 patients (63%) with Ankylosing spondylitis, 33 (21%) had Reactive arthritis, 19 (12%) had Psoriatic arthritis, 6 (4%) had Undifferentiated Spondyloarthritis, and inflammatory bowel disease was diagnosed in 0% in HLA-B27 positive Spondyloarthritis patients. The frequency of HLA-B27 among the Spondyloarthritis (SpA) patients in our study was found to be 54% (156), more common clinical manifestation in men belonging to the age group of 16-25 years positive patients. Ankylosing spondylitis (AS) was found to be the most common sub-groups observed among the SpA patients.

Introduction: In most developing countries, antimicrobial resistance is a public threat, and insufficient knowledge of antibiotics among the public adds to it. This study aimed to determine the efficacy of the clinical pharmacist's pamphlets and video-based educational tools to address the public's knowledge, attitude, and practice gaps on antibiotic use. Methods: This was a pre-and post-intervention cohort study of the adult population in South India who can read and understand Tamil or English. The study participants were designated into two groups-usual care group (pamphlet-based) and interventional group (video-based), with a pre-intervention assessment using a self-administered questionnaire, followed by an educational intervention by a clinical pharmacist, and finally, a post-intervention assessment after three months. Result: Of the162 respondents, the majority were female (58%), in the age group of 26–35 (30%), with intermediate education (43%) from a middle-income family. The mean score calculated for each domain among the two groups: knowledge score (Pamphlet based-Pre: 2.26 ± 1.13; post: 3.23 ± 1.02), (Video based-Pre: 2.22 ± 1.45; post: 3.95 ± 0.89), Attitude score (Pamphlet based-Pre: 2.53 ± 1.96; post: 3.23 ± 0.9), (Video based-Pre: 2.39 ± 1.81; post: 4.21 ± 1.35), Practice score (Pamphlet based-Pre: 2.19 ± 1.02; post: 4.46 ± 1.81). A significant improvement was observed in all domains of the video-based counselling group compared to the pamphlet-based (p

The rise in antibiotic resistance has been a major source of public health concern. As a result, mortality and morbidity rates have risen significantly. This study was done to identify gram-negative organisms causing bacteremia/sepsis, study their prevalence rates, and antimicrobial resistance patterns, as evidence-based knowledge of gram-negative organisms causing sepsis and their resistance profiles is essential for effective hospital control and better management of infections caused by resistant bacteria. A retrospective study, conducted from January 2016 to December 2019, blood samples were collected using aseptic guidelines and cultured using automated blood culture methods. Biochemical tests were done according to microbiology standard procedures, while antimicrobial testing was done according to CLSI guidelines. A total of 13,808 blood samples were received within the study period of four years. Of the total, 2079 showed significant growth, with 765 being GNB isolates. The most common isolates were Escherichia coli (35.42%), Klebsiella pneumonia (19.74%), Acinetobacter species (9.67%), and other non-fermenting gram-negative bacilli (11.76%). Escherichia coli showed yearly resistance to aminoglycosides, cephalosporins, penicillin, fluoroquinolones, and B-lactam combination agents. Routine surveillance and awareness of the prevalence, etiological agents, and antibiotic resistance of gram-negative bacteria causing bacteremia/sepsis is critical for individual therapy, hospital control, and the effectiveness of preventive interventions.

Severe acute respiratory diseases caused by coronavirus disease 2019 (COVID-19) have caused infections around the world, and this disease has been declared a global pandemic by the World Health Organization. COVID-19 has severely impacted the world economy, and as it has multiple unnoticeable transmission routes, it can derail the health care system for a long time. Most states in India are affected by the COVID pandemic. As India is known for its seasonal infections such as dengue, leptospirosis, influenza, malaria, and enteric fever, it is expected that these infections may co-exist. Coinfection of these two viral infections causes challenges in diagnosis and treatment, especially in places with limited resources. Antibody-mediated enhancement of the immune response is a cause for concern in co-infection of COVID-19 and dengue. The present article discusses the clinical features, serological cross reactions, and antibody-dependent enhancement of COVID-19 coinfection with dengue infection.

Sepsis, the second leading cause of death is due to infections. Intensive care units (ICUs) are having the highest burden of treating the patients with sepsis and nosocomial infections compared to other areas of hospitals. Our objective was to identify the bacteriological profile and their antibiogram of sepsis cases in all ICUs. A sum of 102 blood samples were collected from patients with clinically suspected sepsis with elevated CRP. Processed by an automated method using Bact/Alert & growth were identified by Standard guidelines. Out of 102 samples, 54 (53%) were shown positive by culture. Gram-negative bacilli were the predominant and their number were 33 (61.1% ) and the commonest organisms were from the Enterobacteriaceae family. Escherichia coli was the highest number with 15 (27.7%) followed by Klebsiella pneumoniae 10 (18.51%), & the rest were single isolates of Salmonella typhi, Proteus mirabilis and Citrobacter koseri. Nonfermenter isolated were Acinetobacter baumanii 3 (5.6%), Pseudomonas aeruginosa 2 (3.7%). The Gram-positive cocci were 17 & 32.4% of culture positivity. Coagulase-negative Staphylococcus was the highest isolated accounting for 9 (16.6%) followed by Staphylococcus aureus 6 (11.1%) and Enterococcus faecalis (3.7%). Culture positivity will be more when CRP is also included in the selection of samples for sepsis and Gram-negative bacilli are the leading cause in septicemia and organisms belonging to the Enterobacteriaceae family still dominate in septicemia infections in ICUs and a real challenge for treatment are MDRs which needs to be detected regularly by using screening tests.

Candida spp. is one among the major causes of nosocomial infection, with candidemia gaining increasing prevalence worldwide in parallel with mortality rates ranging from 10-49%. Epidemiology and predisposing factors of candidemia have changed since the number of patients receiving transplants and immunosuppressive therapy, the use of broadspectrum antimicrobials, and the number of AIDS patients have increased. Candidemia is more common among patients with subcutaneous and cutaneous candida infections, through percutaneous inoculation. Major predisposing factors for invasive candidiasis includes neutropenia, haematological malignancies, bone marrow transplantation, total parenteral nutrition, chemotherapy, invasive procedures, and immune-suppressive agents. This study analyses the risk factors of immunocompromised patients with candidemia and antibiogram of Candida spp. isolated from ICU patients. To evaluate the prevalence, distribution and antibiogram of Candida spp., associated risk factors, and outcome in candidemia patients. Blood samples received from patients with clinically suspected fungal infections were subjected to gram staining, culture, sugar assimilation & fermentation, Candida Chrome agar (CCA) & Corn meal agar for identification and speciation. Antifungal susceptibility tests were performed by disk-diffusion tests. Among a total of 337 samples received, 22 (6.5%) samples were positive for candida infections, of which Candida tropicalis 9 (41%) was the predominant isolate followed by C. albicans 5 (23%), Candida glabrata 4 (18%), Candida parapsilosis 2 (9%) and Candida krusei 2 (9%). Male patients had a higher prevalence of candidemia 15 (68.2%). Among the age group of 51-70 years, uncontrolled DM(Diabetes mellitus) and CKD (chronic kidney disease) were found to be the predominant co-morbidities with candidemia.

Background and Objectives: The emergence of methicillin resistant Staphylococcus aureus (MRSA) and extended spectrum β– lactamases (ESBLs) in neonatal intensive care unit patients is increasing. This study aims to find out the bacteriological profile in neonatal sepsis and study their antimicrobial susceptibility pattern including detection of MRSA and ESBLs. Materials and Methods: This study was conducted for a period of one and a half years from January 2010 to June 2011 in a tertiary care hospital in Chennai. A total of 182 blood samples were collected using sterile precautions. They were processed following standard laboratory protocol. Antibiogram was done using appropriate antibiotics by Kirby-Bauer disc diffusion method. Isolated Staphylococcus aureus were tested for methicillin resistance using Cefoxitin disc (30µg), ESBL was detected using combined disc method, MIC reduction and Polymerase chain reaction, metallobetalactamases using EDTA and Amp-C beta lactamases using AmpC disc test. C-reactive protein (CRP) was estimated for all the cases. Results: Out of the 182 cases, 110 (60.4%) were culture positive. Fifty five (63.9 %) of early onset sepsis cases had Gram negative bacteria (GNB) and 19 (79.1%) of late onset sepsis cases had Gram positive bacteria. Out of the total pathogens, 31 (28.1%) were Klebsiella pneumoniae and 30 (27%) were Staphylococcus aureus. 17 (56.6 %) of Staphylococcus aureus were found to be MRSA and they were 100% sensitive to Vancomycin. 33 (67.3%) of Enterobacteriaceae were ESBL producers. ESBL isolates were 100% sensitive to Imipenem. Three (6.1%) of Enterobacteriaceae were AmpC producers and 3 (27.2%) of Pseudomonas aeruginosa were MBL producers. CRP was positive in 99 (54.3%) cases, out of which 94 (94.9%) were culture positive. Conclusion: Klebsiella spp. and Staphylococcus aureus were the commonest bacteria causing neonatal sepsis in this centre. Multidrug resistance among the isolates was common. Early diagnosis and institution of specific antibiotics after studying the sensitivity pattern will help in reducing neonatal morbidity and mortality and prevent emergence of drug resistant strains.