Antimicrobial resistance is an important concern for the public health authorities at global level. However, in developing countries like India, recent hospital and some community based data showed increase in burden of antimicrobial resistance. Research related to antimicrobial use, determinants and development of antimicrobial resistance, regional variation and interventional strategies according to the existing health care situation in each country is a big challenge. This paper discusses the situational analysis of antimicrobial resistance with respect to its problem, determinants and challenges ahead with strategies required in future to reduce the burden in India. Recent data from Google search, Medline and other sources were collected which was reviewed and analyzed by the authors. Hospital based studies showed higher and varied spectrum of resistance in different regions while there are limited number of community based studies at country level. There exists lacunae in the structure and functioning of public health care delivery system with regard to quantification of the problem and various determining factors related to antimicrobial resistance. There is an urgent need to develop and strengthen antimicrobial policy, standard treatment guidelines, national plan for containment of AMR and research related to public health aspects of AMR at community and hospital level in India.

AIM:Nonfermenting gram-negative bacilli (NFGNB), which are saprophytic in nature, have emerged as important healthcare-associated pathogens. They exhibit resistance not only to beta lactam and the other groups of antibiotics, but also to carbapenems. This study was undertaken to identify the nonfermenters isolated from various clinical samples, to assess their clinical significance, to know the type of healthcare-associated infections they caused, and to know their anti-microbial sensitivity pattern.Materials and Methods:The nonfermenters were identified using a standard protocol that included tests for motility, oxidase production, oxidation-fermentation test for various sugars, gelatin liquefaction, and growth on 10% lactose agar. The clinical significance was assessed by using various criteria and susceptibility testing was performed with the help of the Kirby-Bauer disc diffusion method.Results:A total of 193 NFGNB were isolated from 189 clinical specimens. Pseudomonas aeruginosa was the most common nonfermenter, accounting for 53.8%, followed by Acinetobacter baumannii (22.2%), and Pseudomonas fluorescens (10.8%). Other significant NFGNB isolated were: Sphingobacterium species (5.2%), Acinetobacter lwoffii (3.1%), and Stenotrophomonas maltophilia (2.6%). P. aeruginosa showed good sensitivity to imipenem (94%), cefoperazone (70%), amikacin (69%), and ticarcillin (63%). A. baumannii showed 100% sensitivity to imipenem and 70% sensitivity to piperacillin.Conclusion:P. aeruginosa and A. baumannii were the common NFGNB isolated in our study from patients of, urinary tract infection, bacteremia, surgical site infections, and ventilator associated pneumonia. P. aeruginosa showed good sensitivity to imipenem, amikacin, and cefoperazone while A. baumannii showed good sensitivity to imipenem and piperacillin.

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Background: Studies in India and other developing countries has shown lack of knowledge and poor practice of Biomedical waste management (BMW). Hence this study was undertaken to know the KAP of BMW in our hospital, to identify the gaps and to take necessary steps for rectification. Materials & Methods:This was an observational descriptive hospital based cross sectional study. The study group included the 337 healthcare personnel which included doctors (residents), nurses, laboratory technicians and multi-purpose workers. The study was done using a pre-tested semi-structured questionnaire. The data was analysed using software SPSS 20 version . Proportions were used for interpretation. Results: It showed that <50% of nursing staff and <25% of MPWs had the knowledge of colour coding and segregation. There was also poor knowledge regarding disposal of sharps among technicians and MPWs. It also brought to our notice that only 50% of the doctors (residents) and nursing staff and 26% of the laboratory technicians have undergone training in BMW management. None of the MPWs had received training regarding BMW management. They had good knowledge regarding the diseases transmitted through improper bio medical waste handling. Conclusion: This study revealed that there is the need to continue the training programme for BMW and to include technicians and MPWs in the programme. It also shows that the administration needs to put protocols, provide PPE and other resources for better compliance of BMW rules.