There has been a continuous evolution in the SARS-CoV-2 genome; therefore, it is necessary to monitor the shifts in the SARS-CoV-2 variants. This study aimed to detect various SARS-CoV-2 variants circulating in the state of Andhra Pradesh, India. The study attempted to sequence the complete S-gene of SARS-CoV-2 of 104 clinical samples using Sanger’s method to analyze and compare the mutations with the global prevalence. The method standardized in this study was able to amplify the complete length of the S-gene (3822 bp). The resulting nucleotide and amino acid mutations were analyzed and compared with the local and global SARS-CoV-2 databases using Nextclade and GISAID tools. The Delta variant was the most common variant reported in the present study, followed by the Omicron variant. A variant name was not assigned to thirteen samples using the Nextclade tool. There were sixty-nine types of amino acid substitutions reported (excluding private mutations) throughout the spike gene. The T95I mutation was observed predominantly in Delta variants (15/38), followed by Kappa (3/8) and Omicron (1/31). Nearly all Alpha and Omicron lineages had the N501Y substitution; Q493R was observed only in the Omicron lineage; and other mutations (L445, F486, and S494) were not observed in the present study. Most of these mutations found in the Omicron variant are located near the furin cleavage site, which may play a role in the virulence, pathogenicity, and transmission of the virus. Phylogenetic analysis showed that the 104 complete CDS of SARS-CoV-2 belonged to different phylogenetic clades like 20A, 20B, 20I (Alpha), 21A (Delta), 21B (Kappa), 21I (Delta), 21J (Delta), and 21L (Omicron).

BACKGROUND Mechanical ventilation is a life-saving procedure for most patients in ICUs. But it has a risk of acquiring respiratory tract infections resulting in high morbidity and mortality. If not treated early, it may lead to ventilator-associated pneumonia (VAP). Early diagnosis and appropriate antibiotic therapy at right time in the right dosage is essential for better clinical outcome. The objectives of the study were to analyse the microbiomes of endotracheal samples and their antimicrobial susceptibility pattern in mechanically ventilated patients in ICUs and to frame an institution based local antibiotic policy especially for them. METHODS A retrospective study was conducted in a tertiary care hospital and sample data was collected which included all adult patients who were mechanically ventilated for various co-morbid conditions in ICUs from January 2019 to December 2019. All the samples were processed for microscopy, culture and antimicrobial susceptibility pattern. RESULTS Among 848 endotracheal samples, 673 (79.4 %) samples were culture positive and 175 (20.6 %) samples were sterile. Most common organism was Acinetobacter spp (N=240) followed by Klebsiella spp (N=225) and Pseudomonas spp (N=97). In our study, polymicrobial infections were 186(21.7 %). Sixty-eight percent of organisms were multidrug-resistant. Carbapenem resistance was 58 %. CONCLUSIONS The most common complication of mechanical ventilation is an endotracheal infection which in turn leads to prolonged stay in hospital, morbidity and mortality. It is essential to know about the local microbiome and its antibiotic susceptibility pattern. KEY WORDS Microbiome-human, Antibiogram, Endotracheal Intubation.