Nitrofurantoin is the first-line drug in the treatment of uncomplicated urinary tract infections (UTIs) and its use has increased exponentially in recent years. Objectives This study aims to determine the susceptibility pattern of nitrofurantoin in gram-negative urinary isolates and to evaluate their bacteriological and epidemiological profile along with co-existing resistance to other important urinary antimicrobials. Material and Methods This was a retrospective study conducted in a tertiary care hospital in New Delhi in which 500 gram-negative bacterial urinary isolates were evaluated. Records of antimicrobial susceptibility were reviewed from July to September 2019. Antimicrobial susceptibility was performed using the Kirby–Bauer disk diffusion method on Mueller Hinton agar and interpreted using CLSI 2019. Test for extended spectrum β-lactamase (ESBL) producers was done using double disk approximation test. Statistical Analysis Data analysis was performed using the SPSS windows version 25.0 software. Results Out of total 500 isolates, 20.17% (94) isolates were resistant (R) to nitrofurantoin and 9.01% (42) were found to be intermediate (I). Highest resistance was seen in Klebsiella sp. (44.61%) and Escherichia coli (8.12%). About 28.82% of the I/R isolates were of the pediatrics age group and most of the isolates belonged to females (64.69%). High resistance was also seen against ampicillin (92.30%), cefazolin (88.46%), ceftazidime (73.0%), and fluoroquinolones (65.38%). Carbapenemase co-resistance was seen in 57.15% isolates whereas ESBL production was seen in 30.76% of E. coli and 12.06% of Klebsiella sp. Conclusion Increase in multidrug resistance uropathogens along with a near absence of novel oral antibiotics has led to increased consumption of nitrofurantoin since its resistance has increased.

Background and Purpose: Routine identification of Candida species and knowledge of antibiotic susceptibility patterns can prevent diagnostic delays and help clinicians choose appropriate empirical therapies. This study aimed to identify and speciate Candida isolates from bloodstream infections and evaluate their epidemiological profile and antibiotic susceptibility pattern in a tertiary care hospital in North India. Materials and Methods: Blood samples were cultured in the Department of Microbiology of a tertiary care hospital from January 2019 to May 2021, and the samples which showed growth of Candida species (spp.) were included in this study. Candida isolates were initially characterized by conventional techniques. Further identification and antifungal susceptibility testing were performed using Vitek 2 compact automated system. Data analysis was performed using the SPSS software (Version 25.0). Results: Candida spp. were isolated from a total of 116 blood samples, 60.92% of which belonged to males. The majority (43.10%) of isolates were obtained from 0-1-month-old neonates, followed by infants (16.38%) and children in the age range of 1-17 years (16.38%). Only 6.89% of isolates were obtained from adults older than 18 years. Candida tropicalis (26.72%) was the most common species, followed by Candida pelliculosa (19.83%), Candida albicans (17.24%), Candida parapsilosis (14.66%), Candida famata (9.48%), and Candida krusei (9.48%). Other isolated species included Candida lusitaniae, Candida sphaerica, and Candida inconspicua. Out of 116 isolates, 101 isolates were subjected to Vitek 2 susceptibility testing. Overall, 21.78% (22/101) of Candida isolates were found to be resistant/intermediate. Among C. albicans isolates, resistance was observed only against voriconazole (20%) and fluconazole (5%); however, among non- albicans Candida species (NAC), resistance was observed against flucytosine (16.04%), followed by fluconazole (14.81%), voriconazole (3.70%), and caspofungin (3.70%). Conclusion: Non-albicans Candida spp. predominated over Candida albicans in causing bloodstream infections and were found to be more resistant to antifungals. Continuous surveillance is necessary to monitor changes in epidemiological and resistance patterns.

INTRODUCTION: Urinary tract infection (UTI) is considered as the most common bacterial infectious disease seen among the pediatric patients. Most commonly, members of Enterobacteriaceae, particularly uropathogenic strains of E. coli and Enterobacter spp. are the primary causative pathogens of UTI in the different part of the world. Emergence of antimicrobial resistance rates among pathogens recovered from urinary tract infections is an increasing problem in the specific region. MATERIALS AND METHODS: Prevalence and anti microbial susceptibility pattern of the bacterial uropathogens isolated from the children attending Gandaki Medical College Teaching Hospital and Reserch Center (GMC) Nepal. A total of 155 children aged upto 15 years were included in this study. Urine cultures were carried out and the isolates were identified by Gram staining and conventional biochemical methods. Antimicrobial susceptibility testing was performed by disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI). RESULTS: In the present study 21.3 % of the sample size, showed significant bacterial growth. E. coli was the most frequently occurring pathogen (39.40%), followed by Proteus spp. 21.2%, Citrobacter spp. and Streptococcus faecalis (12.1%) Klebsiella spp. (9.1%), and Staphylococcus aureus and Enterobacter (3.0%). Susceptibility rate of E. coli were 69.2% to Gentamycin and Amikacin, 53.8% to Norfloxacin, 38.4% to Nalidixic acid and Norfloxacin. CONCLUSIONS: Pediatric urine culture isolates were becoming increasingly resistant to commonly used antibiotics. Finally, we suggest that empirical antibiotic selection should be based on knowledge of the local prevalence of bacterial organisms and antibiotic sensitivities rather than on universal guidelines. DOI: http://dx.doi.org/10.3126/ijim.v2i3.8665   Int J Infect Microbiol 2013;2(3):82-86

Rickettsial infections are being increasingly recognized as a cause of acute febrile illnesses and patients presenting with suggestive clinical features should be considered a distinct possibility. 1 It includes three major groups: Scrub typhus, spotted fever group and the typhus group.A total of 11 rickettsial outbreaks have been reported in India between 2000-2011. Of the 11 outbreaks, four were reported from Himachal Pradesh (Kangra, Shimla, Solan, and Sirmapur districts), two from Manipur (Bishnupur and Senapti districts), and one each from Jammu and Kashmir (Rajouri district), Tamil Nadu (Vellore), Pondicherry, West Bengal (Darjeeling), and Meghalaya (Shillong). 2 Most recent outbreak of Scrub Rickettsial diseases are an important cause of undifferentiated acute febrile illness. The lack of classical manifestations can make their diagnosis difficult. Even though the diseases are endemic in India, they are less reported from New Delhi and surrounding regions. Aim is to estimate the seropositivity of Rickettsial infections in cases of undifferentiated acute febrile illness from a tertiary care hospital in New Delhi and to analyze their clinical profile. This prospective observational study was conducted from November 2016 to March 2018. Samples were first screened for Typhoid, Dengue, Chikungunya and Malaria. Samples seronegative for these diseases were tested further by Weil-Felix test (WFT) and clinical findings were recorded on a pre designed proforma. Data was analyzed using statistical software SPSS version 21. A total of 370 seronegative samples were tested. Out of 370 cases, 12.4% (46) cases were positive by Weil-Felix reaction and most of the cases showed titre between ≥1:80-≥1:160. Of the positive cases, 7.29% were positive for scrub typhus (OXK) and 3.78% cases were positive for tick typhus (OX2) whereas only 1.35% cases were found positive for typhus group (OX19). The most common presentation was fever with headache and pulmonary manifestations or rashes. The most common laboratory findings were increase in AST/ALT, anaemia and thrombocytopenia. The findings of our study indicate significant presence of rickettsial diseases in cases of undifferentiated febrile illness in Delhi population.

Background: Leptospirosis is an important cause of febrile illness with a widespread global distribution. Although endemic in the southern and western states of India, its true incidence in the northern states of the country remains underreported. The main objective of this study was to estimate the seropositivity of infections by Leptospira in patients presenting with undifferentiated acute fever, in a tertiary care hospital in New Delhi.Methods: This prospective observational study was conducted from November 2016 to March 2018 in a tertiary care hospital in New Delhi. Blood samples of the patients (n=370) having fever for more than one week and seronegative for typhoid, dengue, chikungunya and malaria were subjected to Leptospira IgM ELISA (DRG International Inc., USA). Data was analyzed using statistical software SPSS version 21.Results: Out of 370 patients, 142 (38.4%) were males and 228 (61.6%) were females; the mean age was 32.18 years. The most common symptom was headache (55.5%) and icterus (55.55%) whereas increased ALT/AST was the most common laboratory finding (88.8%) followed by anaemia (77.7%). On employing Leptospira IgM ELISA, 2.43% (9 cases, n=370) were strongly reactive (>1.0 OD) whereas 15.1% (56 cases) were weakly reactive (1.15-1.00 OD).Conclusions: There is a need to increase awareness and suspicion regarding diagnosis of leptospirosis. A positive IgM ELISA when correlated with patient’s clinical profile and epidemiological factors can aid in the timely diagnosis and treatment of these infections.