Objective: Dengue is a re-emerging public health problem threatening the tropical developing world, mandating rapid diagnosis and supportive management in the absence of licensed vaccines or anti-dengue therapy. Regions endemic to dengue and related viruses are overwhelmed by the sudden surge of cases during outbreaks. It is difficult to justify confirmatory diagnosis of every case using The World Health Organization (WHO) criteria or differentiate it from other concurrent viral illnesses. The study evaluated a rapid, sensitive and specific diagnostic methodology suitable for dengue outbreaks in resource-limited facilities. Methods: There were one hundred dengue patients as per WHO Criteria, as well as 100 healthy controls from New Delhi, India, were included. Samples collected on the fifth day of onset of fever were tested by lateral flow immunochromatography (LF-ICT), IgM ELISA and reverse transcriptase polymerase chain reaction (RT-PCR) and results were compared. Diagnostic accuracy indices and Kappa analysis were calculated. Results: The sensitivity, specificity, positive and negative predictive values (PPV and NPV) of non-structural protein 1 (NS1) against RT-PCR was 98.31%, 100%, 100%, 99.3% and strength of agreement was good. Conclusion: Antigen-based and molecular tests are a better tool for early diagnosis of dengue. The combined LF-ICT kits are highly sensitive, specific, user-friendly, compact, frugal and thus recommended for use in dengue outbreaks, field conditions and as bedside diagnostic tests, for confirmatory dengue diagnosis. Further studies are required to assess their utility in prognosis, surveillance and establishment of guidelines for dengue outbreaks.

Background & objectives: Extended-Spectrum Beta-Lactamases (ESBLs) is an important resistance mechanism in Enterobacteriaceae infections. Lack of standard guidelines from Clinical Laboratory Standards Institute (CLSI) for Amp C beta-lactamase detection poses a problem. This study was undertaken to detect ESBLs by phenotypic tests and Amp C beta-lactamase by inhibitor based method. Material and Methods: 200 consecutive non-repetitive isolates of E.coli, Klebsiella and Proteus from clinical samples were screened for ESBLs as per CLSI guidelines and confirmed by PCDT, DDST and E-tests (AB Biodisk, Biomerieux). Amp C beta lactamases were screened by cefoxitin resistance and confirmed by inhibitor (Cloxacillin) based method. Simultaneous occurrence of Amp C and ESBLs was detected by combined disk test (Neo-Sensitabs and Diatabs). Descriptive and Kappa statistics were used. Results: Out of 200 isolates studied, 131 were initially screened as ESBL producers and later 114 (57%) were confirmed by phenotypic methods. E-Test was found most sensitive phenotypic test as compared to PCDT and DDST. 13 strains resistant to cefoxitin (30µg) were found to be pure Amp C producers. Combined disk test detected 36 to be ESBL and Amp C co-producers. Surprisingly, six isolates found sensitive to cefoxitin disk were confirmed as Amp C producers by cloxacillin disk inhibition test. Conclusion: 57% ESBLs and 27.5% Amp C producers were isolated from nosocomial pathogens showing significant resistance to 3rd generation cephalosporins. Phenotypic confirmation by E-test, PCDT & DDST were useful for ESBL identification and for detection of Amp C, cloxacillin was found to be an effective inhibitor.

Introduction: Urinary tract infections (UTIs) is one of the most common bacterial infections. Irrelevant use of antibiotics has resulted in the emergence of resistant strains. Aims and objective:To identify and look for the antimicrobial resistance pattern of various isolates in a tertiary care teaching hospital.Methods: A retrospective study was conducted in a tertiary level hospital for 4 years (March 2014to March 2018. A total of 41020 urine samples received in the laboratory and 6114 of them diagnosed to be culture positive UTI were processed for Antibiotic sensitivity by the standard microbiological procedure.Results: Out of 6114 culture, positive samples 2829 (46.27%) had significant bacteriuria. Females more affected (52.27%) than males (48.43%). Amongst fermenters (GNF), E.coli (52.7%) was most common followed by Klebsiella spp. (23.65%). Amongst the Gram-positive organisms Enterococcus spp. (3.67%) was more common followed by Staphylococcus saprophyticus (1.44%). While Pseudomonas spp. followed by Burkholderia sp were the common non-fermenters (GNNF). In GNF, imipenem, meropenem and amikacin were most effective drugs whereas, in GNNF, imipenem, meropenem and piperacillin-tazobactam were more effective. Linezolid and vancomycin were the most sensitive antibiotics in Gram-positive isolates. Conclusion:There is increasing resistance to, and nitrofurantoin noted in our study that is frequently considered drugs of choice for empiric therapy. It is important to determine trends in antimicrobials susceptibilities, to formulate local antibiotics policy that will guide the clinicians regarding the empirical choice for UTI to prevent misuse or overuse of antibiotics.Clinical significance: Because of the emerging resistance to the available group of antimicrobials, regular monitoring of the resistance pattern is essential for the clinicians to choose for the best empiric therapy.

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