Background India is among the nations reporting substantial healthcare burden linked to pneumococcal infections. Nafithromycin is a novel lactone ketolide antibiotic, which recently entered Phase 3 development in India for the indication of community-acquired bacterial pneumonia (CABP). Objectives To assess the in vitro activity of nafithromycin against serotyped invasive and non-invasive Streptococcus pneumoniae isolates, collected from nine medical centres across India. Methods A total of 534 isolates of S. pneumoniae were collected during 2015–20 and serotyped as per CDC protocol. A subset of erythromycin-non-susceptible S. pneumoniae (n = 200) was screened for the presence of erm(B) and mef(A/E) genes. A subset of MDR isolates (n = 54) were also subjected to MLST. The MICs of antibiotics were determined by the reference agar-dilution method (CLSI). Susceptibilities of the comparators were interpreted as per CLSI criteria. Results Fifty-nine distinct serotypes were identified among the 534 isolates. Among erythromycin-non-susceptible isolates, erm(B) and mef(A/E) genes were found in 49% and 59% strains respectively, while MLST showed clonal diversity. Azithromycin (67.6% non-susceptible) and clindamycin (31.8% non-susceptible) showed limited activity. Penicillin (for non-meningitis) or quinolone non-susceptibility was low (<11% and <6%, respectively). Nafithromycin showed potent activity with MIC50 and MIC90 of 0.015–0.03 and 0.06 mg/L, respectively, regardless of the macrolide resistance mechanisms. Conclusions Indian pneumococcal isolates show poor susceptibilities to macrolides, in concordance with the global trend. Nafithromycin overcomes erm as well as mef-mediated macrolide resistance mechanisms expressed individually or concurrently in S. pneumoniae. This study supports continued clinical development of nafithromycin for pneumococcal infections including CABP.

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Vancomycin resistance and high level aminoglycoside resistance in Enterococci has limited its treatment, as Enterococci are susceptible to only narrow spectrum of antibiotics. VRE is known to cause hospital acquired infections. This study was aimed to determine prevalence of vancomycin resistance and HLG resistance among Enterococci in a Pediatric hospital. 310 Enterococcus spp was isolated between Jan 2018-May 2020 from pediatric patients from various samples. Among them 206 (66.5%) isolates were Enterococcus faecalis, 104 (33.5%) isolates were Enterococcus spp including Enterococcus faecium. Most of the isolates were from urine (68%). High Level Gentamicin (HLG) resistance was seen in 69% of the isolates. Vancomycin resistance (VRE) was seen in 29 (9.4%) isolates. HLG resistance among VRE was 79% (23/29), all of them were sensitive to Linezolid. 17 of the VRE isolates were from urine sample and 15 (88%) of these isolates were sensitive to Nitrofurantoin. 90% (26/29) of the VRE isolates were isolated from nosocomial infections. 58% of VRE isolates were Enterococcus faecalis.

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