The purpose of the present study was to determine the microbiological profile and antimicrobial susceptibility pattern of isolates from discharge in CSOM. MATERIAL AND METHODS This study included a total of 187 patients of CSOM with unilateral or bilateral discharge attending department of ENT in SHKM Govt. Medical College and Hospital Nalhar, Mewat, Haryana March 2015 to August 2015. Samples were inoculated on blood and Mac Conkey agar for 24-48hrs and identification of organism was done by using standard biochemical reactions and antibiotic susceptibility testing done by using modified Kirby Bauer method as per CLSI guidelines. RESULT Among 187 patients included in the study, most of the patients were between age group 11-20 years. CSOM was found to be more common in female patients (52%) than in male (48%) patients. The most common organisms were: Staphylococcus aureus (36%); Pseudomonas aeruginosa (34%); Klebsiella species, (6%) Proteus species (5%); Escherichia coli (4%); and other bacteria like Coagulase negative Staphylococcal species; Citrobacter spp, Enterobacter spp,Enterococcus spp,. According to antimicrobial susceptibility testing, Staphylococcus aureus was more sensitive to ciprofloxacin and gentamycin. Majority of gram negative isolates were sensitive to imipenem, quinolones and amikacin. CONCLUSION Result of our study showed high prevalence and resistance rate of Staphylococci and Pseudomonas isolates from CSOM patients to ß-lactam and other commonly used antimicrobials. Our study suggested that Amikacin, Piperacillin-Tazobactam and quinolones are best choice in these cases. Therefore an appropriate knowledge of antibacterial susceptibility of microorganism may contribute to rational antibiotic use and the success of treatment for CSOM.

Malaria is a protozoan disease caused by the parasites of the genus Plasmodium; Plasmodium vivax, Plasmodium malariae, Plasmodium falciparum, and Plasmodium ovale. Microscopy is the gold standard for the laboratory diagnosis of malaria parasite but its turnaround time is much more than that of RDT and it requires adequate training. RDTs are alternative diagnostic methods because they are quick and easy to carry out. We studied 500 blood samples of patients presented with sign and symptoms of malaria from OPD and various wards of SHKM GMC Nalhar, from June 2015 to May 2016. All of the samples obtained were first tested by RDTs, and then the same samples were used to make peripheral blood film. RDT have more sensitivity than PBF. Specificity and PPV of rapid card test were 93.6%, 87.2% and sensitivity and NPV were 91.3%, 95.7%. In case of outdoor fields activity peripheral regions RDT is a good option. We recommended that RDT in conjunction with microscopy should improve the diagnosis of malaria.

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BackgroundCeftriaxone–Sulbactam–EDTA (CSE) is the first cephalosporin–β-lactamase inhibitor combination with an antibiotic resistance breaker–disodium edetate, recently evaluated in a Phase 3 clinical trial for treatment of adults with complicated urinary tract infections (NCT03477422). The addition of Sulbactam and EDTA expands the spectrum of activity of Ceftriaxone to include extended-spectrum-β-lactamase (ESBL) and metallo-β-lactamase (MBL) producing bacteria. This study evaluated the in vitro activity of CSE against 3,150 isolates (716 (22.73%) E. coli; 435 (13.81%) K. pneumoniae; 1,075 (34.13%) A. baumannii; 924 (29.33%) P. aeruginosa) collected from 22 hospitals in India during 2013–2016.MethodsA total of 3,150 nonduplicate Gram-negative clinical isolates were collected, and susceptibility testing was conducted using reference broth microdilution method for CSE and comparators. CLSI defined phenotypic methods were used for ESBL and MBL detection, and thereafter, all isolates were further characterized genotypically using single PCRs and a panel of primers for detection of most β-lactamase enzymes, including blaTEM, blaSHV, blaCTX-M, blaAmpC, blaOXA, blaKPC, blaVIM, blaNDM, and blaIMP.ResultsOf the 3,150 isolates, 2,717 (86.25%) were β-lactamase producers, of which, 851 (31.32%) tested positive for ESBL, 1,591 (58.56%) tested positive for MBL, while 275 (10.12%) tested positive for both ESBL and MBL production during phenotypic evaluation. Once the genotype data were available, isolates were re-characterized as per the functional classification of β-lactamases into four distinct categories, including ESBL, AmpC, Carbapenemase and MBL. An astonishing 1,866 (59.23%) isolates harbored at least one MBL gene, of which, the prevalence was the highest in A. baumannii (78.6%), followed by K. pneumoniae (63%), P. aeruginosa (46.6%) and E. coli (44.1%). A summary of the results of susceptibility testing is shown in Figures 1, 2, and 3. ConclusionCSE showed a high overall susceptibility in ESBL- and MBL-producing bacteria and could provide a useful alternative to carbapenems and colistin in clinical settings.Disclosures R. Girotra, Venus Medicine Research Centre: Employee, Salary. A. Pyasi, Venus Medicine Research Centre: Employee, Salary. M. Chaudhary, Venus Medicine Research Centre: Board Member and Shareholder, Salary. M. A. Mir, Venus Medicine Research Centre: Employee, Salary. S. Chaudhary, Venus Medicine Research Centre: Employee and Shareholder, Salary. P. Mandale, Venus Medicine Research Centre: Employee, Salary.

BackgroundCeftriaxone–sulbactam–EDTA (CSE) is a novel combination being developed to treat serious infections caused by Gram-negative bacteria. In vitro molecular biology studies have shown that the addition of EDTA in the combination helps to prevent horizontal gene transfer during conjugation by chelating the divalent magnesium ions (Mg2+) required for the activity of DNA relaxases enzyme. An assessment of acquisition of resistant genes and a concomitant increase in MIC for patients that failed therapy in the Phase 3 clinical trial (NCT03477422) was conducted.MethodsMICs were conducted on baseline and post-treatment isolates recovered during treatment period. MICs were determined using CLSI reference methods and MIC changes from baseline were further assessed. Bacterial DNA was extracted by the alkaline lysis method. β-Lactamase (BL) genes were amplified in single PCRs using a panel of primers for detection of most β-lactamase enzymes, including extended-spectrum β-lactamases (ESBLs) (blaTEM, blaSHV, blaCTX-M), metallo-β-lactamases (MBLs) (blaVIM, blaNDM, blaIMP), carbapenemases (blaOXA, blaKPC) and class C cephalosporinases (blaAmpC).ResultsNine of 143 [2/74 (2.7%) in CSE; 7/69 (10.1%) in MR (meropenem)] patients had a microbiological failure at the TOC visit. Of these nine patients (all E. coli), a variation in the post-treatment genotypic profile was noted for four patients (44.4%) in the MR group and two of these patients also reported a ≥4-fold increase in post-treatment MIC. Both patients harbored four distinct BL genes (blaTEM + blaSHV + blaCTX-M + blaAmpC) at baseline, and had acquired two additional genes (blaOXA, blaKPC), both carbapenemases, as a result of treatment failure (after 6 days and 8 days of IV therapy respectively) with MR. In the first case, MIC increased 16-fold (1 µg/mL to 16 µg/mL for MR and 2 µg/mL to 32 µg/mL for CSE), while in the second case, MIC increased 8-fold (1 µg/mL to 8 µg/mL) for MR and 32-fold (1 µg/mL to 32 µg/mL) for CSE. No such increase in MIC or acquisition of resistant genes was noted in patients that failed therapy with CSE.ConclusionThese findings highlight the need for an effective choice of empirical therapy as failed treatments could lead to selection for resistant genes, rendering once susceptible drug non-susceptible.Disclosures M. A. Mir, Venus Medicine Research Centre: Employee, Salary. S. Chaudhary, Venus Medicine Research Centre: Employee and Shareholder, Salary. M. Chaudhary, Venus Medicine Research Centre: Board Member and Shareholder, Salary. A. Pyasi, Venus Medicine Research Centre: Employee, Salary. R. Girotra, Venus Medicine Research Centre: Employee, Salary.