Background: Use of colistin is increasing due to the increasing prevalence of multi drug resistant gram negative bacteria (GNB). Increasing prevalence of carbapenem resistant GNB is a serious clinical and public health challenge because the treatment options are limited to colistin, Tigecycline etc. Colistin resistance is being increasingly reported in Indian hospitals. Bacteria resistant to all available antibiotics (Pan Drug Resistance) are also increasing and left no treatment option. Resistance to colistin is a major threat that limits therapeutic choices for treating carbapenem-resistant Pseudomonas aeruginosa and Klebsiella sp. infections. We hereby report the prevalence of colistin resistance among gram negative bacteria from urinary tract infection.Methods & Materials: This study was performed from January 2016 to December 2016 in Max Super Speciality Hospital, Shalimar Bagh, New Delhi, India. A total of 1429 out of 2273 positive urinary isolates of Escherichia coli (975), Pseudomonas aeruginosa (201) and Klebsiella sp. (253) were included in this study. Identification and sensitivity was conducted by Vitek 2 compact automated system. Susceptibility of antimicrobials were interpreted according to the Clinical Laboratory Standards Institute (CLSI 2016) guidelines.

We report a case of a 65-year-old female diagnosed with sever dengue fever. She started showing recovery from dengue fever with medical management. On day 6 of admission, she had leukocytosis, altered mental sensorium, and hemoptysis. Chest tomography showed air space consolidation with multiple nodules in the left upper and middle lobe sputum and bronchoalveolar lavage cultures were positive for Aspergillus flavus. The patient showed improvement with voriconazole and therapy was continued for 6 weeks.

Background/Aims: Rimonabant is a cannabinoid CB1 receptor antagonist. Other CB1 antagonists have biphasic effects on blood glucose levels following acute administration. We therefore tested the effects of rimonabant on glucose tolerance following acute administration. Methods: We tested the effects of oral and intracerebroventricular administration of rimonabant on blood glucose and gastrointestinal transit in mice following oral and intravenous glucose challenge. Results: We found a dose-dependent increase in blood glucose from oral doses of rimonabant of 3 mg/kg and above. WIN55,212-2 (3 mg/kg), a cannabinoid receptor agonist, did not influence blood glucose in the presence or absence of rimonabant. Rimonabant did not induce release of glucose from isolated rat hepatocytes or modify serum insulin concentration in mice. Intracerebroventricular administration of rimonabant caused increases in blood glucose and gastrointestinal transit, suggesting a central nervous system site of action. Increases in blood glucose by rimonabant were partially blocked by the dopamine receptor antagonist haloperidol and significantly blocked by the 5-hydroxytryptophan (5-HT) depleting agent p-CPA and the 5-HT₃ receptor antagonist ondansetron. Conclusions: Rimonabant causes a dose-dependent increase in glucose profile upon glucose challenge partially mediated by the central nervous system control of gastrointestinal carbohydrate absorption through pathways that are modulated by both 5-HT and dopamine.

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Introduction: SARSCoV2 infection increases the risk of secondary bacterial and fungal infections and contributes to adverse outcomes. The present study was undertaken to get better insights into the extent of secondary bacterial and fungal infections in Indian hospitalized patients and to assess how these alter the course of COVID19 so that the control measures can be suggested. Methods: This is a retrospective multicentre study where data of all RTPCR positive COVID19 patients was accessed from Electronic Health Records (EHR) of a network of 10 hospitals across 5 North Indian states admitted during the period from March 2020 to July 2021.The data included demographic profile of patients, clinical characteristics, laboratory parameters treatment modalities and outcome in those with secondary infections (SIs) and those without SIs. Spectrum of SIS was also studied in detail. Results: Of 19852 RTPCR positive SARSCO2 patients admitted during the study period, 1940 (9.8%) patients developed SIs. Patients with SIs were 8 years older on average (median age 62.6 years versus 54.3 years P<0.001) than those without SIs. The risk of SIs was significantly (p < 0.001) associated with age, severity of disease at admission, diabetes, ICU admission, and ventilator use. The most common site of infection was urinary tract infection (UTI) (41.7%), followed by blood stream infection (BSI) (30.8%), sputum/BAL/ET fluid (24.8%), and the least was pus/wound discharge (2.6%). As many as 13.4% had infections with more than organism and 34.1% patients had positive cultures from more than one site. Gram negative bacilli (GNB) were the commonest organisms (63.2%), followed by Gram positive cocci (GPC) (19.6%) and fungus (17.3%). Most of the patients with SIs were on multiple antimicrobials the most commonly used were the BL BLI for GNBs (76.9%) followed by carbapenems (57.7%), cephalosporins (53.9%) and antibiotics carbapenem resistant entreobacteriace (47.1%). The usage of emperical antibiotics for GPCs was in 58.9% and of antifungals in 56.9% of cases, and substantially more than the results obtained by culture. The average stay in hospital for patients with SIs was twice than those without SIs (median 13 days versus 7 days). The overall mortality in the group with SIs (40.3%) was more than 8 times of that in those without SIs (4.6%). Only 1.2% of SI patients with mild COVID 19 at presentation died, while 17.5% of those with moderate disease and 58.5% of those with severe COVID 19 died (P< 0.001). The mortality was highest in those with BSI (49.8%), closely followed by those with HAP (47.9%), and then UTI and SSTI (29.4% each). The mortality rate where only one microorganism was identified was 37.8% and rose to 56.3% in those with more than one microorganism. The mortality in cases with only one site of infection was 28.8%, which steeply rose to 62.5% in cases with multiple sites of infection. The mortality in diabetic patients with SIs was 45.2% while in non-diabetics it was 34.3% (p < 0.001). Conclusions: Secondary bacterial and fungal infections can complicate the course of almost 10% of COVID19 hospitalised patients. These patients tend to not only have a much longer stay in hospital, but also a higher requirement for oxygen and ICU care. The mortality in this group rises steeply by as much as 8 times. The group most vulnerable to this complication are those with more severe COVID19 illness, elderly, and diabetic patients. Varying results in different studies suggest that a region or country specific guideline be developed for appropriate use of antibiotics and antifungals to prevent their overuse in such cases. Judicious empiric use of combination antimicrobials in this set of vulnerable COVID19 patients can save lives.