The rise in multiple-drug-resistant (MDR) phenotypes in Gram-negative pathogens is a major public health crisis. Pseudomonas aeruginosa is one of the leading causes of nosocomial infections in clinics. Treatment options for P. aeruginosa have become increasingly difficult due tdo its remarkable capacity to resist multiple antibiotics. The presence of intrinsic resistance factors and the ability to quickly adapt to antibiotic monotherapy warrant us to look for alternative strategies like combinatorial antibiotic therapy. Here, we report the frequency of P. aeruginosa multidrug-resistant and extensively drug-resistance (XDR) phenotypes in a super-specialty tertiary care hospital in north India. Approximately 60 percent of all isolated P. aeruginosa strains displayed the MDR phenotype. We found highest antibiotic resistance frequency in the emergency department (EMR), as 20 percent of isolates were resistant to 15 antipseudomonal antibiotics. Presence of plasmids with quinolone-resistance determinants were major drivers for resistance against fluoroquinolone. Additionally, we explored the possible combinatorial therapeutic options with four antipseudomonal antibiotics—colistin, ciprofloxacin, tobramycin, and meropenem. We uncovered an association between different antibiotic interactions. Our data show that the combination of colistin and ciprofloxacin could be an effective combinatorial regimen to treat infections caused by MDR and XDR P. aeruginosa.

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Background: Pyogenic liver abscess (PLA) is the end result of a number of pathologic processes that cause a suppurative infection of the liver parenchyma. Materials and Methods: Sixty-five patients of age more than 18 years and radiologically confirmed cases of liver abscess were included in this study. Pus and blood samples were collected. Pus was processed for microscopy of trophozoite of Entamoeba histolytica and aerobic and anaerobic bacterial culture. Blood was processed for antibody ELISA for Entamoeba histolytica and aerobic bacterial culture. Identification of aerobic and anaerobic isolates was done by Vitek2 and antibiotic sensitivity test for aerobic bacterial isolates was done by Vitek2. Result: Out of sixty five, twenty five were confirmed as PLA. All patients were male with mean age 37.9 years. Fever and upper abdominal pain were the most common symptoms. Right lobe comprised 80% of the abscess. Pus sample was more sensitive than blood sample for diagnosis. There were a total of 33 isolates in our study. Klebsiella pneumoniae (6/33) was the most common aerobic isolate and Clostridium spp. (7/33) was the anaerobic isolate. All gram-negative bacteria were showing good sensitivity for 3 rd and 4 th generation cephalosporins, fluoroquinolones, amikacin, gentamicin, piperacillin-tazobactam, imipenem and meropenem. Abscess >5 cm was treated with percutaneous drainage while abscess <5 cm was treated with antibiotics only. Conclusion: Diagnosis should be made with the combination of clinical suspicion, radiology, and microbiology. Empirical therapy should include anaerobic coverage too. Only antibiotic therapy can be given under consideration of size of abscess, persistence of fever after giving antibiotics, and any suspected complications.

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Background: Vibrio cholerae is a common cause of acute diarrhea in India. Extensive and injudicious use of antimicrobials has led to the emergence of V. cholerae strains that are resistant to several antibiotics. The present study was conducted to document the antibiogram of V. cholerae strains isolated at an urban health centre in New Delhi. The present study was a retrospective, record-based analysis conducted from January to December 2015, at the Department of Microbiology of a tertiary care teaching institute.Methods: Stool samples received in the laboratory were processed as per standard microbiological techniques and all the V. cholerae strains isolated were subjected to antimicrobial susceptibility testing as described in the Clinical and Laboratory Standards Institute (CLSI) guidelines. Data was analyzed using the Epi info software, version 3.5.3, and results depicted in the form of descriptive statistics.Results: Vibrio cholerae was isolated in 70 of the 2340 stool samples processed during the study period. Serogrouping revealed that 66 (94.3%) of the isolates were V. cholerae O1 serotype Ogawa, while non-O1 non-O139 serogroups constituted 4 (5.7%) isolates. The strains exhibited resistance to nalidixic acid (94.3%), ampicillin (92.9 %), ciprofloxacin (55.7%), cefotaxime (41.4%), gentamicin (22.9 %) and amikacin (7.1 %). Conclusions: Our study highlights the significance of regular surveillance of antimicrobial resistance profile of V. cholerae strains for proper management of cholera.