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Context: Varied microbial etiology of parapneumonic effusions/lower respiratory infections casts a heavy burden on rural population in India. Aims: To determine microbial etiology, and burden of parapneumonic effusions (PPE) and lower respiratory infections (LRI), affecting adults hailing from rural areas. Settings and Design: Hospital-based, longitudinal and prospective study during the period of March 2009 to March 2010. Materials and Methods: Sputum, endotracheal (ET) tube secretion, bronchial alveolar lavage (BAL), and pleural fluids were collected from adult patients in intensive care unit (ICU) and wards. Economic burden of hospital stay, treatment, and loss of income for patients/family were noted and analyzed. Statistical Analysis: Percentages and proportions. Results: Infections of lower respiratory tract clinically appear as pneumonia, bronchitis, lung abscess, and emphysema. Hence, the types of specimen collected from the patients were varied, and all patients were from rural background. One hundred and fifty three samples were collected. Seventeen sputum samples were rejected by the selection criteria of Murray and Washington grading system. Hence, 136 samples were processed. Fifty-nine out of 136 yielded 48 bacterial isolates and 11 fungi. S. pneumoniae, Klebsiella pneumoniae, and S. aureus were responsible for most of the infections. P. aeruginosa from chronic obstructive pulmonary disease (COPD) patients had history of hospitalization. Acinetobacter baumannii (2), Stenotrophomonas maltophilia (1) were noteworthy among the bacterial isolates. Conclusion: S. pneumoniae was the most frequently isolated organism, over all. In parapneumonic effusions, 36% were Gram-negative bacilli, Escherichia coli being the commonest. Isolation of Acinetobacter and Stenotrophomonas from critically ill patients in ICU and their sensitivity to higher antibiotics warrants strict vigilance. In more than half of the cases (56.62%), a specific etiology could not be determined. The morbidity, mortality, and economic burden due to these infections in rural population are indeed heavy.

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Introduction: Escherichia coli (E.coli) is one of the most common uropathogen worldwide. In the past few years, uropathogenic E.coli has become increasingly resistant to many drugs. Materials and Methods: This prospective observational study was conducted from January 2014 to December 2016. Semiquantitative urine culture was done on blood agar and MacConkey agar using standard technique. Cultures showing a significant growth of 10 5 CFU/ml or more were further processed. Identification and analysis of antibiotic susceptibility patterns was done by VITEK ® 2 (bioMerieux, USA). Results: A total of 674 E. coli samples were included in the final analysis. The isolates showed highest overall sensitivity to imipenem (75.82%) and nitrofurantoin (72.25%) whereas highest resistance was observed in case of amoxicillin-clavulinic acid (84.12%) and cephalosporins (71.96-83.23%), followed by ciprofloxacin (72.70%), amikacin (64.39%) and TMP-SMX (64.24%). Over three years duration, a trend of increasing resistance was observed in the case of cephalosporins, ciprofloxacin and trimethoprim-sulfamethoxazole (TMP-SMX). Percentage of MDR E.coli also increased over three years. Conclusion: There is an increase in antibiotic resistance amongst uropathogenic Escherichia coli over the past three years. Routine surveillance of resistance patterns should continue in the hospitals and antibiotic policy should be constantly updated. Judicious use of antibiotics is the need of the hour.