HighlightsThis study examined long-term trends in antibiotic resistance on a national scale in India.Colistin-resistant Klebsiella pneumoniae and Escherichia coli strains have emerged in India.In 2014, the prevalence of carbapenem-resistant E. coli was11.5%, the highest reported to date globally.

SettingA prospective observational study conducted in Medical college hospital, in a high-TB- prevalence region of northern Telangana, India.ObjectiveTo know the diagnostic role of Xpert MTB/RIF assay in bronchoalveolar lavage fluid (BALF) in sputum-scarce, suspected pulmonary tuberculosis (PTB) patients.DesignStudy period was between October 2014 and March 2017. Suspected pulmonary tuberculosis patients aged 15 years or more, who were sputum-scarce and conforming to the inclusion criteria were submitted to bronchoscopy. BALF thus obtained was submitted to smear for acid fast bacilli (AFB) and Xpert MTB/RIF assay as index tests along with culture for Mycobacterium tuberculosis complex (MTBC). Culture for M. tuberculosis complex was considered as gold standard for the diagnosis of PTB. The sensitivity, specificity and predictive values were calculated for smear AFB and Xpert MTB/RIF assay.Results56 of the 81 patients were included and evaluated in the final analysis. In 10 of these 56 patients PTB was confirmed by culture positivity. The sensitivity and specificity of Xpert MTB/RIF assay was 90% (9/10,95%CI 59.6- 98.2) and 52.2% (24/46, 95%CI 38. 1-65.9) respectively and that of the smear AFB was 60% (6/10, 95%CI 31.2–83.1) and 67.4% (31/46, 95%CI 53.0–79.1). All the patients considered ‘probable’ PTB (pending culture results), were administered antituberculous treatment and showed complete clinicoradiological improvement on follow up. Three of the 31 Xpert MTB/RIF positive patients were detected as resistance to rifampicin (RR).ConclusionsXpert MTB/RIF assay of BALF in the study cohort provides rapid diagnosis of Mycobacterium tuberculosis, and detection of rifampicin resistance at the very outset, aiding in selection of appropriate ATT regimen. In this context, it can be recommended as the first line investigation. Xpert MTB/RIF assay aided by HRCT Chest and suggestive clinical presentation may be helpful in early institution of ATT especially in smear negative, culture negative cases.

Aeromonas infections in healthy individuals are self limiting, but those in patients with immuno-compromised conditions are frequently associated with significant morbidity and mortality. The current case report describes a fatal case of necrotizing soft tissue infection by Aeromonas hydrophila in an immuno-competent patient. CASE REpoRTA 28-year-old female, residing in the rural Alwar district of Rajasthan, India presented to the Emergency Department of a tertiary care hospital in Jaipur, India with complaints of breathlessness and swelling in right arm with pain. On admission, the patient was found to have a body temperature of 101ºF, accompanied by hypotension (71/45 mmHg), tachycardia (160/min), tachypnea (44/min) and oxygen saturation of 64%. Examination of the right upper limb revealed a tender edematous swelling on the entire arm extending up to the digits, with multiple bleb formations and ecchymosis over the skin. A provisional diagnosis of septic shock with cellulitis of the right arm was made.The patient provided a recent history of acute gastroenteritis, for which she had received an I.V. infusion at a rural health care centre. The I.V. line was established on the right arm. The patient subsequently developed swelling and pain in the same arm. Due to progressive clinical deterioration in her condition over the next five days, the patient was admitted and treated conservatively for septic shock in a local hospital in Alwar, before being referred to our hospital. The treatment details of the same were not available with the patient. There was no history of any comorbidity such as hypertension, tuberculosis, diabetes mellitus or asthma.Following admission, the patient was immediately intubated and put on mechanical ventilation. Antibiotics (Piperacillin/Tazobactam and Amikacin) and ionotropes were started as initial treatment for septic shock. Her laboratory investigations revealed marginally increased renal and hepatic function tests:(Serum BUN-49mg/dl, creatinine -2.8mg/dl, SGOT-115 u/l, Alkaline phosphatase-171u/l, total bilirubin-6.15 mg/dl, prothrombin time-28.8seconds), accompanied by thrombocytopenia (platelet count-40 thousand/microlitre) and leucocytosis (TLC-22.4 thousand/microlitre). The blood and urine cultures were sterile.A surgical consultation, taken for the right arm, suggested gangrene on the right upper limb with compartment syndrome. An axial fasciotomy with releasing incision was performed under sedation in the Intensive Care Unit (ICU). During the procedure, a deep wound sample was collected from the necrotic tissue and sent for culture and sensitivity to the microbiology lab. After the procedure, Levofloxacin, Teicoplanin and Clindamycin were added to the existing antibiotic regimen. Over the next few hours, the patient developed conjunctival haemorrhage in the left eye and ecchymotic patches over the left ankle and left wrist. Repeat laboratory investigations revealed a further deranged coagulation profile, liver function tests and renal function tests. The haemoglobin ha...

Rhizobium radiobacter is a gram negative bacillus that is infrequently recognized in clinical specimens but is emerging as an opportunistic human pathogen. Infections due to Rhizobium radiobacter are strongly related to the presence of foreign plastic material and effective treatment often requires removal of the device. We report a case of R. radiobacter bloodstream infection associated with a central venous catheter which was easily controlled by antimicrobial treatment and did not require removal of intravascular device. To the best of our knowledge, this is the first case report from India implicating R. radiobacter as a cause of human infection.

Correlation of MPT64 ICT results with liquid culture smear was useful, especially in MPT64 ICT negative isolates, where the latter could help to determine need and/or type of additional confirmatory testing. Liquid culture smear, however, lacked specificity and cannot be used as a stand alone test.