Current trends in antimicrobial resistance of ESKAPEEc pathogens from bloodstream infections - Experience of a tertiary care centre in North India.

INTRODUCTION: Bloodstream infections (BSI) due to ESKAPEEc pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanni, Pseudomonas aeruginosa, Enterobacter spp. and Escherichia coli), cause significant mobility and mortality worldwide and are among the most common healthcare associated infections. Rising rates of antimicrobial resistance (AMR) in India are alarming, because of the high infection rates and poor control of antibiotic use. This single-centre, retrospective study was undertaken to identify the patterns of distribution and antimicrobial resistance of ESKAPEEc pathogens in bloodstream infections. METHODOLOGY: Blood samples from patients with suspected BSI were cultured and antimicrobial susceptibility testing was performed on automated systems (BD Bactec Fx/BactAlert 3D and Vitek2). The microbiological data on bacterial BSI was retrieved from the laboratory records and antimicrobial resistance profiles were analysed. RESULTS: 10.7% of the blood culture samples showed bacterial growth during the study period (adult > paediatric and intensive care unit (ICU) > ward > outpatient department (OPD)). E. coli (24%) and K. pneumoniae (20.5%) were the predominant species isolated, followed by S. aureus (9.5%) and A. baumanni (9%). High rates of resistance to third generation cephalosporins, ß-lactam-ß-lactamase inhibitor combinations (BL-BLI) and carbapenems was observed, in Gram-negative isolates, especially from ICU patients. Methicillin-resistant S. aureus (MRSA) isolates increased from 67% to 88% over the five-year period. Vancomycin-resistance among Enterococcus isolates also escalated to 40% in 2022 with 11% linezolid resistance. CONCLUSION: The study revealed that more than 77% of bloodstream infections were caused by ESKAPEEc pathogens, with high rates of resistance to most antimicrobials. This reinforces the importance of monitoring the frequency of bacteria and antibiograms in individual treatment and hospital infection control programs.

Corynebacterium Striatum, an Emerging Nosocomial Pathogen: Case Reports.

BACKGROUND: Corynebacterium striatum is an emerging nosocomial pathogen, capable of causing a variety of infections in immunocompromised and hospitalized patients. ; Case Presentation: We describe three cases of infection by C. striatum that were initially considered as contamination. Clinical suspicion in the wake of predisposing factors and accurate identification, using the Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS), were key to implicate this commensal bacterium as a cause of infection.

Identification and Sensitivity of Vaginal and Probiotic Lactobacillus species to Urinary Antibiotics.

Objectives Healthy vaginal microbiota is mainly dominated by Lactobacillus species namely L. crispatus , L. gasseri , L. jensenii , and L. iners . Lactobacilli are thought to play an important role in the prevention of urogenital infections, and Lactobacillus probiotics to restore and/or maintain vaginal health has been advocated. These can interfere with the adherence, growth, and colonization by uropathogenic bacteria, thus reducing the risk of urinary tract infection (UTI). This study aims to isolate and evaluate the susceptibility of healthy vaginal and probiotic Lactobacillus spp. to urinary antibiotics. Materials and methods A total of 50 premenopausal, nonmenstruating women with no symptoms of vaginal infection or UTI or antimicrobial use in the past 2 weeks were enrolled. Two high vaginal swabs were collected for Nugent's scoring and anaerobic culture. Colonies yielding gram-positive rods were confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Lactobacillus strains in a vaginal probiotic tablet were also isolated, and the sensitivity of both sets to urinary antibiotics was determined. Results A total of 29 Lactobacillus spp. were isolated, including L. crispatus (15), L. gasseri (5), L. vaginalis (4), L. paracasei (2), L. curvatus (1), L. fermentum (1), and L. paraplantarum (1). All strains were susceptible to nitrofurantoin and resistant to norfloxacin, gentamicin, and cotrimoxazole (except L. paracasei ). The probiotic strains were pan-sensitive. Conclusions Prophylactic antibiotics are capable of eliminating the normal vaginal inhabitants, which may increase the probability of UTI. The administration of vaginal probiotics as an alternate or multidrug therapy can restore vaginal microbiota and help prevent recurrent UTI.

Burkholderia Cepacia Complex Causing Pneumonia in an Immunocompetent Non-Cystic Fibrosis Patient: Case Report and Review of Literature.

BACKGROUND: Burkholderia cepacia complex is widespread in the environment and has been recognized as a cause of opportunistic pulmonary infections, particularly in patients with Cystic Fibrosis (CF). The natural ecology of the bacteria as part of plant growth-promoting rhizosphere provides stark contrast to its infectious potential. Its preponderance as a nosocomial pathogen may be due to its ability to survive in antiseptic solutions, contaminate equipments and intrinsic antimicrobial resistance. CASE: An elderly, diabetic male was evaluated for hemoptysis, fever and cough. Chest computed tomography showed a thick walled cavity in the left lung and hilar lymphadenopathy. Sputum examination showed Gram negative bacilli and no acid fast bacilli. Sputum culture yielded growth of non-fermentative Gram negative bacilli on two occasions, but blood culture was sterile. The isolate was identified as B. cepacia by Matrix Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS). The patient's general condition remained poor and in spite of initiation of antibiotics, the patient expired after an episode of massive hemoptysis. CONCLUSION: This report raises concerns regarding the spread and severity of B. cepacia infection in non-compromised patients in the community and the need to suspect and identify it. Since the organism is inherently resistant to antipseudomonal penicillins, aminoglycosides and polymyxin B, differentiation from Pseudomonas spp. and determining antimicrobial susceptibility is paramount for treatment.

Post-Traumatic Endophthalmitis Due to Acinetobacter radioresistens: Virulence Potential of Commensal Bacteria.

Acinetobacter species are widely distributed in soil, water and hospital environment. In addition to A. calcoaceticus-baumannii complex, the clinically most relevant species, there are other genomospecies which are less frequently identified, mostly due to lack of accurate methods for routine identification. We describe the first case of post-traumatic endophthalmitis caused by otherwise non-pathogenic A. radioresistens, in India. Gram-negative coccobacilli were observed on Gram stain and culture of vitreous fluid specimen, and identified biochemically as Acinetobacter spp. The species was identified by Matrix Assisted Laser Desorption Ionization- Time of Flight Mass Spectrometry (MALDI-TOF MS). The pathogenic potential of 'commensal' A. radioresistens and its role in dissemination of carbapenem resistance genes underlines the importance of species-level identification in Acinetobacter infections.

Submandibular Lymphadenitis in an Immunocompetent Female: Microbiological Confirmation is Need of the Hour.

BACKGROUND: Non-tuberculous mycobacterial (NTM) infections have been drawing interest recently because of their rising incidence not only in immunocompromised but also in immunocompetent individuals. These are underdiagnosed in India, due to the lack of awareness and a low index of suspicion. In regions endemic for tuberculosis (TB) such as India, presumptive anti-tubercular treatment (ATT) is often prescribed. Non-response of NTM to the treatment may be wrongly ascribed to multidrug-resistant tuberculosis. This emphasizes the need to correctly identify them before initiating therapy. CASE STUDY: We describe the case of a young, healthy female patient who developed cervical lymphadenitis and was given presumptive ATT. Microbiological examination of aspirate revealed M. fortuitum. This not only rectified the course of treatment resulting in complete cure, but also spared the patient from significant side effects of ATT. This case is an awakening call for clinicians to avoid presumptive ATT.