Prevalence of novel Corona Virus (severe acute respiratory syndrome Coronavirus 2) and its uncertain future in the different regions of Punjab.

Background: Coronavirus disease-19 (COVID-19), produced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic, giving rise to a serious health threat globally. Many countries have seen a two-wave pattern in there reported cases during the period of pandemic. Similarly, our country has reported the first peak between March and October 2020 followed by the second peak between April and June 2021. Objectives: The objective of this study was conducted to describe the spatiotemporal patterns and early epidemiological features of COVID-19 cases from November 2020 to May 2021 in the central (Majha) region of Punjab state of India which was considered as the epicenter of the infection. Methods: The multiplexed real-time reverse transcription-polymerase chain reaction (RT-PCR) method was used to detect SARS-CoV-2, with co-amplification of specific target genes using real-time PCR kits. Results: During the second wave, test positivity rate for COVID-19 in our laboratory (the central region of Punjab) was recorded as 4.8%. The study revealed that an increased sustained proportion of COVID-19 incidence is present in young adult age group (20-39 years) with 8.65% positive rate followed by the older age group and least in young ones. It was observed that during the second wave, more symptomatic individuals are positive (10.26%) alongside it was also observed that male population (5.61%) was more prone to infection in comparison to females (3.78%). Whole-genome sequencing carried out on 120 random samples selected from all the districts of Majha region of Punjab state showed two prominent strains, namely alpha variant (95 cases) and delta variant (19 cases). Conclusion: A higher positivity rate in the second wave demonstrates the rapid spread of the new emerging virus variants and warrants the implementation of strict vaccination regimes and quarantine in the affected region.

Geographical distribution of primary & secondary dengue cases in India - 2017: A cross-sectional multicentric study.

Background & objectives: Dengue virus infection is endemic in India with all the four serotypes of dengue virus in circulation. This study was aimed to determine the geographic distribution of the primary and secondary dengue cases in India. Methods: A multicentre cross-sectional study was conducted at Department of Health Research / Indian Council of Medical Research (DHR)/(ICMR) viral research and diagnostic laboratories (VRDLs) and selected ICMR institutes located in India. Only laboratory-confirmed dengue cases with date of onset of illness less than or equal to seven days were included between September and October 2017. Dengue NS1 antigen ELISA and anti-dengue IgM capture ELISA were used to diagnose dengue cases while anti-dengue IgG capture ELISA was used for identifying the secondary dengue cases. Results: Of the 1372 dengue cases, 897 (65%) were classified as primary dengue and 475 (35%) as secondary dengue cases. However, the proportion varied widely geographically, with Theni, Tamil Nadu; Tirupati, Andhra Pradesh and Udupi-Manipal, Karnataka reporting more than 65 per cent secondary dengue cases while Srinagar, Jammu and Kashmir reporting as low as 10 per cent of the same. The median age of primary dengue cases was 25 yr [interquartile range (IQR 17-35] while that of secondary dengue cases was 23 yr (IQR 13.5-34). Secondary dengue was around 50 per cent among the children belonging to the age group 6-10 yr while it ranged between 20-43 per cent among other age groups. Interpretation & conclusions: Our findings showed a wide geographical variation in the distribution of primary and secondary dengue cases in India. It would prove beneficial to include primary and secondary dengue differentiation protocol in the national dengue surveillance programme.

Multiple subcutaneous cysts due to Exophiala spinifera in an immunocompetent patient.

Here we report a case of a 55-year-old Indian male presenting with multiple subcutaneous cysts, which developed from painful nodules at the dorsal right wrist joint. Subsequently a painful nodule appeared on the left knee joint. Cytological examination of the knee swelling revealed a suppurative inflammatory lesion consisting of neutrophils, lymphocytes, multinucleated giant cells and few fungal elements, without involvement of the overlying skin. Exophiala spinifera was cultured (CBS 125607) and its identity was confirmed by sequencing of the internal transcribed spacer (ITS rDNA). The cysts were excised surgically, without need of additional antifungal therapy. There was no relapse during one-year follow-up and the patient was cured successfully. In vitro antifungal susceptibility testing showed that posaconazole (0.063 µg/ml) and itraconazole (0.125 µg/ml) had the highest and caspofungin (4 µg/ml) and anidulafungin (2 µg/ml) the lowest activity against this isolate. However, their clinical effectiveness in the treatment of E. spinifera infections remains to be evaluated. In this case report, we have also compiled cases of human E. spinifera mycoses which have been reported so far.

Surviving ventricular standstill for 111 seconds during Holter monitoring.

Holter electrocardiogram recording revealed symptomatic prolonged ventricular standstill lasting for about two minutes which terminated without any external cardiopulmonary resuscitation.

Acute bioprosthetic mitral valve stenosis in a patient with HITS.

Acute thrombosis involving the left atrium and a bioprosthetic valve during the early postoperative period is an extremely rare complication of heparin-induced thrombocytopenia syndrome (HITS). We present a patient with early bioprosthetic mitral valve stenosis complicated by HITS in a patient with severe mitral regurgitation, atrial fibrillation, and severe left ventricular dysfunction.

Surgical correction of congenital heart disease at 76 years of age.

The management of adult congenital heart disease is challenging and poses specific problems. We report a patient with ventricular septal defect and pulmonary stenosis who underwent successful repair and coronary artery bypass grafting at the age of 76 years.

Coinfection of chikungunya and dengue viruses: A serological study from North Western region of Punjab, India.

INTRODUCTION: Dengue and chikungunya (CHIK) infections appear to be increasing in all parts of India. Aedes aegypti mosquitoes are common vectors for dengue virus (DENV) and CHIK virus (CHIKV). In areas where both viruses cocirculate, they can be transmitted together. There are very few studies discussing the dengue-chik coinfection from Punjab region of India. The present study was undertaken to study the clinical features of dengue-CHIK coinfection and compare with monoinfection. MATERIALS AND METHODS: IgM antibody capture (MAC) ELISA for dengue IgM and CHIK IgM and ELISA for nonstructural protein 1 antigen was performed on serum samples obtained from suspected patients. RESULTS: Out of total 3160 samples from suspected patients for dengue infection, 2178 (68.92%) samples were positive for DENV while CHIK IgM antibodies were positive in 127 patients out of the total suspected 373 cases (34.04%). In addition to this, 283 samples were tested for both viruses, out of which 27 sera were positive (9.54%) for coinfection of dengue and CHIK. The comparison of signs and symptoms showed that the coinfected patients had fever in all cases while rash was seen in only 30% cases. Arthralgia (79%) and thrombocytopenia (77%) was seen in significant number of coinfected cases thus revealing overlapping nature of dengue-CHIK coinfection. CONCLUSION: Increase in the number of Dengue and Chikungunya infections and their cocirculation is an important public health concern which warrants the implementation of strict control measures.

Prevalence of Sars-Cov-2 Detected Through Cartridge-Based Nucleic Acid Amplification Test (Cbnaat) Among Patients of Ili and Sari in Various Districts of Punjab

Background: COVID-19 is an infectious disease caused by the SARS-CoV-2 virus. After a December 2019 outbreak in China, the World Health Organization identified SARS-CoV-2 as a new type of coronavirus. Currently, WHO recommends detection of unique sequences of virus RNA by rRT-PCR. ICMR also recommends use of CBNAAT using Cepheid Xpert Xpress SARS-CoV2. The aim of this study is to determine the prevalence of SARS-CoV-2 detected through CBNAAT.Material & Methods:This retrospective study was conducted from July 2020 to December 2021 at VRDL, GMC, Amritsar. The study group consisted of all the patients presenting with symptoms of Influenza Like Illness (ILI) and Severe Acute Respiratory Illness (SARI) who presented to hospital. The data was collected and subjected to statistical analysis.Results:During the present study, a total of 1,259 samples were analyzed for SARS-CoV-2 by CBNAAT from July 2020 to December 2021. Out of total 1,259 cases which were included in the study, 327 cases (25.97%) were found to be SARS-CoV-2 positive while 870 cases (69.10%) were SARS-CoV-2 negative and 62 cases were found to be inconclusive. 62 inconclusive samples were further tested by RT-PCR. Out of which, 15 were RT-PCR positive and 47 were RT-PCR negative.Conclusions:The COVID-19 pandemic has put forward unprecedented challenge to the public health system across countries to prepare themselves for this current crisis which included isolation, contact tracing, quarantine and enforcement of a nation wide lockdown starting 25th March, 2020.

Prevalence and Epidemiological Profile of COVID-19 Infection Detected Through RT-PCR AmongPatients of Various Districts of Punjab, India

Background: The COVID-19 pandemic has led to a dramatic loss of human life worldwide and presents an unprecedented challenge for healthcare systems worldwide. Earlier to SARS-CoV pandemic, coronaviruses were only thought to cause mild, self-limiting upper respiratory tract infections in humans. COVID 19 presents across a spectrum of symptoms. WHO recommends detection of unique sequences of virus RNA by Nucleic Acid Amplification Test (NAAT) such as real-time reverse-transcriptase polymerase chain reaction (rRT-PCR). The aim of this cross sectional study was analysis and confirmation of Nasopharyngeal/oropharyngeal swab specimen by real-time reverse transcription polymerase chain reaction (RT-PCR).Material & Methods:This was a cross-sectional retrospective study that reviewed records of samples collected from June 2021 to March 2022. Nasopharyngeal/oropharyngeal swab specimen were collected from suspected COVID-19 subjects of various districts of Punjab and referred to Viral Research Diagnostic Laboratory [VRDL], Government Medical College [GMC], Amritsar for laboratory analysis and confirmation by real-time reverse transcription polymerase chain reaction (RT-PCR).Results:During the present study, a total of 11,27,005 samples were analyzed from June 2021 to March 2022 for SARS-CoV-2 detection by ICMR approved COVID-19 RT-PCR kits. Out of total 11,27,005 cases, 24,466 cases (2.17%) were found to be SARS-CoV-2 positive while 11,02,539 cases (97.83%) were SARS-CoV-2 negative.Conclusions:Ever since the COVID-19 global pandemic emerged, the developing countries are facing challenges regarding its diagnosis. Isolation of the infected person will eventually decrease the Reproduction number i.e Ro which will further interrupt the transmission cycle leading to decrease in community spread.

Prevalence and in vitro susceptibility pattern of MRSA,VRSA, VISA isolates from various clinical samples in tertiary care hospital

Background: Staphylococcus is notorious for its ability to become resistant to antibiotics. MRSA emerged as nosocomial pathogen in the early 1960. Methicillin Resistant Staphylococcus aureus are implicated in serious infections and nosocomial infection outbreaks, thus limiting the treating options to very few agents such as vancomycin and teicoplanin. Vancomycin has been regarded as the first line drug for the treatment for MRSA but its irrational use lead to emergence of vancomycin resistance. The Aim was to determine the prevalence and resistance of MRSA ,VRSA,VISA isolates from various clinical samples in a tertiary care hospital.Material & Methods:This present prospective study was done in the Microbiology department of Government Medical College. The study was conducted for a period of one and half year i.e from January 2019 to June 2020. All the samples (pus, urine, blood, body fluids, sputum etc) were processed as per standard protocols.Results:Out of 26,471 samples, 6578(24.85%) were found to be culture positive. 1583 isolates were identified as Staphylococcus aureus. Among them 1278(80.7%) were MRSA, 21(1.3%) were VISA and 8(0.5%) were VRSA. Maximum number of MRSA isolates were obtained from orthopaedics ward (22.7%) and Intensive Care Unit and most of them were isolated from pus(45%) followed by blood (19.09%)samples. Among them highest resistance were observed against azithromycin (85.6%), followed by ciprofloxacin (63.5%) and least resistance to rifampicin and doxycycline. Majority of the VISA and VRSA strains were isolated from ICU followed by orthopaedics, surgery. Most of them were isolated from pus followed by blood and urine specimen and most were found to be multidrug resistant while they retained their sensitivity to Linezolid and Teicoplanin.Conclusions:As there is high prevalence of MRSA isolates so the treatment options are limited to vancomycin. Overuse of vancomycin can lead to emergence of VRSA strains. So the need for rational use in the infection-control practices to prevent transmission of MRSA as well as VISA strains. Strict implementation of hand hygiene, decolonization of MRSA carriers,and education of healthcare team will be quite helpful.

Prevalence of Novel Corona Virus (Severe Acute Respiratory Syndrome Coronavirus 2) and its Uncertain Future in the Different Regions of Punjab

Background: Coronavirus disease?19 (COVID?19), produced by the severe acute respiratory syndrome coronavirus 2 (SARS?CoV?2), has become a global pandemic, giving rise to a serious health threat globally. Many countries have seen a two?wave pattern in there reported cases during the period of pandemic. Similarly, our country has reported the first peak between March and October 2020 followed by the second peak between April and June 2021. Objectives: The objective of this study was conducted to describe the spatiotemporal patterns and early epidemiological features of COVID?19 cases from November 2020 to May 2021 in the central (Majha) region of Punjab state of India which was considered as the epicenter of the infection. Methods: The multiplexed real?time reverse transcription–polymerase chain reaction (RT?PCR) method was used to detect SARS?CoV?2, with co?amplification of specific target genes using real?time PCR kits. Results: During the second wave, test positivity rate for COVID?19 in our laboratory (the central region of Punjab) was recorded as 4.8%. The study revealed that an increased sustained proportion of COVID?19 incidence is present in young adult age group (20–39 years) with 8.65% positive rate followed by the older age group and least in young ones. It was observed that during the second wave, more symptomatic individuals are positive (10.26%) alongside it was also observed that male population (5.61%) was more prone to infection in comparison to females (3.78%). Whole?genome sequencing carried out on 120 random samples selected from all the districts of Majha region of Punjab state showed two prominent strains, namely alpha variant (95 cases) and delta variant (19 cases). Conclusion: A higher positivity rate in the second wave demonstrates the rapid spread of the new emerging virus variants and warrants the implementation of strict vaccination regimes and quarantine in the affected region.

Investigation of Seroprevalence of Sars-Cov-2 IgG Antibodies Among Healthcare Workers in a Tertiary Care Centre in District Amritsar

Background: SARS-CoV-2 infection poses tremendous challenge to the healthcare system of nations across the globe.Healthcare workers (HCWs) are crucial to the ongoing response to the SARS-CoV-2 pandemic. During the course of their work, they are exposed to hazards that place them at the risk of infection. Serological testing for SARS-CoV-2 among healthcare workers, which form a high risk group helps in identifying the burden of hidden infection in an institutional setting. The present study aims to investigate the seroprevalence of IgG antibodies against SARS-CoV-2 among HCWs during 1stand 2ndwave.Material & Methods:A prospective study was conducted at Viral Research and Diagnostic Laboratory, Government Medical College, Amritsar during JuneJuly2020 (1stwave)and April May 2021(2nd wave). During this period, 184 blood samples were collected from healthcare workers from Government Medical College and Hospital, Amritsar. Serum was separated and used for detection of Anti-SARS-CoV-2 IgG antibodies by ELISA technique.Results:Out of the 184 samples, 79 (42.9 %) were found to be seropositive. Higher seropositivity was seen i.e 60.8 % during the 2ndwave (April-May 2021 ) as compared to 25% during 1st wave. The increase in seroprevalence was observed in almost all categories of HCWs, Doctors 44.4% vz 13.04%, nurses 54.8 % vz 34.7 %, lab technicians 72% vz 30.4 % and housekeeping staff 72.2 % vz 21.7%. Also the unvaccinated HCWs showed higher seroprevalence during the second wave and 87.5 % of vaccinated HCWs had demonstrable IgG antibodies.Conclusions:High seropositivity was observed among healthcare workers due to their nature of work. Rise of seropositivity among unvaccinated HCWs during 2ndwave concludes that increase in seroprevalence was attributable to natural infection.The vaccine’s immunological response was also highlighted in the study.

Clinical and Epidemiological profile of SARS-CoV-2 in patients with Severe Acute Respiratory Illness (SARI) at a tertiary care hospital of North India.

Background: Severe acute respiratory illness due to SARS-CoV-2 represents great global public health concern. The spectrum of disease ranges from mild to life-threatening. Surveillance of hospitalized patients with severe acute respiratory infections (SARI) is an important public health tool used to identify etiologies to understand the disease, track changes in circulating viruses and as an alert mechanism for potential pandemic viruses. We aim to find out the rate of SARS-CoV-2 positivity in SARI cases and further study the epidemiological and clinical characteristics of patients.Material & Methods:A Prospective study was conducted on 200 Severe Acute Respiratory Illness patients admitted at tertiary care hospital. The clinical, demographic, epidemiological, risk factors / co-morbidities of all the patients were recorded. Oropharyngeal and nasopharyngeal samples were collected and tested for SARS-CoV-2 by real time reverse transcriptase (RT-PCR) test.Results:Out of 200 SARI patients, 51 (25.5%) were tested positive for SARS-CoV-2. Maximum cases (54.90%) were in the age group of 41-60 years; males were infected predominantly (52.94%). The most common symptoms of presentation were fever (100%), cough (86.27%), dyspnoea (82.35%) and sore throat (56.86%). Comorbidities associated with COVID-19 were Hypertension (56.86%), Diabetes Mellitus (33.33%), Chronic Obstructive Pulmonary Disease (13.72%) and Coronary Artery disease (9.8%). More than 30% of the patients were admitted in ICU and 9.80% received mechanical ventilation.Conclusions:Evaluation of clinical and epidemiological profiles of SARI patients can help in understanding and managing the outbreak more efficiently. Close monitoring and quarantine will be required to prevent extensive transmission within the community.

Hepatitis E virus: A leading cause of waterborne viral hepatitis in Northwest Districts of Punjab, India.

BACKGROUND: Acute viral hepatitis (AVH) caused by enterically transmitted hepatitis A virus (HAV) and hepatitis E virus (HEV) poses a major health problem in developing countries such as India. Despite improving sanitation, heath awareness, and socioeconomic conditions, these infections continue to occur both in sporadic as well as in epidemic forms in different parts of India. AIMS: The aim of this study is to determine the total as well as age-specific prevalence rates of HAV and HEV in the outbreaks of waterborne hepatitis in districts surrounding Amritsar region of Punjab. MATERIALS AND METHODS: The study was conducted in the Virology Research and Diagnostic Laboratory, Government Medical College, Amritsar, during the study period of January 2015-March 2016. Samples from suspected outbreaks of AVH occurring in various districts around Amritsar were included as a part of the study. A total of 95 sera were tested for IgM antibody to HEV and HAV using IgM capture ELISA kit. RESULTS: Out of the total 95 samples received, 73 samples (76.84%) were positive for HAV/HEV. Out of the total positive cases, 65 (68.42%) had HEV infection, 2 (2.1%) had HAV, and 6 cases (6.31%) were coinfected with both HAV and HEV. The 21-30 years age group (25 cases) was identified as the most susceptible group for HEV infection. The coinfected subjects presented a wider range of age distribution (1-10 years: 1; 11-20 years: 3; 21-30 years: 1; 31-40 years: 1). Seasonal distribution of data revealed bimodal peaks for HEV infection. CONCLUSION: There should be some surveillance system to regularly monitor the portability of drinking water from time to time to avoid such preventable outbreaks in future.

Significance of coagulase negative Staphylococcus from blood cultures: persisting problems and partial progress in resource constrained settings.

BACKGROUND AND OBJECTIVES: Coagulase negative Staphylococcus (CoNS) is frequently isolated from blood cultures but their significance is difficult to interpret. CoNS bacteria which are often previously dismissed as culture contaminants are attracting greater importance as true pathogens in the past decades. Clinical evaluation of these isolates suggests that although there is a relative increase of CoNS associated bloodstream infections in recent years, the microorganisms still remain the most common contaminants in blood cultures. The objective of this study was to determine the significance of CoNS isolated from blood cultures. MATERIALS AND METHODS: A retrospective study was conducted to evaluate the rate of contamination in blood cultures in a tertiary care hospital. The paired specimens of blood were cultured using conventional culture methods and the isolates of coagulase negative staphylococci were identified by standard methodology. Clinical data, laboratory indices, microbiological parameters and patient characteristics were analyzed. RESULTS: Of 3503 blood samples, CoNS were isolated from blood culture of 307 patients (8.76%). The isolates were reported as true pathogens of bloodstream infections in only 74 out of 307 cases (24.1%). In the vast majority, 212 of 307 (69.0%), they were mere blood culture contaminants and reported as insignificant/contaminant. CONCLUSION: Determining whether a growth in the blood culture is a pathogen or a contaminant is a critical issue and multiple parameters have to be considered before arriving at a conclusion. Ideally, the molecular approach is for the most part a consistent method in determining the significant isolates of CoNS. However, in countries with inadequate resources, species identification and antibiogram tests are recommended when determining significance of these isolates.

Seroprevalence of Common Viral Diseases: A Hospital Based Study from Amritsar, India.

INTRODUCTION: There is a paucity of published data on epidemiology of the viral infections in Punjab, India. The Viral Research and Diagnostic Laboratory (VRDL) located at Government Medical College (GMC), Amritsar conducts the initial diagnosis of common viruses circulating in the region. AIM: To report the seroprevalence of various viral diseases in Amritsar and neighboring districts of Punjab along with the demographic and geographical data of the patients. MATERIALS AND METHODS: Whole blood sera samples from a total of 5781 patients suspected of various viral diseases (chikungunya, dengue, hepatitis A, hepatitis B, hepatitis C, hepatitis E, herpes simplex-1 or herpes simplex-2) were received at VRDL, GMC, Amritsar from January 2015 to April 2016 and a cross sectional study was conducted. The diagnosis was based on serological assays. RESULTS: Out of total 5781 suspected cases, 1790 were diagnosed with antibodies for atleast one of the tested viral diseases. Dengue virus was the highest occurring viral disease (56.77%). Male patients infected with viruses outnumbered female cases, except for hepatitis E and herpes simplex-1. The 21-40 years age group appeared to be the most susceptible age group for nearly all studied viral infections. Among the total nine reported outbreak investigations, largest encompassed 1335 dengue cases from Amritsar district. CONCLUSION: VRDL established in GMC, Amritsar has become instrumental in detection of emerging and re-emerging viral diseases including outbreak investigation of communicable diseases. Timely action with the help of adequate information and capacity to diagnose the viruses might help in saving numerous lives.

Assessment of bacteriological quality of drinking water from various sources in Amritsar district of northern India.

INTRODUCTION: Safe water is a precondition for health and development and is a basic human right, yet it is still denied to hundreds of millions of people throughout the developing world. Water-related diseases caused by insufficient safe water supplies, coupled with poor sanitation and hygiene, cause 3.4 million deaths a year, mostly in children. METHODOLOGY: The present study was conducted on 1,317 drinking water samples from various water sources in Amritsar district in northern India. All the samples were analyzed to assess bacteriological quality of water for presumptive coliform count by the multiple tube test. RESULTS: A total of 42.9% (565/1,317) samples from various sources were found to be unfit for human consumption. Of the total 565 unsatisfactory samples, 253 were from submersible pumps, 197 were from taps of piped supply (domestic/public), 79 were from hand pumps, and 36 were from various other sources A significantly high level of contamination was observed in samples collected from submersible pumps (47.6%) and water tanks (47.3%), as these sources of water are more exposed and liable to contamination. CONCLUSIONS: Despite continuous efforts by the government, civil society, and the international community, over a billion people still do not have access to improved water resources. Bacteriological assessment of all sources of drinking should be planned and conducted on regular basis to prevent waterborne dissemination of diseases.

Vancomycin Resistance among Enterococci: Further Limiting Our Therapeutic Options

Introduction: Enterococci are indigenous flora of theintestinal tract, oral cavity & genitourinary tract of human.Over recent years, there is increased interest in Enterococcinot only because of their serious infections but becauseof their increasing resistance to many antimicrobials.Vancomycin being the only alternative available. But over thetime, there has been increase in Vancomycin Resistance whichhas spread globally. The aim of this study was to determinethe prevalence of Vancomycin Resistant Enterococci (VRE)isolated from various clinical specimens in a tertiary carehospital in North India.Material and methods: A cross-sectional study was conductedin the Department of Microbiology, Government MedicalCollege, Amritsar from July 1st, 2018 to June 30th, 2019. Allthe samples received were processed and identification ofEnterococci was made by using standard microbiologicaltechniques. Antimicrobial susceptibility was performed byKirby Bauer disc diffusion method as per CLSI guidelines.Results: Out of total clinical samples (11,098), 3,551 (31.9%)were found to be culture positive. Among the culture positive,91 (2.56%) isolates were identified as Enterococcus speciescomprising of 37 E.faecalis (41%) and 54 E.faecium (59%).Maximum number of Enterococci were isolated from urinesamples (54.92%) followed by pus & body fluids (38.02%) andblood (7.04%). 9.52% of E.faecium isolates were found to beresistant to vancomycin. All the strains were 100% susceptibleto Linezolid, Teicoplanin & Quinupristin-dalfopristin.Conclusion: Enterococci have become the major pathogenicbacteria that cause hospital-acquired infections due tomultiple-antimicrobial resistance. VRE has emerged asimportant nosocomial pathogen and pose serious threat topatients. Vancomycin should be cautiously used else wewould be left with very few therapeutic options.