Introduction: Urinary tract infection (UTI) is one of the most common infectious diseases in clinical practice. The choice of antibiotics for the treatment of UTI is limited by the rising rates of antibiotic resistance. There is an urgent need to discover new effective treatment solutions. Fosfomycin may be an interesting alternative to the currently used treatments of UTIs. Materials and Methods: The study was conducted over 6 months period (January to June 2013) in Department of Microbiology, JNMCH, AMU, Aligarh. A total of 1840 urine samples were submitted. Culture and sensitivity was done as per standard microbiological procedures. Methicillin-resistant Staphylococcus aureus (MRSA), high-level aminoglycoside resistance (HLAR), extended spectrum beta-lactamases (ESBL), AmpC and metallo-beta-lactamases (MBL) production was detected. Results: Culture was positive in 504 (27.4%) cases. Gram-negative etiology was identified in 390 (73%) cases. ESBL production was detected in 154 (37.1%) while 82 (21.6%) were Amp C. No, MBL was detected. Among Gram-positive bacteria, 68 (51.5%) were MRSA, while 4 (13.3%) were vancomycin resistant enterococci (VRE). HLAR was seen in 53.3% of enterococci. Fosfomycin was effective in 100% of MRSA, VRE, ESBL, HLAR, and overall, susceptibility to fosfomycin in AmpC producers was extremely high (99%). Norfloxacin and cotrimoxazole were not proved effective as only three isolates were sensitive to norfloxacin, while all Gram-negative isolates were resistant to cotrimoxazole. Pseudomonas species showed 65% and 75% susceptibility to colistin and polymixin B, respectively. Conclusion: Fosfomycin has emerged as a promising option, especially in cases involving multi-drug-resistant pathogens in which previous antibiotics have failed to cure the infection.

Evidence-based prescribing is essential to optimize patient outcomes in cystitis. This requires knowledge of local antibiotic resistance rates. Diagnostic and Antimicrobial Stewardship (DASH) to Protect Antibiotics (https://dashuti.com/) is a multicentric mentorship program guiding centers in preparing, analyzing and disseminating local antibiograms to promote antimicrobial stewardship in community urinary tract infection. Here, we mapped the susceptibility profile of Escherichia coli from 22 Indian centers. These centers spanned 10 Indian states and three union territories. Antibiograms for urinary E. coli from the outpatient departments were collated. Standardization was achieved by regional online training; anomalies were resolved via consultation with study experts. Data were collated and analyzed. Nationally, fosfomycin, with 94% susceptibility (inter-center range 83-97%), and nitrofurantoin, with 85% susceptibility (61-97%), retained the widest activity. The susceptibility rates were lower for co-trimoxazole (49%), fluoroquinolones (31%), and oral cephalosporins (26%). The rates for third- and fourth-generation cephalosporins were 46% and 52%, respectively, with 54% (33-58%) extended-spectrum β-lactamase prevalence. Piperacillin-tazobactam (81%), amikacin (88%), and meropenem (88%) retained better activity; however, one center in Delhi recorded only 42% meropenem susceptibility. Susceptibility rates were mostly higher in South, West, and Northeast India; centers in the heavily populated Gangetic plains, across north and northwest India, had greater resistance. These findings highlight the importance of local antibiograms in guiding appropriate antimicrobial choices. Fosfomycin and nitrofurantoin are the preferred oral empirical choices for uncomplicated E. coli cystitis in India, although elevated resistance in some areas is concerning. Empiric use of fluoroquinolones and third-generation cephalosporins is discouraged, whereas piperacillin/tazobactam and aminoglycosides remain carbapenem-sparing parenteral agents.

Knowledge of local antibiotic susceptibility rates is essential to strengthen antimicrobial stewardship programs. DASH to Protect Antibiotics (https://dashuti.com/), promotes the dissemination of focused local antibiograms in community urinary tract infection (UTI). This study mapped the susceptibility profile of Klebsiella pneumoniae from 18 Indian centers. The centers spanned nine Indian States and three Union Territories. Urinary K. pneumoniae antibiograms from the outpatient clinic were collated and analyzed. Standardization was achieved through online training. For epidemiological purposes, five centers tested fosfomycin. Overall, low susceptibility (<60%) was observed for the standard oral antibiotics prescribed for cystitis: co-trimoxazole, 54% (36-68%); ciprofloxacin, 52% (29-55%); amoxicillin-clavulanic acid, 46%, (35-82%); nitrofurantoin, 39% (19-78%); and cefuroxime, 30% (15-62%). The rates for third- and fourth-generation cephalosporins were 49% (45-52%) and 60% (36-76%), respectively. Extended-spectrum beta-lactamases ranged from 36-61% in India. Piperacillin-tazobactam 74% (65-87%), amikacin 76% (45-91%), and meropenem 81% (61-87%) exhibited higher activity. Fosfomycin was the most active antimicrobial, with 89% (92-97%) susceptibility. K. pneumoniae susceptibility was directly linked to geographic region, log gross domestic product (P <0.001), and humidity, and low and high temperatures (P <0.05). Oral treatment options for K. pneumoniae cystitis are rapidly decreasing. Northern and southern India showed significant differences in antimicrobial susceptibility, highlighting the importance of local antibiograms for promoting antimicrobial stewardship. For uncomplicated cystitis, co-trimoxazole (54%) may be the empirical choice. Good susceptibility to fosfomycin was observed (89%). The empirical use of fluoroquinolones, cephalosporins, and amoxicillin-clavulanic acid has been discouraged. Piperacillin-tazobactam and aminoglycosides are carbapenem-sparing agents.

Emerging and re-emerging zoonoses of diverse etiologies have caused significant morbidity and mortality recently. In the past two decades, several viral zoonoses, such as Bird flu, Ebola hemorrhagic fever, Hantavirus infection, Nipah virus disease, Rift Valley fever, Swine flu, West Nile fever, SARS, MERS, COVID-19 etc., have emerged from different parts of the world. The latest to the list is the “Monkey Pox”, which has recently been renamed as “Mpox” by WHO. The ongoing 2022 multi-country outbreak of monkeypox is the largest in history to occur outside of Africa. Monkeypox is an emerging zoonotic disease that for decades has been viewed as an infectious disease with significant epidemic potential because of the increasing occurrence of human outbreaks in recent years. With increasing case numbers being reported in the current outbreak, it is important for healthcare staff everywhere to update their knowledge of this zoonotic infection, including its prevention, clinical management, prophylaxis, and basics of infection control, to understand the broader implications of the current outbreak. We provide an overview of monkeypox virus infection to serve as a primer for healthcare staff who may encounter this condition in their practice.

Scrub typhus is a re-emerging zoonotic rickettsial disease and is prevalent in many parts of India. Scrub typhus in Uttar Pradesh is virtually unknown but has shown emergence in recent reports. In this context, a prospective study was planned to analyze the prevalence and clinic-epidemiological parameters of scrub typhus in febrile patients present in JNMC hospital. Patients of >15 years with undiagnosed acute febrile illness of more than 5 days with or without acute respiratory failure and acute renal failure (ARF) were included in the study. Clinical profile was recorded through predesigned proforma. Blood samples were collected and serological tests were performed. PCR was performed on whole blood samples of positive patients. Total 414 patients, who were negative for other common febrile etiologies, i.e.: malaria, dengue, enteric fever were included in the study. Out of 414 patients, 112 (27%) were found positive for scrub typhus by ELISA and micro-immunofluorescence (MIF). PCR was negative in all cases. Slight male predominance (52.6%) was observed. Significant number of positive cases 90(80.3%) were between 18-46 years of age (P value <0.05). Majority of cases appeared during winter season Respiratory involvement was significant in positive cases (P value <0.05). Among the gastro-intestinal symptoms, diarrhea and vomiting were also significant (P value <0.005). All the patients responded to the treatment. No complications and mortality was observed. Scrub typhus should be considered in undiagnosed febrile patients coming from rural and agricultural background with respiratory and gastrointestinal symptoms. Serology is reliable in the diagnosis of scrub typhus as molecular testing is costly, labor intensive and not helpful.