S336 Document heading Surveillance of multidrug resistance of 10 enteropathogens in a teaching hospital and in vitro efficacy of 25 ethnomedicinal plants used by an Indian aborigine Shakti Rath 1 , Rabindra N. Padhy 2* 1 Department of Microbiology, IMS & Sum Hospital Medical College, Siksha O Anusandhan University, Kalinga Nagar, Bhubaneswar 751003 2 Central Research Laboratory, IMS & Sum Hospital Medical College, Siksha O Anusandhan University, Kalinga Nagar, Bhubaneswar 751003, Odisha, India Asian Pacific Journal of Tropical Disease (2012)S336-S346 Asian Pacific Journal of Tropical Disease journal homepage:www.elsevier.com/locate/apjtcm *Corresponding author: Dr. R. N. Padhy, CSIR Scientist, Central Research Laboratory, IMS & Sum Hospital, Siksha O Anusandhan University, Kalinga Nagar, Bhubaneswar 751003, Odisha, India; Tel: +91-674-6511205 E-mail: rnpadhy54@yahoo.com 1. Introduction Bacterial pollution of inland waters has become one of the most important public health concerns worldwide, and in India it is graver than imagined, because of the absence of a developed sewage disposal system, in villages and towns at least [1, 2] . Further, it is estimated that there were 93.06 million approximately disadvantaged slum-dwellers in cities without a hygienic management of domestic sewage, in India [3] . More often, hospital sewage/wastes too are badly disposed [1] ; consequently, contamination of inland waters by enteric bacteria is the commonplace of infections [4, 5] . Further, animal husbandry establishments contribute coliform and many enteropathogenic bacteria to inland waters in many countries, because of the lack of scientific disposal of organic farm wastes, as compost. Eventually, sporadic outbreaks of enteropathogenic bacteria including cholera have been frequently precipitated in many countries [6, 7] , and the under-5 mortality in children from diarrhoea has been surfaced in several developing countries [7, 8], creating an uproar in community health; and when those bacteria are reported independently by almost all countries as multidrug resistant (MDR) [9, 10] , there would be outraging commotion with adults even in public health as documented from Malaysia [14] . Thus, the hygienic totem pole of drinking water system as well as the clinical world, in general, gets ARTICLE INFO ABSTRACT Article history: Received 25 June 2012 Received in revised from 5 July 2012 Accepted 7 Octoberr 2012 Available online 28 October 2012 Keywords: Enteropathogens Surveillance Multidrug resistant E. coli Klebsiella sp. Aegle marmelos Azadirachta indica Cassia fistula Holarrhena antidysenterica Salvadora persica Phytoextracts In vitro efficacy Phytochemical analysis Objective: To have an antibiogram of hospital acquired (HA) and community acquired (CA) enteropathogens against 16 antibiotics to assess the infection dynamics for plausible help to the antimicrobial stewardship. To check extracts of 25 lesser-known plants used by an Indian aborigine, for antimicrobial efficacy in vitro and as complementary and alternate medicines against resistant pathogens. Methods: Ten strains of enteric bacteria (Enterobacter aerogenes, Escherichia coli, Klebsiella sp., Salmonella paratyphi, S. typhi, Shigella boydii, S. dysenteriae, S. flexneri, S. sonnei and Vibrio cholerae) were isolated from clinical samples in 6 months and their antibiotic sensitivity was assessed by the disc-diffusion method. Concentrated aqueous and ethanolic extracts of leaves and barks of plants were used for monitoring their antibacterial potencies, by the agar-well diffusion method. Results: Isolated bacterial strains were invariably multidrug resistant (MDR). E. coli was the most frequently isolated organism from HA and CA samples, followed next by Klebsiella sp. From the surveillance, it was evident that the distribution of MDR strains of each was more in HA than CA isolates. Aqueous and ethanolic extracts of Aegle marmelos, Azadirachta indica, Cassia fistula, Holarrhena antidysenterica, Salvadora persica and Terminalia arjuna were highly effective against the all isolated enteropathogenic strains. From the preliminary phytochemical analysis, it was confirmed that both extracts of A. indica, T. arjuna and T. alata contained all the detected phytochemicals (alkaloids, glycosides, terpenoids, reducing sugars, saponins, tannins, flavonoids and steroids), which plausibly attributed to their significant antibacterial activity. Conclusions: Phytoextracts were highly effective against the all enteropathogenic bacterial isolates, in vitro. These 25 plants could be used further for the isolation of pure compounds for use as complementary medicines. Contents lists available at ScienceDirect