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Introduction: Resistance to Carbapenems in Klebsiella may be due to Carbapenem hydrolysing enzymes. Accurate detection of carbapenemase must be done for patient treatment and epidemiological purposes. Aim: To detect carbapenemase production by performing Modified Hodge Test (MHT), Combined Disk Test (CDT) for Metallo-b-Lactamases (MBL) and PCR for blaKPC gene, to evaluate the performance of MHT using MacConkey Agar (MCA) and to access the value of MHT for carbapenemase detection. Material and Methods: Using a prospective laboratory study design, 153 Extended Spectrum Beta-Lactamases (ESBL) producing Klebsiella pneumoniae from clinical samples of patients admitted in the Kasturba Medical College were collected from January 2014 to December 2015. Isolates resistant to carbapenems by disk diffusion were subjected to MHT on MCA and Mueller Hinton agar (MHA). All isolates were tested for (MBL) production by Imipenem and Imipenem-EDTA CDT and subjected to PCR for the presence of blaKPC gene. Results: Out of 153 isolates, 54 were resistant to one of the carbapenems. Among these, 13 were positive for MHT on MHA, while 23 were positive by MHT on MCA. Number of MBL producers was 23 (42.5%), while blaKPC was detected in 2 out of the 54 isolates. Conclusion: Though detection of drug resistance gene remains the method of choice, it can be performed only in centers with adequate resources. Hence, for most laboratories in resource poor countries, the MHT performed on MCA with concomitant CDT for MBL detection seem to be a better option for detection of Carbapenem resistance.

Multidrug-resistant (MDR) Gram-negative bacilli (GNB) have been playing havoc in the field of nosocomial as well as community-acquired infections. Of particular concern are the carbapenem-resistant GNBs, belonging to Enterobacteriaceae and encoding for New Delhi metallo-beta-lactamase-1 (NDM-1) gene. These strains spread rapidly and horizontally in the population, thus exhibiting MDR traits as these can harbour several resistance encoding genes to almost all antimicrobial groups. Several predisposing factors are responsible towards its spread, viz. excessive antibiotic usage, improper aseptic conditions by healthcare workers, lack of awareness, abruptly discontinuing medication course, alternative medications and vector-borne factors contributing to the unchecked harbouring of these super bugs in India. Thus, a bugle call has already been sounded worldwide especially in India, where the country has taken serious cognizance to build up strategy via implementation of several national programs to combat antimicrobial resistance covering human, animal, agriculture and environmental aspects. As there is an exponential rise in variants of NDM-1 harbouring strains, molecular epidemiological investigations of these strains using genotyping techniques are of paramount importance for a better understanding of this rampant spread and curbing resistance thereafter. This review explores the urgent need to develop a cost-effective, rapid molecular assay, viz. the loop-mediated isothermal amplification method for field detection of MBL harbouring bacterial strains, especially NDM-1 and its variants, thus targeting specific carbapenemase genes at a grass root level even to the remote and rural regions of the country. [ABSTRACT FROM AUTHOR]

Background: Vernix caseosa is a naturally occurring substance covering the skin of the newborn babies. Chemical composition of Vernix caseosa has been studied. But the antibacterial properties have not been explored phenotypically. There has been only a few studies related to the properties of Vernix caseosa (VC) and most of them focused on deciphering the chemical nature of VC. These studies found that VC has enzymes such as lysozyme, cathelicidin, lactoferrin, defencins, etc, but no study has proved their presence phenotypically. Aim: To know the anti-bacterial and mechanical barrier properties of VC. Materials and Methods: A cross-sectional study done at Government Lady Goshen Hospital, Mangalore, India. Subjects- 63 healthy infants born by LSCS (Lower Segment Caesaren Section) (Confidence interval- 95%, Power- 90%). In lab, sterility of Vernix caseosa was determined. Lawn culture of S.aureus and E.coli on nutrient agar was done and wells were made in it. Vernix broth was prepared using Tween 80 and was put into the well. It was incubated overnight at 37°C and observed for area of Decreased Bacterial Growth (DBG) around the well. Filter papers impregnated with VC were used for testing for mechanical barrier properties. Statistical Analysis: Data was entered in SPSS 12.0 version and analysed. The zone of inhibition (in mm) in case of bacterial growth was expressed as mean with standard deviation. Student's independent t-test was used to compare the means across the groups (males and females). Results: There was no significant difference in the anti-bacterial property based on gender. DBG {mean (SD)} for E.coli and S.aureus was 18.06 mm (1.56) and 13.34 mm (1.94) respectively (p-value <0.000). Result for mechanical barrier was inconclusive due to limitations explained in the article. Conclusion: Vernix caseosa has antibacterial properties. But further studies are needed to explore the mechanical barrier properties against bacteria. [ABSTRACT FROM AUTHOR]

This is the report of lower respiratory tract infection with Pasteurella canis in a chronic obstructive pulmonary disease (COPD) patient with history of casual exposure to cats. Pasteurella species are part of the oral and gastrointestinal flora in the canine animals. These organisms are usually implicated in wound infection following animal bites, but can also be associated with a variety of infections including respiratory tract infections. [ABSTRACT FROM AUTHOR]