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Members of Enterobacteriaceae family are responsible for both community and hospital acquired infections. Because of development of antimicrobial resistance carbapenem has remained as last resort of drug for treatment of infections caused by these bacteria.Mechanism for development of this resistance in carbapenem resistant Enterobacteriaceae (CRE) may due to production of carbapenemases, efflux mechanism or loss of outer membrane porins.The most common carbapenemase enzymes are Class A – KPC, Class B – NDM, VIM and IMP and Class D oxacillinase(OXA-48 like enzymes).In India, most prevalent carbapenemase encoding gene is NDM-1but there is rising threat of OXA-48 prevalence. Unlike the phenotypic methods, the genotypic methods are useful to discriminate the type of carbapenemase enzyme, specifically for OXA-48 like enzymes. Total 170 CRE isolates were subjected for multiplex PCR study for their molecular characterization. Of the 170 CRE isolates,68.2 % (n=116) were positive for NDM-1 gene while 44.1 % (n= 75) of the isolates showed presence of OXA-48 gene. VIM (2.3%), KPC (1.7 %) were responsible for carbapenemase production while none of the isolates showed presence of IMP gene. NDM-1 and OXA-48 coexisted in 21.2 % (n=36) of the total isolates. OXA-48 causes weak hydrolysis of carbapenem because of which it is under reported with routine diagnostic methods. Early detection of OXA-48 and other carbapenemase encoding genes, helps for contact precautions and effective therapy which prevents further escalation and horizontal spread of CRE.

Acinetobacter is a complex genus, with multiple species. Acinetobacter species are the common etiology of nosocomial infections, principally nosocomial pneumonia catheter-associated bacteremia and urinary tract infections. Multidrug Resistant (MDR) Ventilator Associated Pneumonia (VAP) by Acinetobacter spp is increasingly reported from different parts of the world. Transmission of Acinetobacter is aid by the organism's environmental stubbornness, resistance to desiccation and evasion of host immunity. The virulence properties demonstrated by Acinetobacter spp. is primarily by evasion of rapid clearance by the immune system. The capsular polysaccharide is a critical virulence factor that enables immune evasion and lipopolysaccharide triggers septic shock. Conversely, the primary factor of clinical outcome is antibiotic resistance. Acinetobacter spp. has become a discreditable threat for patients on mechanical ventilation. Considering high rate of antibiotic resistance, new preventive and therapeutic alternative approach for MDR Acinetobacter spp. infections are urgently needed. Worldwide drug resistance in Acinetobacter baumannii is growing. This review article is emphasised on incidence of VAP due to MDR Acinetobacter, phenotypes, genotypes, associated risk factors and preventive strategy.

Background: Although the patients in the Intensive Care Unit (ICU) are at risk for candidemia resulting in complication, rapid diagnosis of aetiologic agent will reduce the delay in initiating the appropriate therapy with adequate dosage of antifungals thus improving the outcome. Due to reduced susceptibility of nonalbicans Candida species to antifungal agents; testing the antifungal susceptibility pattern has become important both epidemiologically and for patient management. Aim and Objectives: To compare the VITEK 2 Yeast antifungal susceptibility testing with Clinical and Laboratory Standards Institute (CLSI) Broth Microdilution (BMD) reference method against isolates of Candida species and assess the Categorical Agreement (CA) and errors. Material and Methods: Candida species isolated from blood samples of patients admitted under Medical and Surgical ICU of Krishna Hospital and Medical Research Centre, Karad were subjected to antifungal susceptibility testing by CLSI reference BMD and VITEK 2 method. Results: Compared to the reference BMD method, the VITEK 2 system yielded highly reproducible and accurate MIC results and excellent overall categorical agreement at 100% for amphotericin B, flucytosine, fluconazole, and voriconazole against C. albicans, C. tropicalis, C. krusei, C. parapsilosis, C. lusitaniae and C. guillermondii except C. rugosa and C. glabrata. Conclusion: The VITEK 2 method demonstrated excellent reproducibility and standardization. It provides a fully automated method for fungal identification, determining the MICs against Candida spp. based on spectrophotometry, thus eliminating the inherent bias of manual MIC determination.

Background: The critically ill patients are particularly susceptible to rapid colonization by endemic pathogens or hospital ora. Both immunocompetent and immunocompromised patients are particularly exposed to various risk factors. Bloodstream infection due to Candida species is now recognized as an important public health problem especially in intensive care unit patients with considerable morbidity, mortality and health care costs. Aim: The aim was to study the incidence, risk factors and antifungal susceptibility of the Candida species isolated from blood of Medical Intensive Care Unit (MICU) patients in our hospital. Material and Methods: The blood samples collected from MICU patients were processed as per standard protocol and antifungal susceptibility testing was done by broth microdilution method. Results: Out of total 111 samples, 22 (19.81%) yielded Candida species of which non-albicans Candida species predominated. In MICU, the risk factors associated with candidemia showing statistical signicance were length of intensive care unitstay > 7 days, use of steroids, mechanical ventilation, central venous catheters and uncontrolled diabetes mellitus. C. albicans, C. parapsilosis and C. guillermondii have showed 100% susceptibility to Amphotericin B, 5-Flurocytosine, Fluconazole, Itraconazole and Voriconazole. C. krusei showed 100% resistance to uconazole. C. glabrata showed 100% resistance to Itraconazole and Voriconazole. The mortality rate among MICU patients with candidemia was 59.09%. Conclusion: Although the patients in the ICU are at risk for candidemia, rapid diagnosis of aetiologic agent will reduce the delay in initiating the appropriate therapy with adequate dosage of anti-fungal agents along with effective correction of underlying risk factors which may actually improve their outcome

Background: The increased incidence of fungal infections in the past two decades has been overwhelming. Despite the fact that invasive fungal infections are still under-diagnosed and underreported, bloodstream infection due to Candida is now being recognized as an important public health problem especially in ICU patients with considerable morbidity, mortality and health care costs. Objective: To study the incidence, risk factors and antifungal susceptibility of Candida bloodstream infection in our hospital. Material and Methods: In the present study, the blood samples were collected from patients admitted in Surgical ICU. Samples were processed and antifungal susceptibility of the isolates was performed using standard protocol. Results: Out of total 93 patients, 14 (15.05%) were positive for candidemia with equal distribution of both C. albicans and nonalbicans Candida spp. The risk factors associated with candidemia showing statistical significance were length of ICU stay > 7 days, mechanical ventilation, central venous catheters and uncontrolled diabetes. Among the patients with candidemia the mortality rate was 78.57 %. Resistance to Amphotericin B was seen in 33.33 % isolates of C. tropicalis and 100 % isolates of C. rugosa. 33.33 % of C. tropicalis and 50 % of C. rugosa showed dose dependent susceptibility to Fluconazole. Conclusion: Early diagnosis and antifungal susceptibility testing is very important in the treatment of candidemia for reducing the mortality rate.

Backgroind: In endemic area for brucellosis background levels of antibodies are found in healthy populations. Aims & Objectives: Theaim of this study was to determine the seroprevalence of anti-brucella antibodies and base line titres among the blood donors.Materials and Methods: 321 blood samples were collected from blood donors. Serological tests - Rose Bengal Plate Agglutination Test(RBPT), Standard Tube Agglutination Test (STAT) and 2-Mercaptoethanol Agglutination Test (2ME), were carried out on all the blood samples. Results: Seroprevalence of brucellosis in blood donors was 5.91%, 3.11 % and 0.62% by RBPT, STAT and 2ME respectively. History of animal exposure and occasional raw milkingestion was observed in 137 individuals residing in rural area. Conclusion: Brucellosis might be common in rural population who comein contact with infected animals and or consume raw milk. For the diagnosis of brucellosis RBPT test should be used only for screening purpose and the positive results should be confirmed by STAT and 2ME tests. Titres of 160 IU and above for STAT and 80 IU and above for 2ME test can be considered significant for diagnostic purpose.