Introduction: Carbapenem resistance in Gram-negative bacilli (GNB) is a major concern in the management of resistant infections. The mechanism of carbapenem resistance is most commonly mediated by carbapenemases. The five most common genes (NDM, KPC, VIM, OXA, and IMP) are responsible for carbapenemase production. Knowledge of these genes is important for the management of the disease. Objective: To estimate the prevalence of different genes responsible for carbapenemase production in GNB at a tertiary healthcare centre in South India. Method: In this retrospective study, samples were collected over 16 months. Carbapenem-resistant GNB underwent to Xpert Carba-R assay (Cepheid, Sunnyvale, California, USA) for the detection of five important genes responsible for carbapenemase production: NDM, KPC, VIM, OXA, and IMP. Results: Out of 184 carbapenem-resistant GNB, 20 samples were not included in this study. The rest of the 164 samples grew Klebsiella pneumoniae (152), Escherichia coli (10), and Enterobacter (2). OXA-48 and NDM were the most common genes responsible, with 137 (84.5%) and 95 (58.6%), respectively. Among them, 70 (43.2%) showed the presence of both genes, and 1 (0.6%) showed the presence of OXA-48, NDM, and VIM. Individually, 66 (40.7%) of OXA-48, 24 (14.8%) of NDM, and one (0.6%) of VIM. In this study, the authors did not find the presence of IMP or KPC genes. Conclusion: As a result of limited options and the higher cost of antibiotics for carbapenem-resistant infections, knowledge of these genes helps in the selection and rational use of antibiotics reduces the cost of management and will prevent mortality and morbidity from these infections.

Carbapenems are an important class of drugs very much useful in the therapy of multidrug-resistant gram-negative pathogens. Though these are available for the past 30 years, they can be administered only parenterally, which can reduce the compliance. Tebipenem-pivoxil (TBPM-PI; Orapenem), a prodrug, is the first oral carbapenem. It has been a promising drug in the therapy of drug-resistant respiratory infections and complicated urinary tract infections. It will also be useful in reducing the incidence of central line associated blood stream infections (CLABSI) and improving the rate of treatment completion.

Introduction: Osteomyelitis is one of the infrequent presentations of Salmonella infection. Most of the case reports are among adult patients. It is very rare in children, and is most often associated with hemoglobinopathies or other predisposing clinical conditions. Case Report: In this article, we present a case of osteomyelitis caused by Salmonella enterica serovar Kentucky, in a previously healthy 8-year-old child. Further, this isolate had an unusual susceptibility pattern; it showed resistance to the third-generation cephalosporins, akin to ESBL production among Enterobacterales. Conclusion: Osteomyelitis caused by Salmonella does not have any specific clinical or radiological features, both in adult and pediatric age groups. A high index of suspicion, using appropriate testing methodologies and awareness about emerging drug resistance helps in accurate clinical management. Keywords: Salmonella, pediatric, immunocompetant, osteomyelitis.

Community-acquired pneumonia in children is a common infection but can be potentially serious in some, leading to hospitalization in those with severe or complicated pneumonias. Diagnosis can be made with appropriate history and relevant clinical examination. Viral and Streptococcus pneumoniae infections remain the most common cause of CAP in preschool children, whereas Mycoplasma pneumoniae can present more commonly in older children. Treatment with the appropriate antibiotics is crucial, especially with the increasing prevalence of viral and bacterial co-infections as well as emerging antibiotic resistance. Appropriate dosage and duration of antibiotics are determined by the severity or complications involved. In addition, immunization is extremely important for prevention of CAP in children.