Providencia rettgeri is a member of Enterobacteriacea that is known to cause urinary tract infection (UTI), septicemia, and wound infections, especially in immunocompromised patients and in those with indwelling urinary catheters. It is an uncommon cause of UTI and sepsis but should be suspected in patients with predisposing factors. The condition has high mortalty and warrants early recognition and treatment. We present here a case of UTI with sepsis by Providencia rettgeri in a young female during post partum period. She had recently delivered a male baby and was catheterized for 10 days. Patient received intravenous antibiotis and recovered completely. …………………………………………………………………………………………………….... Introduction:-The genus Providencia is a member of theEnterobacteriaceae family which commonly dwells in soil, water, and sewage [1]. Human isolates of Providencia species have been recovered from urine, throat, perineum, axilla, stool, blood and wound specimens. The organism is usually isolated from genitourinary and gastrointestinal sources (urine, faeces and perineum), causing diarrhoea and urogenital symptoms .Providencia rettgeri (P. rettgeri) is a motile, gram-negative rod shaped organism and a member of the Enterobacteriaceaefamily [1]. It is inherently resistant to many antibiotics and thus early identification and treatment is needed to treat this infection. We present a case of urinary tract infection during post partum period in a female who had recently delivered and was catheterized.Case report:-A 24 year old young female presented to the OPD with history of dysuria and fever . The fever was high grade and intermittent type. The female had delivered a male baby ten days earlier by cesarian section she had been catheterised for 10 days . General physical examination was normal except for elevated temperature . Heamogram revealed TLC of 12000 . Chest X ray was normal. Urine was sent for culture and sensitivity in our lab. The urine was inoculated on HiCrome agar using a calibrated loop. Inoculated plates were incubated at 35 degree C for 24 hours. Next day plates were examined for colony morphology.Gram smear showed short rod shaped cells ,0.5-0.8 µm. colonies were glossy, white 2-3mm. Providencia rettgeri Was isolated from urine and blood (figure 1).culture revealed that the isolate was resistant to ampicillin, ampicillin/sulbactam, cefazolin, gentamicin, and trimethoprim/ sulfamethoxazole. It was found to be susceptible to ceftriaxone, cefepime, ciprofloxacin, and piperacillin/tazobactam The patient was admitted put on iv ceftrioxone and had complete recovery.

Carbapenem-resistant Enterobacteriaceae (CRE), an emerging threat to public health, belong to a family of microorganisms that are difficult to treat because they are highly resistant to antibiotics.These bacteria can cause serious hospital-and community-acquired infections, such as bloodstream infections, wound infections, urinary tract infections and pneumonia. [1] Unlike Methicillin Resistant Staphylococcus aureus (MRSA) resistance, which is mediated by a single mechanism in a single bacterial species, the mechanisms of carbapenem resistance are complex because they involve a broad range of organisms and are mediated by different mechanisms, such as the production of β-lactamases,efflux pump and porin mutations. [2] Carbapenemases are β-lactamases with versatile hydrolytic capacities. They hydrolyze penicillins, cephalosporins, monobactams, and carbapenems. Bacteria producing these β-lactamases may cause serious infections in which the carbapenemase activity renders many β-lactams ineffective. Carbapenemases are members of the Ambler class A, B, and D β-lactamases. The class A carbapenemase group includes members of the SME, IMI, NMC, GES, and KPC families. Of these, the KPC carbapenemases are the most prevalent,found mostly on plasmids in Klebsiella pneumoniae. [3] The first member of the KPC family was discovered through the ICARE surveillance project in a K. pneumoniae clinical isolate from North Carolina in 1996. [4] The gene encoding the KPC enzyme is usually flanked by transposon-related sequences and has been identified on conjugative plasmids,therefore,potential for dissemination is significant. [5,6,7] Isolates that acquire this enzyme are usually resistant to several other classes of antimicrobial agents used as treatment options. Laboratory identification of KPC-producing clinical isolates will be critical for limiting the spread of this resistance mechanism. [8] The most commonly used method for detection of CRE is the measurement of minimum inhibitory concentration (MIC). MICs are important in diagnostic laboratories to confirm resistance of microorganisms to an antimicrobial agent. It is a quantitative measurement of antibiotic activity, and it is defined as the minimum concentration of an antibiotic that can inhibit visible microbial growth under normal conditions. [9,10] In 2009, CLSI published a recommendation that carbapenem susceptible Enterobacteriaceae with susceptible, but elevated MIC, be tested for the presence of the carbapenemase enzyme using the Modified Hodge Test (MHT). [11] In 2010, the CLSI changed