Diabetic foot problems such as ulcerations, infections and gangrene are dreadful complications of diabetes mellitus and a major cause of hospitalization. Overall 15% of individuals with diabetes mellitus will have foot ulcers during their lifetime. Diabetic foot infected patients are usually prescribed with broad spectrum antibiotics. Our study was done to evaluate the sensitivity pattern of cephalosporins in diabetic foot patients and to assess their prescribing patterns. We carried out a prospective study in the surgery department of a tertiary care hospital on 77 patients who had diabetic foot infections. Prescribing patterns of cephalosporins and wound culture and sensitivity testing on these patients was studied for a period of 6 months. Staphylococcus aureus was the most common gram positive pathogen isolated, E.coli, Klebsiella, Pseudomonas and Citrobacter were the common gram negative organisms isolated. Ceftriaxone was the most commonly prescribed antibiotic. Sensitivity pattern showed that 41.5% of gram positive cocci and 25% of gram negative bacilli were sensitive to Ceftriaxone. Ceftriaxone in our study was found to be an effective drug provided appropriate barrier techniques were used to prevent nosocomial spread. Organisms which were originally sensitive developed resistance approximately in a span of two weeks, probably due to antibiotic pressure. Hence there should be an active infection control team which can monitor the prevalent organisms and their antibiograms and periodically inform the clinicians. The pharmacists should also be included in the team, apart from the microbiologist, the surgeon and the nursing staff.

BACKGROUND Non fermenting gram-negative bacilli (NFGNB) are a group of heterogenous, aerobic and non-sporing saprophytic bacteria, found as commensals in humans and other animals primarily causing opportunistic healthcare-associated infections. They are innately resistant to many antibiotics and are known to acquire resistance by various mechanisms. They pose a particular difficulty for the healthcare community because multidrug resistance is common and increasing among them and a number of strains have now been identified that exhibit pan drug resistance. This study was conducted to isolate and identify various non-fermenter gram negative bacilli (NFGNB), to study their antibiotic sensitivity pattern and their clinical significance from various clinical samples. METHODS A study was undertaken from March 2019 to February 2020 to isolate NFGNB from various clinical samples received for culture and sensitivity in the department of microbiology in a tertiary care hospital, Ahmedabad. Non lactose fermenting colonies on MacConkey agar plates were further processed by Vitek 2 to identify them and to study their antimicrobial susceptibility testing (AST). RESULTS A total of 2010 NFGNB were isolated from various clinical samples and their AST was evaluated by Vitek 2. Pseudomonas aeruginosa (52.7 %) and Acinetobacter baumannii (36.5 %) were the most common NFGNB isolated. Carbapenem resistance was 93 % for Acinetobacter species and 61 % for Pseudomonas species. CONCLUSIONS Accurate and rapid identification and antimicrobial susceptibility testing of NFGNB help in early initiation of appropriate antimicrobial therapy and proper management of patients thereby help in reducing emergence of MDR strains of NFGNB, mortality and overall hospital stay. KEYWORDS NFGNB – Non-Fermenting Gram-Negative Bacilli, Multidrug Resistance, Pan Drug Resistance, Carbapenem Resistance