Preamble: In the visage of multidrug resistance among gram negative bacilli, we look forward to carbapenem group of drugs as empiric choice in seriously ill patients. However increasing resistance to carbapenems, the last resort, is of growing concern for all. It's high time to look beyond Carbapenems and emphasize on Carbapenem sparers.Objective: This study is to find the susceptibility pattern of the novel adjuvant antimicrobial CSE 1034 a combination of Ceftriaxone+sulbactam+disodium edetate for the current ESBL and MBL isolates in a tertiary care centre. Materials and Methods:A total of 823 gram negative bacterial isolates were obtained from different clinical specimens during the period of March, 2013 to October, 2013. The overall prevalence of metallobetalactamase producing gram negative organisms was 11 percent (n=91). We included a total of 141 clinical isolates for this study.Results: Among 141 clinical isolates, 50 isolates (35%) were ESBL producers and 91 (65%) were MBL producers. Maximum numbers of ESBL producers were identified in Escherichia coli followed by Klebsiella pneumoniae, Acinetobacter baumannii and Proteus spp. Maximum numbers of MBL producers were identified in Klebsiella pneumoniae followed by Pseudomonas aeruginosa. CSE 1034 (Ceftriaxone+sulbactam+disodium edetate) showed fairly good in-vitro susceptibility for these ESBL and MBL producing isolates. It exhibited 64 % to 100% susceptibility and 18% to 22% intermediate sensitivity to ESBL producing isolates and 42 % to 89 % susceptible and 10 % to 51 % intermediate response to MBL producing isolates.

Head injury forms the most common and serious form of trauma seen in India. Though data in India as a whole is sparse it does seem appropriate to say that mild to moderate head injury seems to form the major bulk of head injuries. Many such patients with normal CT scans who are discharged after a short period of ICU stay experience cognitive deficits, reduced attention spans and have problems with ?executive functions? like planning, problem solving, abstract reasoning, judgment making etc. Some patients also have language deficits, problems with driving, hand eye coordination, behavioral changes and many other minor problems which may take a long time to recover. Most of these functional abnormalities are probably due to diffuse axonal injury. Axonal injury is one of the common pathological entities in any severity of head injury and is a diagnosis of exclusion for almost all of the clinical symptoms which cannot be explained otherwise. A case has been illustrated in this regards. The review throws light on the pathophysiology and some recent advances in imaging and treatment modalities of traumatic axonal injury due to mild to moderate head injury.