Background:Recently, Acinetobacter has emerged as significant hospital pathogen, notoriously known to acquire antibiotic resistance to most of the commonly prescribed antimicrobials. Many risk factors are associated with Acinetobacter infections, especially in patients in intensive care unit (ICU). This study aims to isolate Acinetobacter from various clinical specimens and to determine its antimicrobial sensitivity pattern.Materials and Methods:Identification, speciation and antimicrobial sensitivity testing were performed using the standard microbiological techniques. Slime production was also tested by microtiter plate and tube method.Results:From the processed clinical specimens, 107 Acinetobacter strains (1.02%) were isolated of which 76 (0.74%) isolates were from general wards and 31 (11.96%) were from ICU. Significantly higher percentage of Acinetobacter strains was found in ICU compared with general wards (P < 0.05). Most common Acinetobacter infection was abscess. Infections were more common in males and were associated with major risk factors such as post-surgical, diabetes mellitus, catheterization, extended hospital stay and prolonged antibiotic usage. Acinetobacter baumanii was the most common species isolated to cause abscess, wound infection, etc. 62.61% and 28.97% isolates produced slime by microtiter plate and tube method. Imipenem was most sensitive drug followed by amikacin. Ceftazidime, cefotaxime, piperacillin were most resistant. 43.00% isolates were IPM resistant. A. baumanii was more resistant to commonly used antimicrobials.Conclusion:Acinetobacter nosocomial infections resistant to most antimicrobials have emerged, especially in ICU. Early identification and continued surveillance of prevalent organism will help prevent the spread of Acinetobacter in hospital environment.

PURPOSE: Fungal infections with candida species are an important cause of morbidity and mortality 1 . Situation is further worsened by increasing resistance to antifungal drugs 2 .The objective of this study was to evaluate antifungal susceptibility pattern of Candida species to fluconazole by disc diffusion and agar dilution method and compare these two methods as far as fluconazole is concerned. MATERIAL & METHODS: Between January 2006 to December 2006, 119 Candida species were isolated from 225 sputum samples of patients of pulmonary tuberculosis and immunocomprised patients. RESULTS: Of the 119 Candida isolates 33 (27.73%) were Candida albicans, 32 (26.89%) were Candida gullermondi, 27 (22.68%) Candida tropicalis, 14 (11.76%) Candida pseudotropicalis, 7 (5.88%) Candida parapsilosis and 6 (5.04%) were Candida krusei. The Candida isolates were tested for fluconazole by disc diffusion method on Muller hinton agar with 2% glucose and 0.5 microgram of methylene blue 3 .Amongst the 119 Candida isolates, 17 (14.28%) isolates were resistant to fluconazole by disc diffusion method. MIC done by agar dilution method using CLSI guidelines 4. Candida isolates showed growth of 15 (88 .23%) Candida strains upto 8 microgram / ml with 80% inhibition of growth whereas 2 (1.7%) isolates showed MIC upto 64 microgram/ ml. CONCLUSIONS: Candida albicans though a common species other species were isolated in significant number. The results of disc diffusion for fluconazole do not correlate with agar dilution method. To cater the need of resource constrained laboratories, it is important to have results that correspond to the clinical outcome of antifungal treatment and show co-relation to those obtained with the reference method as recommended by CLSI guidelines and also be reproducible 5 . Further critical studies are needed.

BACKGROUND Biomedical waste (BMW) management policies are mandated in hospitals to reduce the risks of health hazards from the hospital waste. Strict adherence to the norms requires a teamwork from healthcare workers including doctors, nursing staff, attendants as well as medical interns and residents. MATERIALS AND METHODS In this study, we evaluated the baseline knowledge of medical interns about BMW management using a structured questionnaire and devised a scoring system based on the response. The interns were then inducted with a series of didactic lectures along with practical demonstrations periodically over a period of 3 months. RESULTS At the end of this interventional training, medical interns were reassessed using the same questionnaire. Knowledge on all parameters was markedly improved at post-course evaluation of the participants. Significant improvement in the overall score was achieved (p<0.05). CONCLUSION Management of BMW is a teamwork and medical interns are an essential part of the healthcare team. There were several lacunae in the knowledge about hospital waste management amongst medical interns which subsequently improved with our training interventions. We recommend regular vocational activities by the hospital infection control committee in order to successfully implement the BMW management rules in the hospital. In addition, constant vigilance on the BMW disposal should be integrated in the infection control activities in the hospital.

Background: Serratia marcescenshas emerged as opportunist in increasing number of hospital-associated infections in neonatal intensive care unit (NICUs), particularly as bloodstream infections. It is known to cause outbreaks in the NICUs, with high mortality rate in the vulnerable preterm population. Case presentation: We present a case of one and half month-old preterm neonate who had complaints of intolerance to feeding and failure to thrive. Clinical investigation revealed anaemia and increased inflammatory markers. Blood culture showed growth ofS marcescens.In antimicrobial susceptibility testing, the isolate showed susceptibility to all β-lactams, aminoglycosides and sulfamethoxazole-trimethoprim, but treatment failure occurred with empirical amikacin and piperacillin-tazobactam. Institution of meropenem showed good response. Discussion: In premature babies with very low birth weight along with prolonged NICU stay predisposed them to S marcescens infection. The capacity of S marcescens to resist antibiotic therapy in vivo in spite of the in vitro sensitivity was exemplified in our case. Conclusion: This case study portrays the important feature of S marcescens to develop in-vivo resistance despite being sensitive by in vitro testing which led to therapeutic failure. Carbapenem could be a choice in such treatment failure cases due S marcescens.

BACKGROUND The term osteomyelitis (OSM) was first used by the French surgeon Edouard Chassaignac in 1852, who defined the disease as an inflammatory process accompanied by bone destruction caused by an infecting microorganism. The clinical manifestation and the natural history of OSM depend on several factors. OSM mostly affects the growing ends of long bones. We wanted to study the organisms causing osteomyelitis and their antimicrobial susceptibility pattern. METHODS Pus and bone aspirate were collected from 115 diagnosed patients of osteomyelitis and were processed for isolation of organisms by standard microbiological techniques. Isolates were identified by various biochemical reactions and were subjected to antimicrobial susceptibility test as per CLSI guidelines by Kirby-Bauer disk diffusion technique on Mueller Hinton agar (MHA). Data collected in the questionnaire was entered and analysed in Epi Info software version 7.2. RESULTS In 101 samples, 116 organisms were isolated. In 14 samples no organism was isolated, which can be attributed to the viral aetiology, parasites and anaerobes. Acute Osteomyelitis (AOSM) was found to be more common in the age group of 1-10 years, whereas chronic osteomyelitis (COSM) was found more commonly in 21-30 and 31-40 years age group. Male to Female ratio was 2.2:1. Bones involved in AOSM and COSM were mostly femur followed by tibia and humerus. S. aureus was the most predominant isolate. All the isolates of S. aureus showed 100% sensitivity to Vancomycin, Amikacin, Netilmicin, Chloramphenicol. Out of 48 isolates of S. aureus, 37.50% were MRSA, 6.25% were ICR, 14.58% were MRSA+ICR found. CONCLUSIONS Osteomyelitis is found to be highest in third decade, with the males being predominantly affected. Acute osteomyelitis is predominantly seen in children, whereas chronic osteomyelitis in adults. Even though Staphylococcus aureus has always remained the most common etiological agent of osteomyelitis, increasing infections due to Gram negative bacilli and even poly-microbial infections are gaining importance. MRSA infection is known to increase post-operative complications. Introduction of MBL or carbapenemase production in Gram negative bacilli is a matter of great concern. Timely knowledge of aetiology and antimicrobial resistance pattern of osteomyelitis isolates can help in rational use of antibiotics and control of drug resistance.