Ventilator-associated pneumonia (VAP) is a serious health care-associated infection. It prolongs hospital stay and drives up hospital costs reporting high morbidity and mortality. VAP is defined as pneumonia that occurs 48h or more after endotracheal intubation or tracheostomy, caused by infectious agents not present or incubating at the time mechanical ventilation.VAP requires rapid diagnosis and initiation of the appropriate antibiotics. Materials and Methods: The present study was done in the department of Microbiology, Rajarajeswari Medical college, Bangalore. All the clinically suspected cases of VAP from intensive care units over a period of one year were included in the study. Endotracheal aspirate (ETA) and bronchoalveolar lavage (BAL) samples were collected from all patients and processed . Identification was carried out according to standard biochemical tests. Sensitivity pattern was determined using Kirby-bauer disc diffusion according to CLSI guidelines. Results: Out of 160 patients, who were on mechanical ventilation, 7 patients fulfilled the clinical and microbiological criteria. Incidence of VAP in our study is 4.4 and incidence density is 10.5 for 1000 ventilator days.57% of bacterial isolates were found to be Acinetobacter spp. followed by Pseudomonas aeruginosa 29% and Klebsiella pneumoniae 14%. Among 7 cases, 3(43%) were Early onset, 4(57%) were late onset VAP. Discussion and Conclusion: Even in the era of advanced medical care VAP remains a major challenge. The risk of developing VAP can be reduced by VAP prevention care bundles. Timely diagnosis is a major step to initiate appropriate antibiotics for better outcomes. Both patients and units are at risk of developing multidrug-resistant organisms and therefore appropriate antibiotic stewardship is essential. Better knowledge of local patterns of pathogens causing VAP can help facilitate treatment choice, in turn reducing the ventilator days and hospital stay.

Catheter-associated urinary tract infections (CAUTI), remains the commonest hospital-acquired infection (HAI). This emphasizes the need to implement and monitor effective infection control programs to reduce the risk of CAUTI. Aim of the present study was to determine the etiology with antibiotic susceptibility and also to calculate CAUTI rate. The Patients admitted in intensive care unit (ICU), Rajarajeshwari Medical College and Hospital who were on urinary catheter insertion for >48 hours from 1 August, 2019 to 30 September, 2019 were included in the study. Under aseptic conditions urine samples were collected from clinically suspected cases of CAUTI, the samples were processed in the department of Microbiology, as per standard protocols. Uropathogens were isolated, identified and subjected to antibiotic sensitivity test. CAUTI rate was calculated and results were noted. Among 460 patients on catheter in ICU, 28(6%) patients developed clinical signs or symptoms of UTI. Of 28 urine samples cultured, 4(14%) yielded growth of single organis [Escherichia coli (3), Klebsiella (1)] and 24(86%) showed no evidence of growth. 2300 catheter days were obtained of 460 patients on indwelling catheter in ICU. Thus CAUTI rate was 1.74 per 1000 catheter days over a 2 month period.CAUTI remained a great burden to patient safety and a challenge to the infection control team. Implementation of proper care bundles and continuous education to health care workers plays a key role in reducing the CAUTI rates, thereby decreasing the morbidity and hospital stay to the patients.

Introduction: Infections from gram negative bacilli is a challenge for clinicians and laboratory personnel. Treatment of these infections remained as an area of concern. Both fluroquinolones and cephalosporins are most common choice of antibiotics. Despite Cephalosporins, being drug of choice they are expensive also showed many adverse reactions. This study, compares and reevaluates the susceptibility of gram negative bacteria to fluroquinolones (ciprofloxacin) compared to cephalosporins. Method: Various samples(pus, sputum, urine, blood and bodyfluids) were processed according to standard protocols. Antibiotic done susceptibility by using Kirby-baur disc diffusion method. ESBL and Amp C producers were identified using CLSI guidelines. Result: Among 400 isolates, majority were from pus followed by urine, sputum. The most common organism isolated was Klebsiella spp, (33.25%) Escherichia coli (29.5%), Pseudomonas spp (27.25%), Enterobacter spp (6.25%), Citrobacter 5 (1.25%), and Acinetobacter spp (2.5%). Isolates showed 20-80% susceptibility to ciprofloxacin, 30-60% to third and fourth generation cephalosporins. Klebsiella and Pseudomonas showed 64% and 31% susceptibility to ciprofloxacin. Acinetobacter spp showed 30% susceptibility to cefipime and 20% to ciprofloxacin. 34 isolates were ESBL 18 were AmpC producers, of which 15(44%) ESBL and 7(38%) of AmpC producers were ciprofloxacin susceptible. Conclusion: Ciprofloxacin was found to be more effective than the fourth generation cephalosporin (cefepime) against gram negative bacilli. Ciprofloxacin can be considered for treatment as it is more active and cost effective when compared to cephalosporins. Keywords: Fluroquinolones, Cephalosporins, Multidrug resistant, ESBL, Amp C