Burkholderia cepacia complex (BCC) is a significant opportunistic pathogen in hospitalized and immunocompromised patients, particularly in cystic fibrosis. It is widely distributed in natural habitats such as soil and water and frequently encountered in nosocomial outbreaks due to contaminated disinfectants and medical devices. However reports on outbreaks due to this organism are lacking from the Indian subcontinent. We report here a sporadic outbreak due to BCC which occurred in the pediatric Intensive Care Unit of our institute, the probable source being contaminated distilled water. The isolate from three babies and environmental sources including distilled water were identical and confirmed as BCC. Strict infection control measures were instituted to prevent the spread of infection. This report highlights the potential role of B.cepacia in causing sporadic outbreaks especially in ICUs, associated with water.

An outbreak of food poisoning due to Salmonella enterica serotype Weltevreden ( S.weltevreden ) involving 34 students has been reported from a tertiary care hospital in Mangalore. The symptoms developed 8-10 hours, after consuming a non- vegetarian dish, probably fish, from an outside caterer. The identity of the organism was confirmed at Central Research Institute, Kasauli. This report emphasizes the geographical distribution of this organism in the Coastal Karnataka region. S.Weltevreden may be overlooked due to the biochemical similarity to S. Paratyphi B & S. Typhimurium.

Background:Enteric fever is caused by the serotypes Salmonella Typhi, Salmonella Paratyphi A, Salmonella Paratyphi B and Salmonella Paratyphi C. After emergence of multidrug resistant Salmonellae Ciprofloxacin, a fluorquinolone antibiotic was the first-line therapy. Treatment failure was observed with Ciprofloxacin soon and such strains showed in-vitro resistance to Nalidixic acid. Recent reports suggest re-emergence of Chloramphenicol sensitive strains and increasing Nalidixic acid resistance. This study is aimed at detecting the current trend in the antibiogram of Salmonella isolates from blood culture in coastal Karnataka, with an emphasis on antibiotic susceptibility of Nalidixic acid and Chloramphenicol and evaluate, if there is a need to modify the strategies in the antibiotic therapy for enteric fever.Materials and Methods:Blood samples received for culture in the laboratory between June 2009 and August 2011 was cultured in Brain Heart infusion broth, bile broth or in a commercial BACTEC culture media. The growth from blood cultures were processed for identification and antibiotic susceptibility as per standard methods. Antibiotic susceptibility for Ampicillin, Trimethoprim-sulphamethoxazole, Chloramphenicol, Ciprofloxacin, Ceftriaxone and Nalidixic acid were noted.Results:Out of 9053 blood culture specimens received, Salmonella was isolated from 103 specimens. There were 85 Salmonella Typhi isolates, 16 Salmonella Paratyphi A and two Salmonella Paratyphi B. Salmonella Typhi and Salmonella Paratyphi A showed the highest resistance to Nalidixic acid. Salmonella Typhi showed highest susceptibility to Ceftriaxone and Salmonella Paratyphi A to trimethoprim-sulphamethoxazole and Chloramphenicol. Two isolates were multidrug resistant. One Salmonella Paratyphi A was resistant to Ceftriaxone.Conclusion:Routine screening of Nalidixic acid susceptibility is practical to predict fluorquinolone resistance in Salmonella and preventing therapeutic failure while treating with it. It is worthwhile to consider replacing fluorquinolones with Chloramphenicol or Ceftriaxone as the first line of therapy for enteric fever. Periodic analysis of Salmonella antibiogram should be done to formulate the best possible treatment strategies.

Background: Various factors predispose to neonatal septicemia (NS) and study of these factors and a change in bacterial spectrum and antimicrobial susceptibility pattern was noticed in this study, which will certainly help in treatment of septicemic neonates. Objective: To isolate the causative agents of NS, antimicrobial susceptibility pattern of the isolates and to analyze the various predisposing factors to NS. Materials and Methods: Study was done over a period of two years. Blood samples from 200 clinically suspected NS cases were subjected to aerobic culture and their antimicrobial susceptibility pattern was determined. History of sex, gestational age, birth weight, term or preterm, outborn, or inborn babies were taken. Results: Of 200 cases, 95 (47.5%) were blood culture positive. Of them, 64 (67.37%) were males, 64 (67.37%) were preterm, birth weight <1.5 kg were 41 (43.16%), 71.58% outborn neonates with 55.79% mortality rate. Gram-negative isolates were 67 (70.53%) and Gram-positive isolates were 28 (29.47%). Enterobacter cloacae and Staphylococcus aureus were commonest isolates in 20% and 11.58% of cases, respectively. Gram-negative isolates were sensitive to amikacin, ciprofloxacin, and ofloxacin and least sensitive to ampicillin and amoxiclav. All Gram-positive isolates were sensitive to vancomycin. Conclusion: NS was found to be 47.5% in our study. In this study, we have analyzed various predisposing factors of NS. Blood culture is the gold standard for diagnosis of NS. A change in bacterial spectrum and change in their antimicrobial susceptibility pattern was noticed in this study, which will certainly help in treating such cases.

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Original Article IntrOductIOnClostridium difficile (C. difficile), an anaerobic Gram positive spore forming bacillus is an important pathogen responsible for antibiotic associated diarrhoea (AAD) and pseudomembranous colitis (PMC). Many authors have reported hospital acquired and community based cases of C. difficile associated disease (CDAD) [1,2]. Estimates regarding the occurrence of C. difficile infection (CDI) in United States per year has been mentioned in a study [3]. A few reports are available regarding the prevalence of CDI in Asian countries [4,5]. The mutant hypervirulent strain, NAP1/BI/027 (North American Pulse-field gel electrophoresis type 1 /restriction endonuclease analysis BI/ribotype 027) which was responsible for the outbreaks of CDAD in many parts of the world has given due significance to the organism [6].In children the organism has gained much relevance during the past decade and there are documented reports from various parts of the world especially from 1997 to 2006 with an incidence of 21% among children below one year of age [7,8]. Children of age group1-4 y showed the highest incidence of C. difficile [9]. Gogate et al., reported that C. difficile is an important causative agent for AAD in children of age group 5-12 y [6]. A study conducted among children with cancer revealed that the drugs like aminoglycoside, third generation cephalosporin, cefepime, proton pump inhibitor and chemotherapy had significant role in hospital acquired CDI [10]. Another study performed in paediatric residents of Olmsted County, Minnesota identified that 75% cases of CDI were communityacquired [11].The reports from India regarding the prevalence of C. difficile in children are scanty. The estimates of CDI could be less than the actual picture in our country due to tedious and costly anaerobic techniques required for the detection of C. difficile. The present study is intended to assess the burden of C. difficile from paediatric patients with diarrhoea by means of semi quantitative isolation, characterization and toxin detection. Anaerobic culture has been done on cycloserine cefoxitin fructose agar (CCFA) for the isolation Microbiology SectionPrevalence of Clostridium Difficile Among Paediatric Patients in a Tertiary Care Hospital, Coastal Karnataka, South India ABStrAct Introduction: The study was intended to analyse the burden of Clostridium difficile (C. difficile) and associated intestinal pathogens from children with diarrhoea who were hospitalized in a tertiary care teaching hospital of South India. Materials and Methods:Stool samples from 138 children with diarrhoea belonging to the age group 0-14 years were analysed by semi quantitative culture, latex agglutination and enzyme immunoassay for C. difficile. The associated intestinal pathogens were also detected from the specimens by standard procedures.results: Stool samples of 138 children were tested during the period; 21 (15.22%) samples were culture positive for C. difficile and the isolates were confirmed by biochemical reactions. 9(6.52%) wer...