Objective The extended-spectrum beta-lactamase (ESBL) and carbapenemase producing gram-negative bacteria among the members of Enterobacteriaceae are of major health concern globally. The present study was carried out to determine proportion and genetic characterization of ESBL and carbapenemase producing Klebsiella pneumoniae strains isolated from intensive care units of a tertiary care hospital. Materials and methods A total of 250 non-duplicate K. pneumoniae isolates were recovered from various clinical specimens from our intensive care units from May 2014 to May 2015. Antibiotic susceptibility testing was performed as recommended by Clinical and Laboratory Standard Institute. Phenotypic identification of ESBL and carbapenemase producing isolates were confirmed by the double-disk synergy test, modified Hodge test, imipenem and imipenem-EDTA combined test, respectively. Molecular characterization of β-lactamase genes were performed by polymerase chain reaction. Results Out of 250 Klebsiella pneumonaie , 84% isolates were ESBL producers, 66% were carbapenem resistant based on their reduced susceptibility to imipenem, meropenem and ertapenem. Among these 165 carbapenem resistant isolates, 9.7% were positive for bla NDM-1 and these isolates were also found to be positive for one or more bla genes. Co-carriage of AmpC in ESBL and carbapenem resistant isolates were 7.8% and 3.6%, respectively and were negative for bla KPC genes. Conclusion The study indicated the prevalence of ESBLs and bla NDM-1 , with additional bla genes and AmpC among the K. pneumoniae isolates in our intensive care units. NDM-1 producing Enterobacteriaceae is a growing health care problem. Detection of the prevalence of antibacterial resistance pattern helps towards improved antibiotic policy and empirical antibiotic treatment. How to cite this article Beena HB, Shenoy SM, et al. Molecular Characterization of Extended Spectrum β-lactamase and Carbapenemase Producing Klebsiella pneumoniae from a Tertiary Care Hospital. Indian J of Crit Care Med 2019;23(2):61-66.

Objective: There is an increasing use of colistin consequent to increase in the infections caused by carbapenem-resistant Klebsiella pneumoniae. The present study was conducted to determine the minimum inhibitory concentration (MIC) of colistin and the resistance pattern of colistin in carbapenem-resistant K. pneumoniae (CRKP) strains in our intensive care unit (ICU).Methods: Antibiotic susceptibility testing for other antimicrobial agents was done by Kirby-Bauer disk diffusion method. MIC of colistin was determined by agar dilution method. The results of antibiotic susceptibility testing were interpreted as per Clinical Laboratory Standard Institute guidelines 2016 and MIC of colistin were interpreted as per European Committee on Antimicrobial susceptibility testing. The carbapenem resistance was phenotypically detected by modified hodge test and imipenem/imipenem ethylenediaminetetraacetic acid disk method.Results: Out of 518 K. pneumoniae, 329 were resistant to carbapenems, and 91 isolates showed resistance to colistin. The MIC of colistin ranged between 4 and >512 ug/ml and MIC 90 was 16 ug/L and MIC 50 was 4 ug/ml. A majority of the colistin-resistant isolates were found in multidisciplinary ICU (85/91). Conclusion:The emergence of colistin-resistant strains is a major problem due to limited treatment options for infections caused by CRKP carbapenemase producing K. pneumoniae. Colistin should not be used alone, combination therapy should be preferred.

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Introduction: Candidemia has emerged as one of the life-threatening causes of invasive infection in both adults and children worldwide. Materials and methods: We performed a retrospective study of children (≤16 years) with candidemia diagnosed in our center in 2010 to 2019. Demographics, comorbidities, Candida species distribution, antifungal susceptibility, and outcomes were analyzed. Results: A total of 96 children were identified in the last 10 years. The predominant species identified were C. tropicalis (23%), C. parapsilosis (15.6%), C. pelliculosa (15.6%), C. albicans (13.6%), C. krusei (7.3%), and C. haemulonii (5.2%). Male to female ratio was 2:1. The most common risk factor was found to be congenital malformations (27%), followed by hematological malignancy in 13.5%. Candidemia was diagnosed while being admitted in the intensive care unit in 74%, 14.5% in wards, and 11.5% in outpatients. The overall mortality rate was found to be 31.3%. C. tropicalis was found to be sensitive to fluconazole in 95.5%, flucytocine in 95.2%, and 100% susceptible to amphotericin B, voriconazole, and caspofungin. Conclusion:Invasive candidiasis occurs frequently in hospitalized patients and is associated with high mortality rates. C. tropicalis was the most frequently isolated species. We have observed a shift in Candida spp. with an increasing isolation of C. pelliculosa. The occurrence of azole resistance is a matter of concern. Clinical significance: This type of data analysis is needed to track trends of serious infection and to develop guidelines for infection control strategies and antimicrobial stewardship program.

Wegener's granulomatosis (WG) patients can rarely have antineutrophil cytoplasmic antibodies (ANCAs) directed against myeloperoxidase (MPO), producing a cytoplasmic pattern on indirect immunofluorescence (IIF). This has important implications in the diagnosis and pathophysiology of the disease. We present to you a report of three cases of WG, demonstrating a cytoplasmic-ANCA pattern on indirect IIF, but directed against MPO. It is necessary to diagnose a patient taking into account both the autoimmune test results and the clinical features.