Background: Bone marrow aspiration and trephine biopsy are two most important techniques which are complementary for diagnosing both neoplastic and non- neoplastic haematological diseases. The present study was conducted in the department of pathology to compare the role of bone marrow aspirate and trephine biopsy for diagnosing the haematological diseases.Methods: The study was conducted in the department of pathology government medical college Srinagar over a period of 2 years from Feb 2016 to Jan 2018. The study was one-year retrospective and one year prospective. Bone marrow aspiration was done in 626 cases out of which biosy was done in 300 cases.Results: Out of the selected 300 cases were both aspiration and trephine biopsy were available, diagnostic material on bone marrow aspirate was adequate in 288 cases. 12 cases were aparticulate. Biopsy was inadequate in 8 cases. Overall megaloblastic anaemia (26.6%) was most common followed by dual deficiency anemia. Multiple myeloma was the most common neoplastic pathology (13%) followed by followed by acute leukaemia’s (6%) and Chronic lymphoproliferative disorders (CLPDS) (5%). 1 case each of visceral leishmaniasis and malarial parasite were also noted. 4 cases (1.3%) of granulomatous pathology and 2 cases (0.6%) of Hodgkins lymphoma were diagnosed exclusively on bone marrow biopsy.Conclusions: Bone marrow aspiration and biopsy are complimentary to each other in diagnosing hematological disorders with biopsy being gold standard in the assessment of cellularity, pattern, extent of tumor infiltration and focal infiltration. It is more helpful in diagnosing granulomatous pathology and metastatic deposits of tumors eliciting fibrotic response.

Providencia rettgeri is a member of Enterobacteriacea that is known to cause urinary tract infection (UTI), septicemia, and wound infections, especially in immunocompromised patients and in those with indwelling urinary catheters. It is an uncommon cause of UTI and sepsis but should be suspected in patients with predisposing factors. The condition has high mortalty and warrants early recognition and treatment. We present here a case of UTI with sepsis by Providencia rettgeri in a young female during post partum period. She had recently delivered a male baby and was catheterized for 10 days. Patient received intravenous antibiotis and recovered completely. …………………………………………………………………………………………………….... Introduction:-The genus Providencia is a member of theEnterobacteriaceae family which commonly dwells in soil, water, and sewage [1]. Human isolates of Providencia species have been recovered from urine, throat, perineum, axilla, stool, blood and wound specimens. The organism is usually isolated from genitourinary and gastrointestinal sources (urine, faeces and perineum), causing diarrhoea and urogenital symptoms .Providencia rettgeri (P. rettgeri) is a motile, gram-negative rod shaped organism and a member of the Enterobacteriaceaefamily [1]. It is inherently resistant to many antibiotics and thus early identification and treatment is needed to treat this infection. We present a case of urinary tract infection during post partum period in a female who had recently delivered and was catheterized.Case report:-A 24 year old young female presented to the OPD with history of dysuria and fever . The fever was high grade and intermittent type. The female had delivered a male baby ten days earlier by cesarian section she had been catheterised for 10 days . General physical examination was normal except for elevated temperature . Heamogram revealed TLC of 12000 . Chest X ray was normal. Urine was sent for culture and sensitivity in our lab. The urine was inoculated on HiCrome agar using a calibrated loop. Inoculated plates were incubated at 35 degree C for 24 hours. Next day plates were examined for colony morphology.Gram smear showed short rod shaped cells ,0.5-0.8 µm. colonies were glossy, white 2-3mm. Providencia rettgeri Was isolated from urine and blood (figure 1).culture revealed that the isolate was resistant to ampicillin, ampicillin/sulbactam, cefazolin, gentamicin, and trimethoprim/ sulfamethoxazole. It was found to be susceptible to ceftriaxone, cefepime, ciprofloxacin, and piperacillin/tazobactam The patient was admitted put on iv ceftrioxone and had complete recovery.

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Background:The urinary tract is a common site of infection in the paediatric population. Vesicouretric reflux (VUR) refers to the retrograde passage of urine from the bladder into the ureter. A high incidence of VUR is reported in patients undergoing evaluation for UTI. The aetiology of paediatric UTI and the antibiotic susceptibility of urinary pathogens in both the community and hospitals have been changing, and drug resistance has become a major problem. With this background, the present study was conducted to observe the profile of the paediatric UTI, to find out the bacterial pathogens involved and their antimicrobial susceptibility pattern in patients with VUR and consecutive renal scarring in these patients at a tertiary care centre in North India. Material and Method: All patients from 0-15 years of age diagnosed with urinary tract infection and vesicoureteral reflux attending the OPD and admitted in the hospital were included in the study. Urine was inoculated on Hicrome agar using a calibrated loop the plates were examined after 24 hours for colony morphology, significant colony count, and their characteristics. Patients underwent VCUG and DMSA scan when indicated. Results: Overall males were more affected than females. E Coli was the commonest organism grown on culture. Quinolones, cotrimoxazole and amoxicillin were among the less effective drugs where as nitrofurantoin, aminoglycosides were highly effective drugs. Renal scars were more commonly seen in higher grade of reflux whereas there was no difference in scarring in E Coli vs Non E Coli infections. Conclusion: Cotrimoxazole should not be used for antimicrobial prophylaxis where as nitrofurantoin is a better option for prophylaxis. Aminoglycosides can be used as empirical therapy till the results of antimicrobial sensitivity are available. Renal scars are seen more often in higher grades of vesicoureteric reflux and thus need to be treated aggressively.

Introduction: Multidrug resistant bacteria is causing a very serious problem in the proper treatment and management of sick patients in ICU's. Study aimed to find out antimicrobial susceptibility pattern of bacterial isolates from tracheal culture. Material and methods: This study was carried over a period of 6 months from July to December 2017 in the department of microbiology. Total of 470 tracheal aspirates were studied. Each specimen was streaked on 5% sheep blood agar and MacConkey agar. After isolation and identification, sensitivity of selected organisms against different antibiotics was studied Results: Out of 470 tracheal aspirates, 328 samples showed single bacterial growth, 76 were sterile; contaminants were grown in 58 samples and in remaining 8 samples yeast were grown. The incidence of positivity in our study was 83.8%, with gram negative bacteria outnumbering the gram positive ones. Of the 328 samples which showed bacterial growth, Acinetobacter spp 159(40.3) was the most common organism followed by Klebsiella pneumoniae 72(18.2), Pseudomonas spp 46(11.6), Escherichia coli 27(6.8), Staphylococcus aureus 13(3.2), Klebsiella oxytoca 5(1.26), Enterococcus spp 3(0.76), Proteus spp, Citrobacter spp, Providencia stuartii 1(0.25) each. Also XDR (extensively drug resistant) bacteria were isolated at a high frequency (67%) with Acinetobacter spp. being the most common 128(56.6)) followed by Klebsiella spp. 39(17.2) Pseudomonas spp. 38(16.8), and E.coli 12(5.3). Conclusion: Gram negative were main organisms responsible for lower respiratory tract infections in hospitalized patients and the majority of the isolates belong to XDR and MDR category.

Background: Carbapenems are considered the broadest-spectrum β-lactam agents and are often required for treatment of severe hospital-acquired infections caused by multidrug-resistant Gram-negative organisms. Minimum inhibitory concentrations (MICs) are important in diagnostic laboratories to confirm resistance of microorganisms to an antimicrobial agent and also to monitor the activity of new antimicrobial agents. Aims and Objectives: To compare the MIC obtained by Broth Microdilution method (BMD) with that of Vitek-2(automated method) for recovered isolates of Klebsiella pneumoniae. Materials and Methods: Prospective study conducted over a period of one year. It included all isolates of Klebsiella pneumoniae recovered from blood culture of the patients. The identification and antimicrobial susceptibility was done on Vitek-2.These Isolates were subjected to Microbroth dilution method for MIC determination. Results: Out of the 55 meropenem resistant  isolates by vitek-2, 20(36.3%) had MIC of ≥256 µg/ml followed by 18(32.7%) isolates with a MIC of 128 µg/ml, followed by 11(20%) isolates with MIC of 64 µg/ml and 6(10.9%) isolates with MIC of 32 µg/ml. Also among 15 meropenem sensitive isolates by Vitek-2, 13(86.7%) had MIC of ≤0.5 µg/ml, followed by two (13.3%) isolates with MIC of 2 µg/ml. Results obtained by vitek 2 were compared with those from BMD(the reference method), which showed a 13.3% minor error rate and no major or very major error rate. Conclusion: Overall, the Vitek 2 performance was comparable to that of BMD for testing a limited number of Klebsiella pneumoniae isolates.

Aim: Despite improvements on immunosuppressive therapy and surgical techniques, infections remain important complication in renal transplant and have been associated with increased morbidity and graft rejection. Role of microbiological cultures in isolating bacteria and formulating their antibiogram has potential benefits with regards to targeted therapy for MDR bacteria. No such study has been conducted previously from this region so we designed this study to find out the organisms causing infections in renal transplant patients and their antibiotic susceptibility pattern. Materials and Methods: This retrospective study was conducted over a period of 1 year from 2016 to 2017. All samples were sent from Kidney Transplant Unit (KTU) for culture and sensitivity irrespective of duration of post renal transplant. Qualitative culture of other infected body fluids was performed on blood agar, MacConkey agar plate (Hi media, India). Positive cultures were processed for antimicrobial susceptibility testing on Mueller-Hinton agar plates, using the Kirby-

Carbapenem-resistant Enterobacteriaceae (CRE), an emerging threat to public health, belong to a family of microorganisms that are difficult to treat because they are highly resistant to antibiotics.These bacteria can cause serious hospital-and community-acquired infections, such as bloodstream infections, wound infections, urinary tract infections and pneumonia. [1] Unlike Methicillin Resistant Staphylococcus aureus (MRSA) resistance, which is mediated by a single mechanism in a single bacterial species, the mechanisms of carbapenem resistance are complex because they involve a broad range of organisms and are mediated by different mechanisms, such as the production of β-lactamases,efflux pump and porin mutations. [2] Carbapenemases are β-lactamases with versatile hydrolytic capacities. They hydrolyze penicillins, cephalosporins, monobactams, and carbapenems. Bacteria producing these β-lactamases may cause serious infections in which the carbapenemase activity renders many β-lactams ineffective. Carbapenemases are members of the Ambler class A, B, and D β-lactamases. The class A carbapenemase group includes members of the SME, IMI, NMC, GES, and KPC families. Of these, the KPC carbapenemases are the most prevalent,found mostly on plasmids in Klebsiella pneumoniae. [3] The first member of the KPC family was discovered through the ICARE surveillance project in a K. pneumoniae clinical isolate from North Carolina in 1996. [4] The gene encoding the KPC enzyme is usually flanked by transposon-related sequences and has been identified on conjugative plasmids,therefore,potential for dissemination is significant. [5,6,7] Isolates that acquire this enzyme are usually resistant to several other classes of antimicrobial agents used as treatment options. Laboratory identification of KPC-producing clinical isolates will be critical for limiting the spread of this resistance mechanism. [8] The most commonly used method for detection of CRE is the measurement of minimum inhibitory concentration (MIC). MICs are important in diagnostic laboratories to confirm resistance of microorganisms to an antimicrobial agent. It is a quantitative measurement of antibiotic activity, and it is defined as the minimum concentration of an antibiotic that can inhibit visible microbial growth under normal conditions. [9,10] In 2009, CLSI published a recommendation that carbapenem susceptible Enterobacteriaceae with susceptible, but elevated MIC, be tested for the presence of the carbapenemase enzyme using the Modified Hodge Test (MHT). [11] In 2010, the CLSI changed