IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 19, Issue 5 Ser.8 (May. 2020), PP 15-21 www.iosrjournals.org DOI: 10.9790/0853-1905081521 www.iosrjournal 15 | Page Occurrence of Carbapenem resistant enterobacteriaceae in Ventilator Associated Pneumonia cases admitted to tertiary care center of Wayanad- analysis of in vitro efficacy of Modified Hodge test. Lubna Basheer Nalakath Mohammed 1 , Dr. Linda Rose Jose 2 Dr. Suresh Gogi 3 , Hareesh PV 4 Department of microbiology, DM Wayanad Institute of medical science -Kerala University of Health sciences , India Abstract: Background: The emergence and spread of carbapenem resistant enterobacteriaceae in association with conditions like ventilator associated pneumonia which becomes a significant and a major public health concern in the hospital settings. The main objectives of this study is to analyse the microbiological profile of ventilator associated pneumonia in patients attending the tertiary care hospital and study the occurrence of CRE, also to determine the efficacy of modified Hodge test for detection of carbapenemase producing gram negative rods. Materials and method:The study has been conducted for a period of three months with a sample size of 50. The Endotracheal aspirate (ETA) samples were collected with proper aseptic precautions and sent immediately to microbiology laboratory for processing and identified based on standard microbiological techniques. Modified Hodge Test is then performed on positive sample to study its efficacy. Report:A total of 123 patients were prospectively reviewed for the 3 months study period and among them only 53 patients were infected. Metallo-betalactamases was produced by 48.1% and ESBL by 51.9% of non- fermenters. 1.8% of the pathogens in our study were MDR. These MDR pathogens included Gram-negative bacteria producing ESBL and MBL. 21 isolates (38.1%) showed resistance to carbapenem group of drugs (meropenem and imipenem). Among them maximum resistance was shown by Acenitobactor baumannii (47.6%), followed by Klebsiella pnuemoniae (33.3%) and Pseudomonas aeruginosa (19.1% ). Among the 21 isolates which showed carbapenem resistance only 16 of them were found to be positive by modified Hodge test (76.1%). Conclusion: The emergence of carbapenemase-producing multidrug resistant (MDR) gram-negative bacteria is major public health problem particularly in the hospital settings. Prevention of VAP may be carried out by early isolation and decreasing the length of stay along with proper knowledge of the MDR organisms and during the shorter duration of this study we did not come across any VAP cases which can be considered as a successful hospital infection control impact. A detailed study on VAP for longer duration is required to determine for a proper understanding Also knowledge of the susceptibility pattern of the local pathogens should guide the choice of antibiotics, in addition to the likelihood of organisms, as there is an increasing prevalence of MDR, MBL and ESBL pathogens.Testing all isolates showing intermediate or sensitive zone diameter on disc diffusion for production of carbapenemases by Modified Hodge test will avoid treatment failures and development of resistance due to unnecessary use of this class of antibiotic for a better future. Key words:ventilator associated pneumonia, enterobacteriaceae, ModifiedHodge test --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 04-05-2020 Date of Acceptance: 18-05-2020 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction: Health care-associated infections represent a major health issue to mankind in terms of personal distress, economical loss, morbidity, and mortality.[1,2] Among all HAI, pneumonia is assumed to be one of the leading causes of death.[3] The occurrence of pneumonia is more in the intensive care units (ICUs) chiefly because of utilization of invasive procedures such as mechanical ventilation.[4,5] Ventilator-associated pneumonia (VAP) is defined as pneumonia occurring more than 48 hrs after endotracheal intubation; initiation of mechanical ventilation (MV) including pneumonia developing even after extubation.[6] Ventilator-associated pneumonia indirectly influences the length of stay, cost of treatment, and mortality. Nearly 10%–20% patients on MV for longer than 48 hrs develop VAP.[7,8] VAP is less severe and is likely with a better prognosis and diagnosis during first 4 days, caused by antibiotic sensitive bacteria. Late onset VAP, which develops after 4