Objective: To determine the comprehensive antibiotic susceptibility profile of carbapenem-resista... more Objective: To determine the comprehensive antibiotic susceptibility profile of carbapenem-resistant Enterobacterales among clinical samples received at the Armed Forces Institute of Pathology (AFIP), Rawalpindi. Study Design: Cross-sectional study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan, from Apr to Sep 2020 Methodology: Over six months, 150 carbapenem-resistant Enterobacterales were isolated at the Armed Forces Institute ofPathology, Rawalpindi Pakistan. The antimicrobial susceptibility testing was performed using the Kirby-Bauer Disk-Diffusion technique, and their susceptibility was interpreted according to the CLSI 2020 and EUCAST 2020 guidelines. Results: Out of 150 clinical isolates resistant to Carbapenems, 99(66%) were identified as Klebsiella Pneumoniae, followed by Escherichia Coli 38(25.7%), Proteus Mirabilis 7(4.6%), Enterobacter Cloacae, Serratia Marcescens, Citrobacter Freundii, Providenci...
Objective: To determine important errors in initial Gram staining of clinical specimens and evalu... more Objective: To determine important errors in initial Gram staining of clinical specimens and evaluate the types of Gram-stain errors. Study Design: Cross-sectional study. Place and Duration of Study: Microbiology Department, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Aug 2018 to Feb 2019. Methodology: Gram staining and culture inoculation of all specimens were performed per recommended guidelines. The Gram stain results on day-0 were compared with the results of the culture on day-2. There was no discrepancy if similar organisms were obtained on culture as on Gram stain. Nevertheless, if the Gram stain and culture results were not similar, it was termed a discrepancy. The consultant microbiologist reviewed all discrepant slides, and if not resolved, possible causes of error were sought, and the results documented. Results: Of the total 300 clinical specimens, errors were observed in the initial gram staining of 29 specimens (9.7%), whereas 271(90.3%) specimens wer...
Objective: To provide a laboratory-based surveillance report of typhoid fever cases diagnosed at ... more Objective: To provide a laboratory-based surveillance report of typhoid fever cases diagnosed at a tertiary care hospital in Lahore during the ongoing outbreak. Study Design: Cross-sectional study. Place and Duration of Study: Department of Microbiology, Combined Military Hospital, Lahore Pakistan, from Mar 2018 to Jun 2019. Methodology: All positive blood culture samples that yielded the growth of Salmonella Typhi were included in the study. The samples were dealt with according to standard microbiological procedures. Antimicrobial susceptibility was performed using Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: During the study period, (377) Typhoidal Salmonellae were isolated, of which 327 (86.7%) were Salmonella Typhi and 50 (13.3%) were Paratyphi A. The percentage of XDR Salmonella isolates was 41.9%. Conclusion: Extensively drug-resistant typhoid fever cases reported in this study represent just the tip of an iceberg. Therefore, nationwide surveillance...
Objective: To study the frequency and type of invasive fungal disease in critically ill and immun... more Objective: To study the frequency and type of invasive fungal disease in critically ill and immunocompromised patients. Method: The prospective, cross-sectional, descriptive study was conducted at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from January 2017 to December 2020, and comprised pathological samples from immunocompromised and critically ill patients for fungal culture. Data regarding demographics, comorbidities, results of direct microscopy and fungal culture was recorded. Data was analysed using SPSS 22. Results: Of the 8285 patients specimens, 4722(57%) belonged to males and 3563(43%) to females. The mean age of the patients was 48.32±5.42 years (range: 14-98 years). Out of total 8285, 3465(41.82%) were related to blood, 2640(32%) endobronchial washing, 837(10%) sputum, 623(7.5%) tissue, 332(4%) body fluids, 288(3.5%) bronchoalveoar lavage and 100(1.2%) cerebrospinal fluid. Aspergillus flavus (20.7%) and candida albicans (14.5%) were the two most comm...
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2017
OBJECTIVE To determine the current trend of antimicrobial susceptibility of typhoidal Salmonellae... more OBJECTIVE To determine the current trend of antimicrobial susceptibility of typhoidal Salmonellae. STUDY DESIGN Descriptive cross-sectional study. PLACE AND DURATION OF STUDY The study was carried out in the Department of Microbiology, PNS Shifa Hospital, Karachi, from January 2014 to December 2015. METHODOLOGY Blood culture samples received from the wards and outpatient departments were included. Isolates of Salmonella were dealt with standard microbiological procedures. The antimicrobial sensitivity against the typhoidal Salmonellaewas determined using Kirby-Bauer disc diffusion method as per the guidelines of Clinical and Laboratory Standards Institute (2013). RESULTS Atotal of 460 typhoidal Salmonellaewere isolated; out of which 270 were Salmonella typhiand 190 were Salmonella paratyphiA. The percentage of MDR isolates of S. typhiwas 57% and that of S. paratyphiAwas 42%. None of the isolates were resistant to ceftriaxone, while sensitivity to ciprofloxacin (07% and 0% for S. typ...
Objective: To estimate burden of multi drug resistant, extensively drug resistant and pan drug re... more Objective: To estimate burden of multi drug resistant, extensively drug resistant and pan drug resistant superbugs isolated from various indoor microbiological specimen at tertiary care centers Rawalpindi. Study Design: Cross sectional study. Place and Duration of Study: Department of Microbiology in Institute of Pathology, from Jul 2017 to Jun 2018. Methodology: A total of 6126 bacteria isolated from various indoor microbiological specimen were included in the study. All specimen were collected aseptically and bacterial cultures were processed as per standard microbiological practices. Bacterial isolates were identified by using VITEK 2 systems-Version 08.01 (bio Merieux, France). Results: Out of 6126 bacteria isolated 76% were multi drug resistant, 44% were extensively drug resistant and 1.2% were pan drug resistant. About 83% and 3.8% and 0% of bacteria isolated from pus/tissue, 67%, 58%, 0.8% of bacteria recovered from urine, 72%, 52% and 4.5% of bacteria isolated from respirato...
Objective: To assess Bacterial spectrum and antimicrobial pattern of Blood Stream Infections asso... more Objective: To assess Bacterial spectrum and antimicrobial pattern of Blood Stream Infections associated with non-tunneled double lumen catheter in hemodialysis patients. Study Design: Prospective observational study. Place and Duration of Study: Department of Nephrology, Pakistan Emirates Military Hospital Rawalpindi Pakistan; Armed Forces Institute of Pathology Rawalpindi, Pakistan, from May 2019 to Apr 2020. Methodology: A total of 753 patients underwent placement of non-tunneled double lumen catheter (457 femoral, 296 Internal Jugular). Patients with clinically suspected bloodstream infections had their catheters removed with tips being sent for culture along with 2 sets of peripheral blood cultures. Patients were labelled as having bloodstream infection if growth of organism was detected in catheter tip and at least one peripheral blood culture. Susceptibility testing was done for available antimicrobials. Results: One hundred and thirty six (18.06%) incidences or 5.48 bloodstre...
Background Current year 2021, brought a hope for the world due to availability of various vaccine... more Background Current year 2021, brought a hope for the world due to availability of various vaccines to prevent COVID 19. Researchers around the Globe, kept working around the clock to dig up various correlations of this infection. So, that morbidity and mortality rates can be reduced. In all this sprint, cases of black fungus came into light in India. The Indian researchers identified strong association of black fungus co infection in COVID patients resulting in high mortality rates. Objectives Therefore, this current systematic review was planned to identify the predisposing factors, clinical presentations and management options for black fungus in COVID 19 patients. Methodology: This ‘systematic review’ was carried out following preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines & various search engines. Total 20(N) articles were selected and included for study. After following PRISMA guidelines and based upon inclusion and exclusion criteria of s...
To determine the frequency and antifungal susceptibility pattern of Candida species causing candi... more To determine the frequency and antifungal susceptibility pattern of Candida species causing candidemia or blood stream infections (BSI) in immunocompromised patients of a bone marrow transplant unit. The study was conducted at the Department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi in collaboration with Armed Forces Bone Marrow Transplant Center (AFBMTC), Rawalpindi, from 1st June 2019 to 31st December 2019. A total 256 paired blood culture samples from patients of all ages, irrespective of gender were collected during a period of seven months. The samples were processed as recommended Clinical & Laboratory Standard Institute (CLSI) guidelines. Antifungal susceptibility by break point MICs was performed through VITEK® 2 system (version: 08.01) for Fluconazole, Itraconazole and Amphotericin B. Of the total 256 blood cultures, 46 (17.97%) were positive for Candida species. The susceptibility of C. albicans was 100% to Amphotericin B, 90% to Fluconazole ...
Objective: To determine the frequency of Type-able and untype-able genotypes in hepatitis C infec... more Objective: To determine the frequency of Type-able and untype-able genotypes in hepatitis C infected patients,and to observe their association with gender, age, Alanine Aminotranferease and viral load. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Microbiology, Combined Military Hospital, and Lahore, Pakistanfrom Sep 2017 to Mar 2018. Methodology: Six hundred forty seven anti HCV antibodies positive serum samples by Enzyme Linked ImmunoSorbant Assay were received from a total of 6791 serum samples. The positive sera were subjected to qualitative PCR and quantitative real time (RT) PCR to determine pre-treatment viral load. Quantitative PCR positive sera with viral load >500IU/ml were further subjected to molecular genotyping by using Ohno et al method. Result: Out of 647 positive serum samples, type-specific PCR fragments were seen in 424 sera, while 13 (3.1%) of serum samples were of untype-able genotype. In all age groups genotype 3a...
The objective of current meta-analysis was to identify the predisposing factors, diagnostic, and ... more The objective of current meta-analysis was to identify the predisposing factors, diagnostic, and anti microbial therapy guidelines for clostridium difficile infection. The methodology of this meta analysis involved the simple random sampling technique. Total 67 articles were selected and included for study i.e three decades (1988 uptil 2019). The results revealed significant drugs association and predisposing factors includes over use of antibiotics especially in immunosuppressed persons i.e 42.8% and 64.2% respectively. The common clinical presentations are temperature greater than 38°C (73.3%) and abdominal pain (53.3%). The lab diagnostic options includes WBCs ; ≥ 15,000 cell/µL (54.5%), albumin; ≤2.5 g/dL (54.5%), creatinine; ≥ 1.5 (54.5%), positive toxin assay (31.8%), and positive PCR including NAAT (27.2%) respectively. Next in sequence are the details for the complications i.e toxic megacolon (84.6%), hemodynamic instability (69.2%) and pseudo membarnous colitis (53.8%). In...
The emergence of anti-microbial resistance (AMR) is one the biggest challenges faced by the clini... more The emergence of anti-microbial resistance (AMR) is one the biggest challenges faced by the clinicians around the Globe. To coup up with the situation, further management options are heading towards deficiency. In such condition appropriate selection of antibiotics in light of results obtained from culture and sensitivity harbors great significance. The currently used microbiological diagnostic and management options are based upon the guidelines derived from Western data. The National data regarding accurate guidelines for diagnostic and management modalities are deficient. Therefore, the objectives of this review article will be to identify the significance of reviewing and establishing the National guidelines, as a stride to reduce AMR. The literature review had emphasized the need of reviewing and establishing the regional and National guidelines as a significant factor to reduce anti-microbial resistance.
To find out the frequency of Extensively Drug Resistant (XDR) and pre-XDR tuberculosis in clinica... more To find out the frequency of Extensively Drug Resistant (XDR) and pre-XDR tuberculosis in clinical isolates of Multi-Drug Resistant (MDR) Tuberculosis (TB) by determining the susceptibilities against Levofloxacin and Amikacin (classical second line antituberculosis drugs). Adescriptive cross-sectional study. Microbiology Department, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from September 2011 to August 2013. Amikacin (AK) and Levofloxacin (LEVO) were obtained in chemically pure form from Sigma (Taufkirchen, Germany). The breakpoint concentration used for AK was 1.0 µg/ml and for LEVO 2.0 µg/ml. Mycobacterial Growth Indicator Tube (MGIT) 960 system was used to carry out drug susceptibility testing as per recommended protocol. Atotal of 3 MDR-TB isolates (3%) turned out to be XDR-TB based upon simultaneous resistance to injectable second line antituberculosis drug AK and one of the fluoro-quinolones (LEVO). Atotal of 24 MDR-TB isolates (24%) were found to be pre-XDR bas...
Journal of the College of Physicians and Surgeons--Pakistan: JCPSP
A BSTRACT Objective: To determine the in vitro susceptibility of chloramphenicol against methicil... more A BSTRACT Objective: To determine the in vitro susceptibility of chloramphenicol against methicillin-resistant Staphylococcus aureus . Study Design: Cross-sectional study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from January to June 2012. Methodology: One hundred and seventy four isolates of methicillin-resistant Staphylococcus aureus were included in this study using cefoxitin (30 μg) disc for detection. Minimum inhibitory concentration (MIC) of chloramphenicol against MRSA was determined by using E-strip (AB BIO DISK). The susceptibility was determined by swabbing the Mueller-Hinton agar (MHA) plates with the resultant saline suspension of MRSA and applying E-strip of chloramphenicol from AB Biodisk Sweden and determining the MIC of chloramphenicol (in μ g/ml). Clinical and Laboratory Standards Institute (CLSI) recommendations of ≤ 8 μ g/ml being sensitive, 16 μ g/ml as intermediate and ≥ 32 μ g/ml as resistant were...
Journal of the College of Physicians and Surgeons--Pakistan: JCPSP
Neutropenic fever is an important cause of morbidity and mortality during therapy of acute myeloi... more Neutropenic fever is an important cause of morbidity and mortality during therapy of acute myeloid leukemia. Patients with acute myeloid leukemia are at increased risk of acquiring vancomycin resistant enterococcal infection and its treatment remains problematic. Vancomycin therapy for more than 7 days is usually associated with inducible vancomycin-resistant enterococcal infections. We report a case of vancomycin resistant enterococcal sepsis in a patient of acute myeloid leukemia.
Journal of the College of Physicians and Surgeons--Pakistan: JCPSP
Objective: To determine the types of pathogens causing blood stream infections and their drug sus... more Objective: To determine the types of pathogens causing blood stream infections and their drug susceptibility profile in immunocompromised patients. Study Design: Cross-sectional, observational study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from January to September 2012. Methodology: Blood culture bottles received from immunocompromised patients were dealt by two methods, brain heart infusion (BHI) broth based manual method and automated BACTEC system. The samples yielding positive growth from either of two methods were further analyzed. The identification of isolates was done with the help of biochemical reactions and rapid tests. Antimicrobial susceptibility of the isolates was carried out as per recommendations of Clinical and Laboratory Standards Institute (CLSI). Results: Out of the 938 blood culture specimens received from immunocompromised patients, 188 (20%) yielded positive growth. Out of these, 89 (47.3%) is...
Objective: To determine the comprehensive antibiotic susceptibility profile of carbapenem-resista... more Objective: To determine the comprehensive antibiotic susceptibility profile of carbapenem-resistant Enterobacterales among clinical samples received at the Armed Forces Institute of Pathology (AFIP), Rawalpindi. Study Design: Cross-sectional study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan, from Apr to Sep 2020 Methodology: Over six months, 150 carbapenem-resistant Enterobacterales were isolated at the Armed Forces Institute ofPathology, Rawalpindi Pakistan. The antimicrobial susceptibility testing was performed using the Kirby-Bauer Disk-Diffusion technique, and their susceptibility was interpreted according to the CLSI 2020 and EUCAST 2020 guidelines. Results: Out of 150 clinical isolates resistant to Carbapenems, 99(66%) were identified as Klebsiella Pneumoniae, followed by Escherichia Coli 38(25.7%), Proteus Mirabilis 7(4.6%), Enterobacter Cloacae, Serratia Marcescens, Citrobacter Freundii, Providenci...
Objective: To determine important errors in initial Gram staining of clinical specimens and evalu... more Objective: To determine important errors in initial Gram staining of clinical specimens and evaluate the types of Gram-stain errors. Study Design: Cross-sectional study. Place and Duration of Study: Microbiology Department, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Aug 2018 to Feb 2019. Methodology: Gram staining and culture inoculation of all specimens were performed per recommended guidelines. The Gram stain results on day-0 were compared with the results of the culture on day-2. There was no discrepancy if similar organisms were obtained on culture as on Gram stain. Nevertheless, if the Gram stain and culture results were not similar, it was termed a discrepancy. The consultant microbiologist reviewed all discrepant slides, and if not resolved, possible causes of error were sought, and the results documented. Results: Of the total 300 clinical specimens, errors were observed in the initial gram staining of 29 specimens (9.7%), whereas 271(90.3%) specimens wer...
Objective: To provide a laboratory-based surveillance report of typhoid fever cases diagnosed at ... more Objective: To provide a laboratory-based surveillance report of typhoid fever cases diagnosed at a tertiary care hospital in Lahore during the ongoing outbreak. Study Design: Cross-sectional study. Place and Duration of Study: Department of Microbiology, Combined Military Hospital, Lahore Pakistan, from Mar 2018 to Jun 2019. Methodology: All positive blood culture samples that yielded the growth of Salmonella Typhi were included in the study. The samples were dealt with according to standard microbiological procedures. Antimicrobial susceptibility was performed using Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: During the study period, (377) Typhoidal Salmonellae were isolated, of which 327 (86.7%) were Salmonella Typhi and 50 (13.3%) were Paratyphi A. The percentage of XDR Salmonella isolates was 41.9%. Conclusion: Extensively drug-resistant typhoid fever cases reported in this study represent just the tip of an iceberg. Therefore, nationwide surveillance...
Objective: To study the frequency and type of invasive fungal disease in critically ill and immun... more Objective: To study the frequency and type of invasive fungal disease in critically ill and immunocompromised patients. Method: The prospective, cross-sectional, descriptive study was conducted at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from January 2017 to December 2020, and comprised pathological samples from immunocompromised and critically ill patients for fungal culture. Data regarding demographics, comorbidities, results of direct microscopy and fungal culture was recorded. Data was analysed using SPSS 22. Results: Of the 8285 patients specimens, 4722(57%) belonged to males and 3563(43%) to females. The mean age of the patients was 48.32±5.42 years (range: 14-98 years). Out of total 8285, 3465(41.82%) were related to blood, 2640(32%) endobronchial washing, 837(10%) sputum, 623(7.5%) tissue, 332(4%) body fluids, 288(3.5%) bronchoalveoar lavage and 100(1.2%) cerebrospinal fluid. Aspergillus flavus (20.7%) and candida albicans (14.5%) were the two most comm...
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2017
OBJECTIVE To determine the current trend of antimicrobial susceptibility of typhoidal Salmonellae... more OBJECTIVE To determine the current trend of antimicrobial susceptibility of typhoidal Salmonellae. STUDY DESIGN Descriptive cross-sectional study. PLACE AND DURATION OF STUDY The study was carried out in the Department of Microbiology, PNS Shifa Hospital, Karachi, from January 2014 to December 2015. METHODOLOGY Blood culture samples received from the wards and outpatient departments were included. Isolates of Salmonella were dealt with standard microbiological procedures. The antimicrobial sensitivity against the typhoidal Salmonellaewas determined using Kirby-Bauer disc diffusion method as per the guidelines of Clinical and Laboratory Standards Institute (2013). RESULTS Atotal of 460 typhoidal Salmonellaewere isolated; out of which 270 were Salmonella typhiand 190 were Salmonella paratyphiA. The percentage of MDR isolates of S. typhiwas 57% and that of S. paratyphiAwas 42%. None of the isolates were resistant to ceftriaxone, while sensitivity to ciprofloxacin (07% and 0% for S. typ...
Objective: To estimate burden of multi drug resistant, extensively drug resistant and pan drug re... more Objective: To estimate burden of multi drug resistant, extensively drug resistant and pan drug resistant superbugs isolated from various indoor microbiological specimen at tertiary care centers Rawalpindi. Study Design: Cross sectional study. Place and Duration of Study: Department of Microbiology in Institute of Pathology, from Jul 2017 to Jun 2018. Methodology: A total of 6126 bacteria isolated from various indoor microbiological specimen were included in the study. All specimen were collected aseptically and bacterial cultures were processed as per standard microbiological practices. Bacterial isolates were identified by using VITEK 2 systems-Version 08.01 (bio Merieux, France). Results: Out of 6126 bacteria isolated 76% were multi drug resistant, 44% were extensively drug resistant and 1.2% were pan drug resistant. About 83% and 3.8% and 0% of bacteria isolated from pus/tissue, 67%, 58%, 0.8% of bacteria recovered from urine, 72%, 52% and 4.5% of bacteria isolated from respirato...
Objective: To assess Bacterial spectrum and antimicrobial pattern of Blood Stream Infections asso... more Objective: To assess Bacterial spectrum and antimicrobial pattern of Blood Stream Infections associated with non-tunneled double lumen catheter in hemodialysis patients. Study Design: Prospective observational study. Place and Duration of Study: Department of Nephrology, Pakistan Emirates Military Hospital Rawalpindi Pakistan; Armed Forces Institute of Pathology Rawalpindi, Pakistan, from May 2019 to Apr 2020. Methodology: A total of 753 patients underwent placement of non-tunneled double lumen catheter (457 femoral, 296 Internal Jugular). Patients with clinically suspected bloodstream infections had their catheters removed with tips being sent for culture along with 2 sets of peripheral blood cultures. Patients were labelled as having bloodstream infection if growth of organism was detected in catheter tip and at least one peripheral blood culture. Susceptibility testing was done for available antimicrobials. Results: One hundred and thirty six (18.06%) incidences or 5.48 bloodstre...
Background Current year 2021, brought a hope for the world due to availability of various vaccine... more Background Current year 2021, brought a hope for the world due to availability of various vaccines to prevent COVID 19. Researchers around the Globe, kept working around the clock to dig up various correlations of this infection. So, that morbidity and mortality rates can be reduced. In all this sprint, cases of black fungus came into light in India. The Indian researchers identified strong association of black fungus co infection in COVID patients resulting in high mortality rates. Objectives Therefore, this current systematic review was planned to identify the predisposing factors, clinical presentations and management options for black fungus in COVID 19 patients. Methodology: This ‘systematic review’ was carried out following preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines & various search engines. Total 20(N) articles were selected and included for study. After following PRISMA guidelines and based upon inclusion and exclusion criteria of s...
To determine the frequency and antifungal susceptibility pattern of Candida species causing candi... more To determine the frequency and antifungal susceptibility pattern of Candida species causing candidemia or blood stream infections (BSI) in immunocompromised patients of a bone marrow transplant unit. The study was conducted at the Department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi in collaboration with Armed Forces Bone Marrow Transplant Center (AFBMTC), Rawalpindi, from 1st June 2019 to 31st December 2019. A total 256 paired blood culture samples from patients of all ages, irrespective of gender were collected during a period of seven months. The samples were processed as recommended Clinical & Laboratory Standard Institute (CLSI) guidelines. Antifungal susceptibility by break point MICs was performed through VITEK® 2 system (version: 08.01) for Fluconazole, Itraconazole and Amphotericin B. Of the total 256 blood cultures, 46 (17.97%) were positive for Candida species. The susceptibility of C. albicans was 100% to Amphotericin B, 90% to Fluconazole ...
Objective: To determine the frequency of Type-able and untype-able genotypes in hepatitis C infec... more Objective: To determine the frequency of Type-able and untype-able genotypes in hepatitis C infected patients,and to observe their association with gender, age, Alanine Aminotranferease and viral load. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Microbiology, Combined Military Hospital, and Lahore, Pakistanfrom Sep 2017 to Mar 2018. Methodology: Six hundred forty seven anti HCV antibodies positive serum samples by Enzyme Linked ImmunoSorbant Assay were received from a total of 6791 serum samples. The positive sera were subjected to qualitative PCR and quantitative real time (RT) PCR to determine pre-treatment viral load. Quantitative PCR positive sera with viral load >500IU/ml were further subjected to molecular genotyping by using Ohno et al method. Result: Out of 647 positive serum samples, type-specific PCR fragments were seen in 424 sera, while 13 (3.1%) of serum samples were of untype-able genotype. In all age groups genotype 3a...
The objective of current meta-analysis was to identify the predisposing factors, diagnostic, and ... more The objective of current meta-analysis was to identify the predisposing factors, diagnostic, and anti microbial therapy guidelines for clostridium difficile infection. The methodology of this meta analysis involved the simple random sampling technique. Total 67 articles were selected and included for study i.e three decades (1988 uptil 2019). The results revealed significant drugs association and predisposing factors includes over use of antibiotics especially in immunosuppressed persons i.e 42.8% and 64.2% respectively. The common clinical presentations are temperature greater than 38°C (73.3%) and abdominal pain (53.3%). The lab diagnostic options includes WBCs ; ≥ 15,000 cell/µL (54.5%), albumin; ≤2.5 g/dL (54.5%), creatinine; ≥ 1.5 (54.5%), positive toxin assay (31.8%), and positive PCR including NAAT (27.2%) respectively. Next in sequence are the details for the complications i.e toxic megacolon (84.6%), hemodynamic instability (69.2%) and pseudo membarnous colitis (53.8%). In...
The emergence of anti-microbial resistance (AMR) is one the biggest challenges faced by the clini... more The emergence of anti-microbial resistance (AMR) is one the biggest challenges faced by the clinicians around the Globe. To coup up with the situation, further management options are heading towards deficiency. In such condition appropriate selection of antibiotics in light of results obtained from culture and sensitivity harbors great significance. The currently used microbiological diagnostic and management options are based upon the guidelines derived from Western data. The National data regarding accurate guidelines for diagnostic and management modalities are deficient. Therefore, the objectives of this review article will be to identify the significance of reviewing and establishing the National guidelines, as a stride to reduce AMR. The literature review had emphasized the need of reviewing and establishing the regional and National guidelines as a significant factor to reduce anti-microbial resistance.
To find out the frequency of Extensively Drug Resistant (XDR) and pre-XDR tuberculosis in clinica... more To find out the frequency of Extensively Drug Resistant (XDR) and pre-XDR tuberculosis in clinical isolates of Multi-Drug Resistant (MDR) Tuberculosis (TB) by determining the susceptibilities against Levofloxacin and Amikacin (classical second line antituberculosis drugs). Adescriptive cross-sectional study. Microbiology Department, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from September 2011 to August 2013. Amikacin (AK) and Levofloxacin (LEVO) were obtained in chemically pure form from Sigma (Taufkirchen, Germany). The breakpoint concentration used for AK was 1.0 µg/ml and for LEVO 2.0 µg/ml. Mycobacterial Growth Indicator Tube (MGIT) 960 system was used to carry out drug susceptibility testing as per recommended protocol. Atotal of 3 MDR-TB isolates (3%) turned out to be XDR-TB based upon simultaneous resistance to injectable second line antituberculosis drug AK and one of the fluoro-quinolones (LEVO). Atotal of 24 MDR-TB isolates (24%) were found to be pre-XDR bas...
Journal of the College of Physicians and Surgeons--Pakistan: JCPSP
A BSTRACT Objective: To determine the in vitro susceptibility of chloramphenicol against methicil... more A BSTRACT Objective: To determine the in vitro susceptibility of chloramphenicol against methicillin-resistant Staphylococcus aureus . Study Design: Cross-sectional study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from January to June 2012. Methodology: One hundred and seventy four isolates of methicillin-resistant Staphylococcus aureus were included in this study using cefoxitin (30 μg) disc for detection. Minimum inhibitory concentration (MIC) of chloramphenicol against MRSA was determined by using E-strip (AB BIO DISK). The susceptibility was determined by swabbing the Mueller-Hinton agar (MHA) plates with the resultant saline suspension of MRSA and applying E-strip of chloramphenicol from AB Biodisk Sweden and determining the MIC of chloramphenicol (in μ g/ml). Clinical and Laboratory Standards Institute (CLSI) recommendations of ≤ 8 μ g/ml being sensitive, 16 μ g/ml as intermediate and ≥ 32 μ g/ml as resistant were...
Journal of the College of Physicians and Surgeons--Pakistan: JCPSP
Neutropenic fever is an important cause of morbidity and mortality during therapy of acute myeloi... more Neutropenic fever is an important cause of morbidity and mortality during therapy of acute myeloid leukemia. Patients with acute myeloid leukemia are at increased risk of acquiring vancomycin resistant enterococcal infection and its treatment remains problematic. Vancomycin therapy for more than 7 days is usually associated with inducible vancomycin-resistant enterococcal infections. We report a case of vancomycin resistant enterococcal sepsis in a patient of acute myeloid leukemia.
Journal of the College of Physicians and Surgeons--Pakistan: JCPSP
Objective: To determine the types of pathogens causing blood stream infections and their drug sus... more Objective: To determine the types of pathogens causing blood stream infections and their drug susceptibility profile in immunocompromised patients. Study Design: Cross-sectional, observational study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from January to September 2012. Methodology: Blood culture bottles received from immunocompromised patients were dealt by two methods, brain heart infusion (BHI) broth based manual method and automated BACTEC system. The samples yielding positive growth from either of two methods were further analyzed. The identification of isolates was done with the help of biochemical reactions and rapid tests. Antimicrobial susceptibility of the isolates was carried out as per recommendations of Clinical and Laboratory Standards Institute (CLSI). Results: Out of the 938 blood culture specimens received from immunocompromised patients, 188 (20%) yielded positive growth. Out of these, 89 (47.3%) is...
Uploads