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Objective: To discover the frequency of vancomycin resistant enterococci (VRE) fecal colonization and subsequent bacteremia in patients with hematological diseases in a bone marrow transplant center. Study Design: Cross-sectional study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology (AFIP), in collaboration with Armed Forces Bone Marrow Transplant Center, Rawalpindi, from Jan 2016 to Dec 2019. Methodology: Stool specimens/anal swabs from all enrolled patients were collected aseptically and transported to the laboratory without delay. Blood cultures were collected aseptically from only those enrolled patients who developed signs and symptoms of bacteremia. Stool and blood cultures were processed as per standard microbiological protocols. Enterococci were identified to species level by colony morphology and biochemical tests. Modified Kirby Bauer disc diffusion method and VITEK-2 system (Version-8.01 bio Merieux, France) were used to perform antimicrobial sensitivity of each isolate. Results: A total number of 246 patients were studied. Among them, 67 (27%) patients had fecal colonization by vancomycin resistant enterococci. We report a statistically significant association of recent hospitalization, prolonged exposure to antimicrobial therapy, chemotherapy exposure and use of indwelling devices during the hospital stay with vancomycin resistant enterococci colonization. Vancomycin resistant enterococci bacteremia was detected in 57 (23%) patients. Among these 57 patients, 53 (93%) were vancomycin resistant enterococci colonizers. Vancomycin resistant enterococci colonization was significantly associated with vancomycin resistant enterococci bacteremia. Conclusion: A considerable burden of vancomycin resistant enterococci fecal colonization exists among patients with hematological diseases. vancomycin resistant enterococci colonization poses a considerable risk of vancomycin........

Objective: To evaluate the cytospin slide microscopy method for detection of acid fast bacilli (AFB) in bronchoalveolar lavage (BAL) fluid comparing it with concentrated smear microscopy. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, from Dec 2016 to Sep 2018. Methodology: BAL specimens from suspected tuberculosis patients who were sputum smear negative, submitted to AFIP for diagnosis were included in the study. Smears for microscopy were prepared with the modified cytospin method as well as the standard concentrated technique. The prepared smears from both methods were stained with Ziehl–Neelsen (ZN) staining method and examined under 100 × oil immersion lens. TB culture performed on BACTEC MGIT 960 automated culture system (Becton Dickinson, USA) was taken as gold standard for TB diagnosis. The two methods were compared in terms of sensitivity, specificity, positive predictive value and negative predictive value. Results: Out of the 130 samples tested, 62 (47.7%) were positive on culture using MGIT 960 system. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of the modified cytospin method for pulmonary TB diagnosis was found to be 68.3%, 100%, 100%, 77% and 84.6%, respectively. Conclusion: The sensitivity of the modified cytopsin smear method was significantly higher than that of the concentrated method. The study concludes that this is a simpler and more accurate method for BAL fluid microscopy.

Objective: To determine cut off value of Interferon Gamma Release Assay (IGRA) among Tuberculosis (TB) suspected patients and to compare median Interferon Gamma Release Assay value for Tuberculosis culture positive and culture negative patients. Study Design: Cross sectional study. Place and Duration of Study: Department of Microbiology, Armed Forces Institute of Pathology, National University of Medical Sciences, from Oct 2015 to Apr 2016. Methodology: The study was conducted on patients with suspected tuberculosis. Quantiferon Tuberculosis Gold that has an important role in the immune response to Tuberculosis was performed by Enzyme Linked Immunosorbent Assay method and specimens were cultured on Mycobacterium Growth Indicator Tube 960 System (MGIT 960 system). Quantiferon Tuberculosis Gold values obtained by Enzyme Linked Immunosorbent Assay method were used to determine the sensitivity and specificity of this test. Results: A total of 240 suspected isolates of tuberculosis during the study period were subjected to culture using MGIT 960 system, as per recommended protocol for the method. These samples were also subjected to Quantiferon TB Gold (QTBG) to measure Interferon Gamma Release Assay release. Sensitivity and specificity of IGRA was determined keeping tuberculosis culture as gold standard for this study. Conclusion: Sensitivity and specificity values showed a significant p-value

Objective: To compare the in vitro disk diffusion method and agar dilution method for sensitivity of Polymyxin B against multi drug resistant Acinetobacter baumannii. Study Design: Comparative cross sectional. Place and Duration of Study: The study was carried out in the department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi from 1st Dec 2016 to 30th Dec 2017. Methodology: Total 253 clinical specimens received from intensive care units with yielded growth of multidrug resistant Acinetobacter baumannii were evaluated for Polymyxin B susceptibility. Both Kirby bauer disk diffusion and agar dilution methods were compared with a reference method, broth microdilution. Results: Among 253 multidrug resistant isolates, 180 (71%) were extensively drug resistant and 221 (87%) were carbapenem resistant. Comparison of the disk diffusion and the MIC method by Agar dilution showed 100% correlation. 251 isolates were sensitive and 2 were resistant to Polymyxin B with MICs and disk zone diameters within the range recommended by the CLSI (2014-17). MIC 50 and MIC 90 of Polymyxin B were found to be 0.5 and 1μg/ml with 99.2% susceptibility. Conclusion: Both disk diffusion and agar dilution can be used together as initial screening methods in low income countries for susceptibility reporting of polymyxins. They are simple, reliable and economical. Also hetero resistance shown by some Acinetobacter baumanii strains can easily be picked up by agar dilution method.

Objective: To investigate and document the clinical course of typhoid fever and the sensitivity pattern of Salmonella typhi to antibiotics among patients admitted to Pakistan Naval Ship Shifa Hospital. Study Design: Cross-sectional study. Place and Duration of Study: Pakistan Naval Ship Shifa Hospital, from Jul to Dec 2021. Methodology: The patients admitted with typhoid fever to the hospital during the study period were included using consecutive sampling. After getting informed consent, the patients’ demographic characteristics, course of the disease, blood culture sensitivity, the treatment administered, the complications that emerged, and the length of their hospital stay were noted. Results: There were 77 patients with culture-proven typhoid fever admitted during the study period. The mean age was 18.6±11.84 years (range 1-55 years). The most frequent presenting complaints were fever, abdominal pain, and vomiting. Additional symptoms included a rash, bodily aches, and weariness. Out of the 77 patients, 76(99%) were extensively drugresistant (sensitive to Meropenem and Azithromycin only). The complications noted were hepatitis, myocarditis, ascites, pleural effusion, and shock. The mean length of stay in the hospital was 16.56+3.87 days. The typical time gap between commencing culture-specific antibiotics and fever defervescence was 4.03±2.84 days. Conclusion: Almost all (99%) patients admitted with typhoid fever in PNS Shifa are extensively drug-resistant and require a relatively longer hospital stay for management.

Objective: to determine the frequency of the possible side effects of the COVID -19 inactivated vaccine. Study Design: Cross-sectional survey. Place and Duration of Study: Pakistan Naval Ship Shifa Hospital, Karachi Pakistan from Jan to Apr 2021. Methodology: A total of 305 recipients of inactivated COVID-19 vaccine were asked to fill out a questionnaire themselves or by the health care worker via telephonic conversation. The questionnaire comprised queries regarding general and local side effects that the participants experienced after getting vaccinated for COVID-19. Results: Out of 305 recipients, 270(88.5%) were men, and 35(11.5%) were women. Participants' age ranged from 18-60 years.After the first dose, 83(27.2%) cases [male 63(23.3%) vs. female 20(57.1%)], were reported with side effects, while 75(24.5%)recipients, [male: 54(19.9%) vs. female: 21(58.8%)], had side effects after the second dose. Generalized symptoms were fever,headache, dizziness, and body aches, while local side effects were pain, itching, swelling and rash at the injection site.259(84.9%) recipients reported spontaneous recovery after the first dose. After the second dose, 286(93.8%) recipients recovered spontaneously. The remaining 44(13%) of the recipients' required symptomatic treatment. After the second dose,only 19(6%) recipients needed symptomatic treatment. Conclusion: It is important to document the possible side effects of COVID vaccine so that public awareness and education can be made to minimize public fear of vaccine side effects. Inactivated vaccine for COVID-19 has minimal reported side effects and hence has a good safety profile.