Multidrug resistant A. baumannii has emerged as an important and problematic human pathogen as it is the causative agent of several types of infections especially in neonates and immunocompromised patients because they have least capacity to fight against infections. Carbapenems are used as last resort antibiotics for treating these infections but currently resistance against carbapenems due to MBL production is on the rise. The objective of this study was to determine the frequency of antibiotic resistance in A. baumannii and also to compare the efficacy of combined disk test and double disk synergy test for detection of metallo-beta-lactamases. A total of 112 A. baumannii were identified from various clinical samples and antibiotic susceptibility profile was determined by Kirby-Bauer Disk Diffusion method. Out of 112, 66 (58.9%) isolates were resistant to both imipenem and meropenem (OXOID). These resistant isolates were tested for carbapenemase production, and 55 (83.3%) were carbapenemase producers by Modified Hodge Test. These isolates were further tested for MBL production by combined disk test and double disk synergy test. Out of 66, 49 isolates were positive by both methods, CDT and DDST, and only one isolate was detected as negative (with kappa value = 0.038). All MBL producing strains showed remarkable resistance to cephalosporins, fluoroquinolones, aminoglycosides, and piperacillin/tazobactam (OXOID). The antibiotic resistance was very high in A. baumannii which were isolated from children in Pakistan specially attending a nephrology unit.

ObjectiveTo describe disease pattern, bacteriological profile, morbidity and mortality of acute bacterial meningitis (ABM) in children and to compare these parameters before and after the introduction of Pneumococcal vaccine in Pakistan National Immunisation Program.Study designA descriptive study.MethodologyA total of 503 children 1 months to 5 years of age admitted with diagnosis of meningitis. Complete blood count, CSF cytology, biochemistry, culture sensitivity and blood culture sensitivity were performed. Data was analysed using SPSS 20.ResultsOut of 503 children with ABM, there were 199 cases in 2012 and 304 in 2013–2015. Frequency of meningitis decreased by 50%.Most children in both groups were under one year. Relatively less children were fully vaccinated in new group, 30.3% vs 45%.Increased complications seen in the newer group 20% vs 17%.CSF culture positivity decreased from (12%) to (6.6%). The common pathogens identified on CSF culture were Coagulase negative staphylococci (CoNS) 11 (5.5%), Streptococcus pneumoniae 5 (2.5%), H. influenzae 2 (1%) in 2012, whereas in the new group Klebsiella 7 (2.3%) was the most common followed by Streptococcus pneumoniae 4 (1.3%), and (CoNS) 3 (1%). Refusal to take feed (p=0.002), impaired sensorium (p=<0.001), severe malnutrition (p=0.001), prolonged duration of symptoms (p=<0.001)and incomplete vaccination status (0.005)were associated with mortality. Mortality rate decreased from 20 (10%) in 2012 to 17 (5.6%) in 2013–2015 but more children developed neurological squealier 2.7% versus 1% previously.ConclusionAcute bacterial meningitis mostly affected children<1 year. Frequency and mortality of meningitis decreased significantly but more severe disease with neurological complications developed in those children who were unvaccinated in 2013– 2015 compared with 2012.