This study aimed to evaluate the minimum inhibitory concentration (MIC) of azithromycin (AZM) in clinical isolates of extensively drug-resistant (XDR) Salmonella Typhi (i.e., resistant to chloramphenicol, ampicillin, trimethoprim-sulfamethoxazole, fluoroquinolones, and third-generation cephalosporin) using the E-test versus the broth microdilution method (BMD). From January to June 2021, a retrospective cross-sectional study was carried out in Lahore, Pakistan. Antimicrobial susceptibility was performed initially by the Kirby-Bauer disk diffusion method for 150 XDR Salmonella enterica serovar Typhi isolates, and MICs of all the recommended antibiotics were determined by the VITEK 2 (BioMérieux) fully automated system using Clinical Laboratory Standard Institute (CLSI) 2021 guidelines. The E-test method was used to determine AZM MICs. These MICs were compared with the BMD, which is the method recommended by the CLSI but not adopted in routine laboratory reporting. Of 150 isolates, 10 (6.6%) were resistant by disk diffusion. Eight (5.3%) of these had high MICs against AZM by the E-test. Only three isolates (2%) were resistant by E-test, having an MIC of 32 μg/mL. All eight isolates had a high MIC by BMD with different MIC distributions, but only one was resistant, having an MIC of 32 μg/mL by BMD. The sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy of the E-test method versus BMD were 98.65%,100%, 99.3%, 33.3%, and 98.6%, respectively. Similarly, the concordance rate was 98.6%, negative percent agreement was 100%, and positive percent agreement was 33%. The BMD is the most reliable approach for reporting AZM sensitivity in XDR S. Typhi compared with the E-test and disk diffusion methods. Potentially, AZM resistance in XDR S. Typhi is around the corner. Sensitivity patterns should be reported with MIC values, and if possible, higher values should be screened for the presence of any potential resistance genes. Antibiotic stewardship should be strictly implemented.

Typhoid fever is a significant health problem in developing countries like Pakistan. Salmonella Typhi the causative agent of typhoid has developed resistant to almost all recommended antibiotics. Emergence of resistance to third generation cephalosporins has further complicated the situation and such strains are called as extensively drug resistant (XDR) Salmonella Typhi. Currently only available options are azithromycin and cabapenems. Recently few reports of azithromycin resistance have emerged from countries like Pakistan, India, Bangladesh and Nepal. As azithromycin is the only oral option available to treat XDR Typhoid, development of resistance may change treatment strategy altogether from out patient management to hospitalization of every patient. This may increase the burden on already weak health care system of countries like Pakistan. So there is dire need to look for the alternative treatment options. Manuka honey is well known for its therapeutic potential against wide range of bacteria including Salmonella Typhimurium. In this study 3 azithromycin resistant isolates were isolated and identified using disc diffusion, E-test and broth micro dilution methods and antibacterial activity, MIC and MBC of manuka honey was performed by agar well diffusion assay and broth micro dilution assay respectively. Manuka honey manifested significant antibacterial activity against all test isolates with zone of inhibition ranging from 7.3mm to 7.5mm, MIC and MBC values were between 10 to 15% v/v Here, we conclude that Manuka honey possess potent antibacterial activity and might be used as an alternative treatment option against azithromycin resistant XDR Typhid. However, further clinical trials are mandatory to validate our initial findings.

Background: For the past two decades, Acinetobacter spp. has emerged as an important pathogen globally in various infections mostly in hospital settings. Objectives: This study was conducted to determine the frequency and antibiotic susceptibility pattern of Acinetobacter spp isolated from pus and wound swabs. Methods: This retrospective cross-sectional study included a total of 110 Pus and wound samples collected from patients presenting to Fatima Jinnah Medical University, Lahore laboratory from Jan 2016 to March 2016. The samples were processed and identified by standard protocol. The Acinetobacter isolates were tested for antibiotic resistance by Kirby-Bauer disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: From 110 wound samples, 87 (79%) showed significant growth of 87 positive cultures 20 samples (23%) showed growth of Acinetobacter, 11(12.7%) Klebsiella Spp 22(25.3%) Staphylococcus Spp 18 (20.6%) Pseudomonas Spp and 16 (18.4%) Escherichia coli. Out of 20 isolates of Acinatobacter, 13 (65%) were resistant to more than three classes of antibiotics (multidrug resistant) and 3 (15%) were resistant to all commonly used antibiotics (pan-drug resistant). Majority of the isolates were sensitive to Imipenem, Amikacin and Tigecycline and showed resistance rates of 45%, 50%, and 45%, respectively. Conclusion: This hospital-based epidemiological data will help to implement better infection control strategies and improve the knowledge of antibiotic resistance patterns in our region.

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Background: HIV has been under serious consideration by the World Health Organization as well as the Federal government and Provincial health departments. Strict measures have been taken and protocols implemented to curtail the spread of HIV along with Hepatitis B and Hepatitis C. Data from privately-run blood banks have not been reflected in the last 15 years. Aim: To identify current trends of HIV positivity in Lahore Methods: This prospective cross-sectional study was conducted at the Department of Pathology & Laboratory, Doctors Hospital & Medical Centre, Lahore from August 2021 to January 2022. After fulfilling the selection criteria 3160 non-remunerated blood donors selected through non-probability consecutive sampling, were enrolled. Anti-HIV test was performed using chemiluminescence. Results: 3160 voluntary blood donors were investigated. All subjects were males with mean age 29.7 years ranging from 21 years to 46 years. 2 candidates for blood donation (0.06%) were tested positive for HIV. Conclusion: This study reflects stagnation in HIV control as depicted by the frequency of its positivity. There is need to enhance awareness programs in controlling the spread of blood borne diseases especially HIV. Keywords: HIV, blood donor, blood borne diseases, blood transfusion