While antimicrobial resistance (AMR) continues to be a major public health problem in Pakistan, data regarding trends of resistance among pathogenic bacteria remains scarce, with few studies presenting long-term trends in AMR. This study was therefore designed to analyze long-term AMR trends at a national level in Pakistan. We report here results of a comprehensive analysis of resistance, among pathogens isolated from blood and cerebrospinal fluid (CSF), between 2011 and 2015. Susceptibility data was obtained from a local laboratory with collection points all across Pakistan (Chughtai Laboratory). Resistance proportions to most commonly used antimicrobials were calculated for each pathogen over a period of five years. While Acinetobacter species demonstrated highest resistance rates to all tested antimicrobials, a sharp increase in carbapenem resistance was the most noticeable (50%-95%) between 2011–2015. Our results also highlight the presence of third and fourth generation cephalosporins resistance in Salmonella enterica serovar Typhi in Pakistan. Interestingly, where rise in AMR was being observed in some major invasive pathogens, decreasing resistance trends were observed in Staphylococcus aureus, against commonly used antimicrobials. Overall pathogens isolated from blood and CSF between 2011–2015, showed an increase in resistance towards commonly used antimicrobials.

The COVID-19 pandemic caused by SARS-CoV-2 spread across many countries between 2020 and 2022. The similarities in clinical presentation with other endemic diseases pose a challenge to physicians in effectively diagnosing and treating the infection. Approximately 129 nations have a risk of dengue infection, and more than 100 of those are endemic to dengue. During the COVID-19 pandemic, the number of dengue cases decreased in many countries owing to the isolation measures followed. However, the common clinical presentation between them has led to misdiagnosis. Both COVID-19 and dengue fever cause a surge in proinflammatory cytokines and chemokines, thus sharing a common pathophysiology. False positive serological test results also posed difficulty differentiating between COVID-19 and dengue fever. This review aims to compare the clinical features, pathophysiology, and immune response between dengue and COVID-19, to benefit public health management during the pandemic.

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To the best of our knowledge, Non-O1 Vibrio cholerae (NOVC) bacteremia has never been documented in Pakistan. This case report is the first reported case of bacteremia in an infant due to NOVC in Pakistan. A neonate was admitted to a hospital with fever and no history of diarrhea. The isolate was identified biochemically and serologically and was sensitive to all the drugs tested as per CLSI 2014 guidelines.

| Bacteremia is associated with high rates of morbidity and mortality. For early diagnosis of bacteremia; prior use of antibiotics, suboptimal volume of blood sample and improper microbiological techniques are strongly condemned. In time-diagnosis of bacteremia can reduce the antibiotic resistance, hospital stay and cost to the treatment. Blood samples from patients with history of fever in conjunction with clinical signs and symptoms of bacteremia (from July 2013 to July 2014) were processed using BACTEC 9050 automated system. ESR (erythrocyte sedimentation rate), CRP (C-reactive protein) and TLC (total leukocyte count) were also measured, respectively. Out of 3559 samples, 525 (14.75%) samples were positive for bacterial growth. Among positive blood cultures, the pathogens isolated were coagulase negative Staphylococcus aureus (36.38 %), E. coli (18.28%), Methicillin sensitive Staphylococcus aureus (MSSA) (7.04%), Strept. fecalis (5.9%), Salmonella typhi (6.09%), Candida species (4.95%), Pseudomonas species (4.38%), Klebsiella pneumonia (4%), Acinetobacter species (3.42%), Salmonella paratyphi A (2.85%), Methicillin resistant Staphylococcus aureus (MRSA) (2.67%), Citrobacter species (2.47%), Streptococcus species other than Strept. faecalis (1.52%), Xanthomonas maltophilia (0.57%), Vibrio species (0.19%), Yersinia species (0.19%) and Klebsiella oxytoca (0.19%). ESR, CRP and TLC showed poor correlation with bacteremic patients. In addition, increased antimicrobial resistance was observed in all pathogens isolated. ESR, CRP and TLC were considered as preliminary indicator of infections having low specificity and sensitivity in blood stream infections. Keywords