Comparison of the Disease Severity and Outcome of Vaccinated COVID-19 Patients with Unvaccinated Patients in a Specialized COVID-19 Facility: A Retrospective Cohort Study from Karachi, Pakistan.

We compared the clinical characteristics and outcome of vaccinated hospitalized COVID-19 patients with unvaccinated hospitalized COVID-19 patients. A retrospective cohort study was conducted at the Sindh Infectious Diseases Hospital and Research Center, Karachi, Pakistan. A total of 1407 hospitalized COVID-19 positive patients were included from April 2021 to March 2022, of which 812 (57.71%) were males. Of the 1407, 378 (26.87%) patients were vaccinated while 1029 (73.13%) were unvaccinated. Of the vaccinated patients, 160 (42.32%) were partially vaccinated while 218 (57.68%) were fully vaccinated (vaccine breakthrough infection). Fewer unvaccinated COVID-19 patients survived compared to vaccinated patients (62.5% vs. 70%, RR 0.89, 95% CI: 0.82-0.96, p-value = 0.004). Despite there being more vaccinated patients above 60 years of age (60.05% vs. 47.13%), their risk of mortality was lower by 43% (OR = 0.578; CI = 0.4201 to 0.7980, p = 0.0009). On survival analysis, vaccinated patients had better 30-day survival compared to unvaccinated patients (p = 0.028). Moreover, comparing waves 3-5, unvaccinated patients of wave 4, which was driven by the delta variant, had the worst survival (51.8%, p ≤ 0.001) while vaccinated patients of wave 3 (driven by the alpha variant) had the best survival (71.6%).

Diagnostic Accuracy and Agreement between Four Phenotypic Carbapenemase Detection Tests among Enterobacterales.

INTRODUCTION: Carbapenem-resistant Enterobacterales (CREs) are becoming increasingly popular as a cause of hospital-acquired infections that are difficult to treat and are frequently reported as causes of outbreaks in various hospitals. Conventional culturing techniques take at least 2 days to report a case as carbapenem resistant, and it is therefore important to detect such resistance mechanisms as early as possible. METHODS: This study aimed to compare the diagnostic performance of Carba NP, modified Hodge test (MHT), ethylenediaminetetraacetic acid (EDTA) disk synergy test (DST), and the modified carbapenem inactivation method (mCIM). This study was done at Microbiology Laboratory, Aga Khan University Hospital, Karachi. It was an observational study. Carba NP, MHT, EDTA DST, and the mCIM were performed on consecutive isolates of Enterobacterales. Sensitivity, specificity, and agreement between the four tests were calculated. RESULTS: Of 207 Enterobacterales isolated, 127 were resistant to carbapenems. One hundred and fourteen of these were tested by a polymerase chain reaction, and the sensitivities of the Carba NP, MHT, EDTA DST, and the mCIM were found to be 94.34%, 75.47%, 79.25%, and 98.11%, respectively. CONCLUSIONS: Due to increased rates of carbapenem resistance, there is a need to employ mechanisms in hospitals that can identify such organisms as early as possible, both from clinical and epidemiological standpoints. The Carba NP test is a rapid, cost-effective, and reliable method and mCIM is more accurate but time consuming and both can be safely used for the screening of CREs.

Microbiological and antimicrobial pattern of diabetic foot ulcers (DFUs) at a tertiary care center in North East, Punjab.

OBJECTIVE: To determine the pattern of antimicrobial sensitivity of common microorganisms isolated from diabetic foot infections. METHODS: The cross-sectional study was conducted from January to August 2019 at the Diabetes and Footcare Clinic, Mayo Hospital, Lahore, Pakistan, and comprised deep-seated tissue samples from the ulcer bed that were tested for culture and sensitivity. Antimicrobial susceptibility was determined in accordance with Clinical and Laboratory Standards Institute guidelines. Data was analysed using SPSS 26. RESULTS: There were 389 bacterial isolates collected from 201 patients who had a mean age of 53.05±10.70 years. . Of the isolates, 238(61.11%) were gram-negative and 151(38.89%) were gram-positive organisms. Methicillin-resistant Staphylococcus aureuswas found in 62(64.58%) isolates. CONCLUSIONS: Early identification of diabetic foot infections can help in timely initiation of empirical treatment and prevention of unwanted amputations.

Diagnostic evaluation of heel prick newborn screening of thyroid stimulating hormone on dissociation-enhanced lanthanide fluorescence immunoassay with the establishment of reference value in Pakistani neonates.

OBJECTIVE: To develop and validate a method on Dissociation Enhanced Lanthanide Fluorescence Immunoassay for neonatal heel prick blood human thyroid stimulating hormone and the establishment of its reference value in the local population. METHODS: The multi-centre cross-sectional validation study was conducted from September 2016 to September 2018 at Zahra Beau Naqvi Foundation Welfare Trust laboratory, Islamabad, Pakistan, and comprised samples related to newborns aged 1 month or less taken from neonatal units of 39 hospitals based in Punjab, Khyber Pakhtunkhuwa, Gilgit-Baltistan and Azad Jammu and Kashmir. Samples were collected after 24 hours of birth using the heel prick test. The samples were dried and sent to the laboratory for assessment where Dissociation Enhanced Lanthanide Fluorescent Immunoassay was used to estimate thyroid stimulating hormone levels. Data recorded included age, gender, and birth detail, like gestational age, mode of delivery etc. Data was analysed using SPSS 21. Method validation and reference value were manually calculated. RESULTS: Of the 14,147 samples received, 8,207(58%) related to boys and 5,940(42%) to girls. Most samples 4903(34.6%) came from Peshawar. The overall mean age of the newborns was 5.6±4.8 days. Thyroid stimulating hormone data was divided into three groups; positive with median value 27.8±36.6 uIU/ml, negative with median 1.42±1.60 uIU/ml, and borderline with median 11.4±4.12uIU/ml. Prevalence of congenital hypothyroidism in high-risk population in the positive group was 39(0.3%), negative 14,012(99.0%) and borderline 96(0.7%). Reference cut-off was calculated as 7.06uIU/ml for screening of healthy and positive cases of congenital hypothyroidism. Method Validation results showed limit of detection -0.5uU/ml, limit of quantitation LOQ 0.8uU/ml, accuracy 100±5%, precision coefficient of variation at each level of calibrators -4, 8.8, 1.2, 11.3, 7.2 and 4.3% respectively, and linearity from to 0.8uU/ml to 254.1uU/ml. CONCLUSIONS: Neonatal human thyroid stimulating hormone by heel prick blood was found to be an affordable and highly sensitive method of screening for congenital hypothyroidism.

Antimicrobial susceptibility and clinical characteristics of Nocardia isolates from a tertiary care centre diagnostic laboratory in Pakistan.

OBJECTIVES: Nocardiosis is an opportunistic infection that can present as cutaneous, pulmonary and/or disseminated disease depending on the host immunity. Treatment choices include trimethoprim/sulfamethoxazole (co-trimoxazole; SXT) and imipenem along with some other antibiotics. The Clinical and Laboratory Standards Institute (CLSI) recommends the broth microdilution (BMD) method to determine antimicrobial susceptibility, however there is a lack of susceptibility data using this method in Pakistan. Therefore, this study was undertaken to outline the susceptibility profile of Nocardia isolates in Pakistan. METHODS: From November 2014 to June 2016, 52 consecutive isolates of Nocardia obtained from clinical specimens cultured at the clinical microbiology laboratory of Aga Khan University Hospital (Karachi, Pakistan) were tested for susceptibility to recommended antibiotics using the CLSI-recommended BMD method. The frequency and percentage of susceptibility and resistance of Nocardia to antimicrobials recommended by CLSI were calculated. The susceptibility profiles of pulmonary and extrapulmonary specimens were compared by χ2 test. RESULTS: Of the 52 isolates, 47 (90.4%) were susceptible to SXT, 20 (38.5%) to imipenem, 49 (94.2%) to amikacin and 52 (100%) to linezolid. No significant differences were found when susceptibilities were compared between pulmonary and extrapulmonary isolates. CONCLUSION: This study highlights the importance of using the gold-standard BMD method for susceptibility testing of Nocardia isolates. Larger studies are needed in the region to establish susceptibility profiles of Nocardia spp. using the BMD method in order to monitor resistance trends and to inform empirical therapy choices.