Swine Flu; an experience at a tertiary care hospital in Rawalpindi

To determine the cases of swine flu in a tertiary care hospital in Rawalpindi. Study Design: Cross-sectional descriptive study. This study was carried out at Combined Military Hospital Rawalpindi from December 2010 to February 2011. The probable cases having a temperature more than 100°F or 37.8°C with cough or sore throat in the absence of a known cause other than influenza were referred by the consultant physicians to the clinical laboratory of this hospital for testing H1N1 by real time polymerase chain reaction [RT-PCR] on throat swabs. The throat swab samples were collected under the supervision of a consultant pathologist, the samples were immediately immersed in viral transport medium and RT- PCR was carried out at National Institute of Health Islamabad. During the study period a total of 89 cases were sampled, out of these 49 [55%] were males and 40 [45%] females. The age range was from 6 days to 73 years, representing an extremely skewed age distribution defying a reasonable summary measure. A total of 33 cases [37%] were positive. Three deaths of the positive cases with mortality of 9.09% was seen. Swine flu has emerged as a new challenge to the whole world and an RT-PCR based positive rate of 37% marks the need for considering it in the differential diagnosis of influenza like illness

Spectrum and antimicrobial susceptibility of bacterial organisms isolated from patients in a bone marrow transplant centre-A review of 6 years

To determine the spectrum and antimicrobial susceptibility pattern of pathogens isolated from bone marrow transplant centre and to examine the evolution of bacterial resistance to antibiotics in these patients. It was a retrospective study conducted in the department of Microbiology, Armed Forces institute of Pathology [AFIP] from January 2004 to December 2009. Isolation, identification and antimicrobial susceptibilities were performed by standard methods. Gram negative bacterie accounted for 50.4% of the total isolates and Gram positives 49.6%. Escherichia coli was the most common isolate among the gram negative rods followed by Pseudomonas spp and Acinetobacter spp. Amongst the Gram positive organisms staphylococcus aureus and coagulase negative staphylococci followed by enterococci were the predominant organisms. The susceptibility of methicillin resistant staphylococcus aureus remained 100% for Vancomycin and Linezolid, while those of minocycline, fusidic acid and doxycycline were at an acceptable level of above 60%. Imipenem remained the most effective antibiotic for Gram negative rods. Acinetobacter spp. was the most problematic organism as only 62% isolates were susceptible to imipenem. Linezolid, vancomycin and tigecycline were very effective for enterococci. Ciprofloxacin sensitivity has been reduced among most of the bacteria isolated. The spectrum of isolates from neutropenic patients in our population appears to be changing with a shift towards Gram-positive microorganisms. At the same time resistance to most of the commonly used antimicrobials is increasing. Continuous surveillance of their susceptibility patterns is essential for formulation of empiric therapeutic regimens for these patients

Community-acquired bacterial pneumonias in Rawalpindi

The objective of the study was to determine the bacterial spectrum and antimicrobial susceptibility pattern of bacteria causing community-acquired pneumonia in Rawalpindi. Laboratory based, non-interventional descriptive study In vitro activity of various antimicrobials was tested against isolates from 510 specimens including sputum, broncho-alveolar lavage fluid and tracheal aspirates. Antimicrobial susceptibility testing was done by the modified Kirby-Bauer disk diffusion technique using standard antibiotic sensitivity disks and the results were interpreted according to the National Committee for Clinical Laboratory Standards criteria. Minimal inhibitory concentration of penicillin was determined by agar dilution method in all cases where the inhibition zone diameter was 19 mm or less. Bacterial pathogens were isolated from 88 specimens. These included Haemophilus influenzae [73%], Moraxella catarrhalis [12%], Streptococcus pneumoniae [10%] and Haemophilus parainfluenzae [5%]. Isolates of Haemophilus influenzae were generally sensitive to co-amoxiclav [88%] and ceftriaxone [97] where as 33% were resistant to chloramphenicol. All the isolates of M. catarrhalis were sensitive to co-amoxiclav. One isolate of S pneumoniae was resistant to penicillin, while 2 showed relative resistance. H. parainfluenzae was generally sensitive to most of the antibiotics. In our setup co-amoxiclav can be given as empirical treatment for community-acquired bacterial pneumonias