Objective: To determine incidence of MRSA in our community and its antibiotic susceptibility pattern. Study Design: Cross Sectional study. Setting: Department of Pathology, Sahara Medical College Narowal. Period: January 2020 to June 2020. Material & Methods: Bacterial isolates were taken from the samples of blood, pus and other body fluids sent to the hospital laboratory to determine culture and sensitivity pattern. Those samples positive for staphylococcus aureus were included in the study for further examination. MRSA were detected using conventional technique (catalase, coagulase and DNase methods) and confirmed by phenotypic and molecular characterization techniques (cefoxitin and oxacillin sensitivity, mec-A gene and 16S rRNA genes sequencing methods). Their antibiotic sensitivity was determined using standard Kirby Bauer disc diffusion technique. Chi square test was applied on collected data using SPSS-24. Results: Total 158 bacterial isolates containing staphylococcus aureus were included in the study. MRSA (multi drug resistant staphylococcus aureus) was detected in 33.5% samples and MSSA (multi drug sensitive staphylococcus aureus) was detected in 66.5% samples. Frequency of MSSA was more than MRSA. Male gender was more affected (60%) than female (40%). All bacterial isolates containing staphylococcus aureus were resistant to oxacillin and cefoxitin. MRSA isolates were sensitive to vancomycin, linezolid, teicoplanin, fosfomycin and fusidic acid, rifampicin, clindamycin, minocyclin and chloramphenicol, while resistant to penicillin, azithromycin, ciprofloxacin, erythromycin and co-trimoxazole. Conclusion: MRSA is detected by conventional technique followed by phenotypic and molecular characterization methods for confirmation. Methicillin sensitive staphylococcus aureus was detected more commonly than methicillin resistant staphylococcus aureus in our study sample. Proper culture and antibiotic sensitivity pattern is necessary to deal with MRSA.

Objective: To study prevalence of various gram negative bacteria in infected burn wounds among stable burn patients reporting to out-patient department on follow-ups. Study Design: Cross Sectional study. Setting: Department of Pathology, Sahara Medical College Narowal. Period: January to June 2020. Material & Methods: Patients with burn wounds with clinical signs and symptoms of infection but vitally stable, wound less than one month old involving < 20% body surface, reporting to out-patient door of study institution on follow-ups were enrolled into the study. Swabs of infected wounds were taken and sent for bacterial culture and sensitivity to the pathology department of the institution, where micro flora were isolated and their antibiotic susceptibility pattern was determined using standard techniques. Consent was taken from patients before including them in study. Results: Total 210 cases were studied. Gram negative bacteria were isolated from 190 cases, out of them 30% were oxidase positive ad 70% were oxidase negative. Most common organism isolated was Pseudomonas Aeruginosa (30%), followed by Proteus Sps. (25.3%) and Entero bacter Sps. (15.8%) etc. Conclusion: Among gram negative bacteria pseudomonas is a major isolated organism from infected burn wounds having high susceptibility to imipenem and cefepime.

Objective: To determine frequency of gram negative bacterial isolates and their antibiotic sensitivity pattern among patients with chronic suppurative otitis media. Study Design: Descriptive Cross Sectional study. Setting: Department of Pathology Sahara Medical College Narowal. Period: January 2020 to June 2020. Material & Methods: Total 126 bacterial isolates were taken from the patients having unilateral or bilateral ear discharge reporting to OPD or emergency department during study period. After taking detailed history, examination and baseline investigations diagnosis was confirmed. Specimens of ear discharge were taken from all patients and sent to the pathology department of study institution to determine culture and sensitivity pattern of Gram-negative bacterial isolates. Consent was taken from ethical review committee. Data was analyzed on SPSS-24. Chi square test was applied on collected data. Results: Bacterial isolates were taken from 126 cases having age 2-54 years with mean age of 11.45±5.73 years of either gender. Mostly children less than 8 years of age were found with otitis media. Gram positive bacteria were detected in 41.3% and gram negative in 55.6% and candida albicans in 3.2% out of total 126 bacterial cultures. Out of gram negative cultures, pseudomonas aeruginosa was found in 41.4%, proteus mirabilus in 44.3% and E.coli in 14.3% specimens. Conclusion: Gram negative bacteria are common cause of chronic suppurative otitis media in our region, mostly affecting young children. There is variable antibiotic sensitivity pattern depending on cultural, climate changes and previously taken antibiotics.

Objective: To determine frequency, molecular characterization and sensitivity of bacterial isolates against commonly used antibiotics in neonatal sepsis. Study Design: Cross Sectional study. Setting: Department of Pathology Sahara Medical College Narowal. Period: October 2019 to March 2020. Material & Methods: Neonates admitted in neonatal intensive care unit (NICU) of study institution having signs and symptoms of neonatal symptoms such as fever, irritability, seizures, anorexia and lethargy, were included in the study using consecutive sampling technique. Blood sample from all study patients taken and sent for culture to determine bacterial isolates and antibiotic sensitivity against commonly used antibiotics for neonatal sepsis. Bacterial isolates identification was done using standard bacteriological technique performed by modified Kirby & Bauer disc diffuse method as per Clinical and Laboratory standards institute (CLSI) guidelines. Results: Total 200 cases were studied having neonatal sepsis and admitted in NICU including 58% female and 42% male children. Bacterial growth occurred in 10.5% samples and in 89.5% samples no bacterial growth seen. There were 1% samples with gram positive and 9.5% samples with gram negative bacterial isolates. Klebsiella was the commonest organism isolated in 38.1% cases out of total positive isolates. There were 72.5% neonates having age 1-14 days and 27.5% neonates having age 15-28 days. Conclusion: Gram negative bacteria are common cause of neonatal sepsis, out of which Klebsiella is the commonest organism. Antimicrobial drug resistance in different infections is a serious emerging issue.

Objective: To determine frequency and pattern of extended spectrum beta lactamase in Klebsiella pneumoniae and E. coli in bacterial cultures. Study Design: Cross Sectional study. Setting: Department of Pathology Sahara Medical College Narowal. Period: January to June 2020. Material & Methods: Total 1100 bacterial isolates were studied out of them 655 E.coli and 445 of klebsiella pneumoniae. All samples were subjected to double disc diffusion method using third generation cephalosporin and amoxacillin-clavulanic acid for detection of ESBL. Data was analyzed using SPSS software version 24, and results were calculated in the form of frequency, percentage and standard deviation. P-value ≤0.05 was taken as statistically non-significant. Results: There were 48.9% male and 51.1% female subjects out of 1100 total cases. E.coli was detected in 59.5% and klebsiella in 40.5% samples. Total 44.2% samples were positive for ESBL enzyme. Of 655 E.coli samples 40.8% and of 445 Klebsiella pneumoniae samples 49.2% were positive for ESBL enzyme. Conclusion: It is necessary to detect ESBL positive Klebsiella pneumoniae and E.coli in laboratory workflow to avoid unnecessary use of antibiotics and development of resistance against them.