Background: The duration and immunity nature in form of antibodies to COVID-19 is still not clear. But so far we know that an immune response protects the individuals from future illness for some specific time. The presence or absence of immunity tells us about the future transmission of illness. Objectives: To determine the frequency of antibodies to COVID-19 after three weeks of negative PCR report. To predict the association of the antibodies values with severity of the disease the patient had in recent past. Material and methods: We did a cross sectional study in department of Pathology on 36 patients recovered from COVID-19 from 3rd July 2020 to 31st July 2020. Antibodies level was measured by electro-chemiluminescence immunoassay using Roche Cobas E411 Chemistry Analyzer for which commercial kits of Roche diagnostics were used as per the instructions of the manufacturer, in respondents after 3 weeks of a negative PCR report. Results: The mean with standard deviation for numerical variables i.e. (age and antibodies) was 34+11 years and 34.52+12.71 respectively. 29(80.55%) were males and 7(19.45%) females. The mean antibodies level was statically significantly higher in patients with age less than 50 years (p-value: 0.01). Patients who had severe symptoms at time of being reported positive by PCR had significantly higher antibodies cut off values as compared to asymptomatic positive patients (p-value:0.04). Clinically sever Covid-19 patients positively moderates with an increase in the values of the post infection anti SARS-COV-2 antibodies supported by an interaction term with (β=0.388**; ΔR²=0.126, p-value=0.02). Male gender supported by the results of an interaction term with (β=0.388**; ΔR²=0.126, p-value=0.02) had sever disease as compared to female. Conclusion: The higher anti SARS-COV-2 antibodies were reported in patients with age <50 years and in patients who had severe symptoms or history of hospitalization during the infectious period. There was a statistically significant relationship supported by the interactions terms of higher post infection antibodies level with male gender, an increase in age and with history of sever disease or hospitalization.

Objectives: To determine the phenotype and frequency of Extended Spectrum Beta-Lactamase in Uro-pathogens in a tertiary care hospital of Nowshera. Material and methods: This Prospective cohort study was performed in the clinical pathology laboratory of Qazi Hussain Ahmed Medical Complex (QHAMC) Nowshera from 1st Jan 2019 to 30th May 2019. Relevant information was recorded on a predesigned proforma prepared as per CLSI Recommendation for data collection. Results: A total of 192 urine samples were received for Culture and sensitivity. Out of which 56 cases were ESBL phenotypically positive (29.16%). 39(69.9%) were females and 17(30.4%) were males. The age range of the patient was from 3 months to 63 years of age, with a mean age of 30 years with +5.4 SD Frequency of ESBL producing uro-pathogens was; 51(91%) E-Coli, 4(7.1%) Klebsiella pneumonia and 1(1.8%) Proteus mirabilis. Out of 39 ESBL producing uro-pathogen in Female gender, E Coli-ESBL producing strains were isolated in 35 patients, Klebsiella Pneumonia in 3 patients and one case was of Proteus mirabilis-ESBL. In the male gender, 17 cases with E Coli-ESBL were reported and one case of Kliebsilla Pneumonia ESBL. Conclusion: The prevalence of ESBL producers in the present study was quite alarming and challenging to the clinician in treating urinary tract infections. These types of resistant infections are a challenge to treat and a public health threat that needs accumulative response through advocacy, communication, and social mobilization. Keywords: ESBL, Urinary Tract Infection, antibiotic resistance.

Background: Antibiotic resistance is a challenge to treat.Extended Spectrum Beta Lactamases (ESBL) is one of the phenomenon by which the uropathogen express resistance to the commonly used antibiotic.Objectives: To determine the frequency of ESBL in uropathogens and ESBL preference for age and gender.Methods: This cross sectional study was conducted in Qazi Hussain Ahmed Medical Complex Nowshera from 1 st Mar 2019 to 31 st Jan 2020.A total of 315 urine samples were received for culture and sensitivity out of which 77 cases reported to be ESBL positive (24.44%).Relevant information's were recorded in SPSS version 25.Results: A total of 77 cases with established ESBL phenomenon were studied.Fourty percent were males and 60% females.The frequency of ESBL positive isolates was (24.44%).In 71(92%) cases of ESBL, Escherichia coli strain was reported, Klebsiella pneumonia in 5(6.5%) and Proteus mirabilis in 1.3% cases.The difference in means +SD of age of the male gender (24.25years+9.6) was statistically significant with female gender (31.16years+14.49)(p-value 0.02).The probability of ESBL infections was 2.16 times higher in female gender (p-value: 0.01, OR:2.16).The sensitivity pattern of the ESBL producing Escherichia coli was; Imipenem(IMP) 100%, meropenem (Mem)100%, piperacillin tazobactam (TZP) 92%, nitrofurantoin (F)-85% .While imipenem & meropenem were drugs of choice for ESBL-Klebsiella pneumonia and ESBL -Proteus mirabilis.Conclusion: The frequency of ESBL isolates was 24.44%.Female gender reported more ESBL infection as compared to male gender.Escherichia coli ESBL was most common.The common sensitivity pattern to ESBL was: Imipenem(IMP) 100%, meropenem (Mem)100% and piperacillin tazobactam 95%.

Methods: This cross sectional study was performed in the pathology laboratory of Qazi Hussain Ahmed Medical Complex Nowshera from 1st May 2018 to 30th Oct 2019. A total of 235 isolates were studies and 86 samples showed MRSA. Out of 86 MRSA, 19 were also resistant to Macrolide-lincosamidestreptogramin-B antibiotics (MLS-B). Relevant information were recorded on a predesigned proforma prepared as per CLSI Recommendation for data collection.

Objectives: Phenotypic Detection and sensitivity pattern of erm gene/D-Test positive Methicillin Sensitive (MSSA) and Methicillin Resistant Staphylococcus Aureus (MRSA). Study Design: Prospective Cohort study. Setting: Department of Pathology at Qazi Hussain Ahmed Medical Complex Nowshera. Period: From 1st March 2019 to 30th Sept 2019. Material & Methods: Relevant information’s were entered in a SPSS version 16 for descriptive and inferential analysis of different variable. Results: Out of 186 patients Staph Aureus isolates, 52(27.95%) showed D-test Positive. Thirty (57.7%) cases were females and 22(42.3%) males. The Mean age with Standard Deviation was 28.36+3.8 years. In 45(86.5%) cases D-Test phenomenon was observed in MRSA while in 7(13.5%) cases in MSSA. Chi-square test showed a significant correlation in gender groups for acquiring resistance to Macrolide-Lincosamide-Streptogrammin-B (MLS-B) antibiotic (p = 0.07) by expressing erm gene encoding methylase. The probability of resistance in female gender are 4.5 times more as compared to male gender (p=0.09, OR=4.53). The sensitivity pattern to D+ MRSA was; Vancomycine 100%, Lanezolid 100%,Rifampicin 84.23%, Fusidic acid 55.77%, Doxycyclin 32,59%, levofloxacin 21.15%, Gentamycine13.46%, ciprofloxacin 13.46%. It is pertinent to mention that the sensitivity to cefoxetin (Beta lactam antibiotics) was seen only in cases with D+MSSA cases only (13.5%) cases. Conclusion: D-Test phenomenon can be seen in both MRSA & MSSA infections. D+MSSA cases where sensitive to b-lactam antibiotics shall be treated with b-lactams only, and precious drugs like Vancomycine & Lanezolid should be kept reserved for D+ MRSA cases to reduce resistance.

Objectives: To determine the frequency of COVID-19 and its association with age, gender, travel and exposure. Methods: This cross-sectional study was conducted in COVID-19 clinic, Qazi Hussain Ahmed Medical Complex, Nowshera, from February 2020 to April 2020. A total of 260 suspects were included under strict criteria. Patients received in general OPD and emergencies were excluded. Data was entered in a format in SPSS version 25 for analysis and reporting. Descriptive, inferential and correlation statistics were used. Results: Out of a total 260 of suspects/patients, 66(25.4%) females and 194(74.6%) were males. The nasopharyngeal swabs of 63(24.23%) cases were sent for viral detection selected for PCR testing on the bases of a scoring system. Out of 63 cases 18(6.92%) were COVID-19 positive, 32(12.30%) negative and results of 12(4.61%) were still awaited. The estimated relative risk in male gender was rr=1.08, 95%CI, 0.77-1.55 and in age group>60 years was rr=2.27, 95%CI, 1.35-5.14. There was a positive statistically significant correlation of disease in patients with contact and travel history (p=0.05, rho=0.12; p=0.001, rho=0.34), respectively. Conclusion: The results suggest that the age>50 years has higher susceptibility for COVID-19. Similarly, infectivity with 2019-nCoV has a statistically significant correlation with travel history, contact history and age.

This study was conducted from May 2018 to Oct 2019 to determine the culture and sensitivity pattern of Methicillin resistant Staphylococcus aureus (MRSA) and MRSA with Macrolide Lincosamide and Streptogramin-B (MLS-B) antibiotics in a tertiary care hospital of Nowshera. A total of 235 isolates were studies and 86 samples showed MRSA. The prevalence rate of MRSA was 89/235 (37.87%). Out of 86 isolates with MRSA, 19 (22.09%) were also resistant to MLS-B antibiotics.Regarding gender specification, 52 (60.5%) were females and 34 (39.5%) were males. The mean age with standard deviation of patients was 29 + 6.8 years. The sensitivity pattern to MRSA was; Vancomycin 100%, Linezolid 100%, Rifampicin 86.04%, Clindamycin, 73.25%, Fusidic acid 60.46%, Erythromycin 44.18%., Doxycyclin 32.55%, levofloxacin 16.27%, Gentamycin 13.95% and Ciprofloxacin 11. 62%. Sensitivity of Vancomycin & Linezolid was 100% in MRSA and MLS-B resistant isolates, and should be kept reserved for MRSA cases to avoid misuse of antibiotics and to reduce resistance.

Shigella flexneri is considered as an important causative agent of Shigellosis causing diarrhea in the countries with a low socioeconomic status. No study has been carried out on the molecular prevalence of S. flexneri in Khyber Pakhtunkhwa, Pakistan. So this study was designed to evaluate the molecular prevalence of S. flexneri and their associated risk factors. A total of 2014 diarrheal stool samples were collected from January 2016 to May 2017 from pediatrics patients of Khyber Pakhtunkhwa followed by identification of S. flexneri through biochemical, serological, and molecular methods. The overall prevalence of Shigella species was found to be 7.9% (n = 160). The predominant Shigella specie was S. flexneri (n = 155, 96.8%) followed by S. boydii (n = 5, 3.1%). Interestingly, no sample was found positive for S. sonnei and S. dysenteriae. The majority of Shigellosis cases occurred from June to September. Potential risk factors related with Shigellosis were unhygienic latrine usage, bad hand washing, and consumption of unhygienic food and water, and pipe leakage in the sewage system. In this study, we have observed a high number of Shigellosis cases especially those caused by S. flexneri. It is suggested that effective health awareness programs should be organized by the regional health authorities to minimize the magnitude of pediatrics Shigellosis.

Objectives: To quantitatively analyze the impact of type of contact and duraton of contact with infectivity of novel Corona virus Material and methods: We analyzed 378 suspects/cases to prove our null hypothesis Relevant information was recorded on a predesigned proforma prepared in accordance with the objective of the study, in SPSS version 25th Results: Out of 378 suspects, 180(47 61%) were advised PCR based on their higher score on the approved scale Of the total tested cases, 41/180(22 77%) were COVID-19 positive History of contact with positive COVID-19 patients was contributing in 35/41(85 36%) confirmed cases We observed that 25/41(60 97%) of the positive cases had a contact history > 5 days The relationship of duration of contact with COVID-19 infection was statistically significant (p=0 001) 22/41(53 65%) of the positive cases had history of hand shake and hugging, followed by 8/41(19 5%) hand shake only and 5/41(12 19%) with history of mass gathering with a significant relation with viral infectivity (p=0 02) A moderate uphill positive correlation of duration of contact was recorded with test positivity (p=0 001, rho=0 33) as compared to type of contact (p=0 14, rho=0 11) We observed that contact with strong suspect/COVID-19 patients irrespective of type or duration of contact, the probability and relative risk of acquiring infection was 6 times (OR=6 1, rr=1 82) more than in case with no history of contact When the type of contact was kept as static variable and measured the probability for an increase in duration of contact, the probability and relative risk of COVID increases by 26 times (OR=26, rr=2 83) as compared to no contact group At static duration of contact variable, the probability and relative risk for type of contact for COVID-19 was (OR=1 4, rr=1 03) as compared to no contact group Conclusion: It is the duration of contact and not the type of contact that has a statistically significant correlation and a higher probability of exposure to COVID-19

Thrombocytopenia has been shown to have significant mortality if ignored. Platelet indices have been reported to be useful prognostic indicators. The objectives of this study was to determine the diagnostic importance of the platelet indices in diagnosis of hyperdestructive thrombocytopenia i.e ITP. Study Design: Cross sectional observational study. Setting: Department of Pathology (MTI) Qazi Hussain Ahmed Medical Comeplex Nowshera Medical College. Period: Aug 2017 to Jan 2018. Materials and Methods: These blood samples were analyzed in clinical Pathology laboratory of QHAMC. Required information’s were recorded on predesigned proforrma as per objectives of the study. Results: The peripheral smears of 139 cases were reported in the study. Detailed history and Thorough clinical examination was conducted. Mean age of the study population of the patients with standard deviation was 30.90(±6.4) years. Mean platelet count was 27. 37(±12.8) x109/. Mean platelet volume MPV was 11.4(±1.4) fl. Mean platelet distribution width (PDW) was 15.4(±3.3) fl. Mean platelet large cell ratio (PLCR) was 39.6(±8.9) %. Eight cases with MPV lower than 11fl and cases with PDW more than 15fl that were also having pancytopenia or bycytopenic picture were advised bone marrow aspiration for further diagnosis if clinically indicated. Six cases out of eight to whom bone marrow was advised were sent for bone marrow examination by the clinicians and we found that three of them were idiopathic thrombocytopenia and one Megaloblastic anemia, one case with pancytopenia due to hyperspleenism and one with acute leukemia with eosinophilia. Conclusion: From the above we concluded that all cases with MPV>11fl and PDW>14fl are sensitive and specific indicators for ITP and These indices help to distinguish hyper-destructive thrombocytopenia and hypo-productive thrombocytopenia very easily and it is also cost effective on a very simple test that is special smear. We must look for platelet indices very keenly while reporting a case with bi-cytopenia and pancytopenia.

Background: Nosocomial infections are major health issues in developing as well as developed countries. The objective of this study was to determine the frequency of MBL production in Pseudomnas aeruginosa that causes resistance to Imipenem and other ß-lactam antibiotics. Materials & Methods: A sample of 52 Imipenem resistant Pseudomnas aeruginosa colonizing or infecting the hospitalized patients were collected in Department of Pathology, Post Graduate Medical Institute, Lady Reading Hospital, Peshawar from June 2014 till May 2016. The organisms were identified by routine laboratory tests including biochemical methods and API NE System (Biomeriux) and the sensitivity pattern of commonly used antibiotics was established for each of these isolates using the disc diffusion method. Imipenem resistant strains were tested for MBL production by Imipenem-EDTA disc diffusion method. Results: The frequency of MBL activity was positive in 39 (75%) cases of Pseudomnas aeruginosa which encodes resistance to Imipenem and other ß-lactam antibiotics except monobactam. The sensitivity pattern of these antibiotics was as follows: piperacillin/ tazobactam 30.8%, amikacin and polymyxin B each 17.9%, tobramycin 12.8%, cefoperazone/ sulbactam and ceftazidime each 5.1%, ciprofloxacin, moxifloxacin, colistin sulphate, tetracycline, azithromycin and aztreonam each 2.6% and co-trimoxzole, gentamicin & rifampin each 0%. Conclusion: MBL production in P. aeruginosa confers a challenge for clinicians to treat such resistant infections with conventional antibiotics. Therefore testing each Imipenem resistant Pseudomnas aeruginosa for MBL production must be taken in routine consideration.

Objectives: To determine the frequency and characteristics of dengue patients.Study Design: Cross sectional observational study. Setting: Qazi Hussain Ahmed MedicalComplex Nowshera. Period: 5th July to 25th Sept 2017. Material and Methods: A total of72 cases were received for dengue serology. Relevant information’s were collected on a predesignedquestionnaire prepared in accordance with the objectives of the study. Results: Atotal of 117 patients were referred from fever clinic and emergency OPD for dengue serology.72(61.5%) were males and 45(38.5%) were females. 24(20.5%) cases were dengue positive.14(12%) were NSL1 positive, 8(8.8%) were IgM positive and 2 (1.7%) were IgM&IgG positive.We received patient in the range of 4 years to 60 years, Mean with SD was 27 +3 years. Out of14 NSL1 positive cases 8 were males and 6 females. 2 females were IgG positive. The spectrumof dengue in correlation with gender was significantly positive with p value .026. In two casesplatelet at first visit were 58000/cmm3 that were both IgM&IgG positive. Out of 24 positivedengue cases two cases were also positive for plasmodium vivax (ring tropozoites). 6 caseswere managed in hospital and discharged home with an average stay of 3 days and 4 casesreferred to Lady Reading Hospital Peshawar for repeated platelet transfusion. Mortality waszero in our cases. Conclusion: The suspicion rate of the clinician for dengue from fever clinicwas 1:7. The cause of poor rate can be contributed to the patient insist for doing the denguetest before they are screened for MP and FBC etc. NSL1 was positive in 6 cases that showsthat people reach the health care facility for screening well in time and patient are educatedabout the dengue. Females 50% positive cases were IGM and IGG positive that shows femalereceive the health care later than males as NSL1 positivity in female gender is less than males.The spectrum of dengue in correlation with gender was significantly positive with p value .025that shows mosquito has some affinity for specific gender, or dengue virus has it for differencein gender or the inside immunity of the both gender is involved that causes different mode ofpresentation and activation of antibodies.

Objectives: To determine the frequency and characteristics of dengue patients.Study Design: Cross sectional observational study. Setting: Qazi Hussain Ahmed MedicalComplex Nowshera. Period: 5th July to 25th Sept 2017. Material and Methods: A total of72 cases were received for dengue serology. Relevant information’s were collected on a predesignedquestionnaire prepared in accordance with the objectives of the study. Results: Atotal of 117 patients were referred from fever clinic and emergency OPD for dengue serology.72(61.5%) were males and 45(38.5%) were females. 24(20.5%) cases were dengue positive.14(12%) were NSL1 positive, 8(8.8%) were IgM positive and 2 (1.7%) were IgM&IgG positive.We received patient in the range of 4 years to 60 years, Mean with SD was 27 +3 years. Out of14 NSL1 positive cases 8 were males and 6 females. 2 females were IgG positive. The spectrumof dengue in correlation with gender was significantly positive with p value .026. In two casesplatelet at first visit were 58000/cmm3 that were both IgM&IgG positive. Out of 24 positivedengue cases two cases were also positive for plasmodium vivax (ring tropozoites). 6 caseswere managed in hospital and discharged home with an average stay of 3 days and 4 casesreferred to Lady Reading Hospital Peshawar for repeated platelet transfusion. Mortality waszero in our cases. Conclusion: The suspicion rate of the clinician for dengue from fever clinicwas 1:7. The cause of poor rate can be contributed to the patient insist for doing the denguetest before they are screened for MP and FBC etc. NSL1 was positive in 6 cases that showsthat people reach the health care facility for screening well in time and patient are educatedabout the dengue. Females 50% positive cases were IGM and IGG positive that shows femalereceive the health care later than males as NSL1 positivity in female gender is less than males.The spectrum of dengue in correlation with gender was significantly positive with p value .025that shows mosquito has some affinity for specific gender, or dengue virus has it for differencein gender or the inside immunity of the both gender is involved that causes different mode ofpresentation and activation of antibodies.

Objectives: To determine the frequency and characteristics of dengue patients.Study Design: Cross sectional observational study. Setting: Qazi Hussain Ahmed MedicalComplex Nowshera. Period: 5th July to 25th Sept 2017. Material and Methods: A total of72 cases were received for dengue serology. Relevant information’s were collected on a predesignedquestionnaire prepared in accordance with the objectives of the study. Results: Atotal of 117 patients were referred from fever clinic and emergency OPD for dengue serology.72(61.5%) were males and 45(38.5%) were females. 24(20.5%) cases were dengue positive.14(12%) were NSL1 positive, 8(8.8%) were IgM positive and 2 (1.7%) were IgM&IgG positive.We received patient in the range of 4 years to 60 years, Mean with SD was 27 +3 years. Out of14 NSL1 positive cases 8 were males and 6 females. 2 females were IgG positive. The spectrumof dengue in correlation with gender was significantly positive with p value .026. In two casesplatelet at first visit were 58000/cmm3 that were both IgM&IgG positive. Out of 24 positivedengue cases two cases were also positive for plasmodium vivax (ring tropozoites). 6 caseswere managed in hospital and discharged home with an average stay of 3 days and 4 casesreferred to Lady Reading Hospital Peshawar for repeated platelet transfusion. Mortality waszero in our cases. Conclusion: The suspicion rate of the clinician for dengue from fever clinicwas 1:7. The cause of poor rate can be contributed to the patient insist for doing the denguetest before they are screened for MP and FBC etc. NSL1 was positive in 6 cases that showsthat people reach the health care facility for screening well in time and patient are educatedabout the dengue. Females 50% positive cases were IGM and IGG positive that shows femalereceive the health care later than males as NSL1 positivity in female gender is less than males.The spectrum of dengue in correlation with gender was significantly positive with p value .025that shows mosquito has some affinity for specific gender, or dengue virus has it for differencein gender or the inside immunity of the both gender is involved that causes different mode ofpresentation and activation of antibodies.

Objectives: To determine the frequency and characteristics of dengue patients.Study Design: Cross sectional observational study. Setting: Qazi Hussain Ahmed MedicalComplex Nowshera. Period: 5th July to 25th Sept 2017. Material and Methods: A total of72 cases were received for dengue serology. Relevant information’s were collected on a predesignedquestionnaire prepared in accordance with the objectives of the study. Results: Atotal of 117 patients were referred from fever clinic and emergency OPD for dengue serology.72(61.5%) were males and 45(38.5%) were females. 24(20.5%) cases were dengue positive.14(12%) were NSL1 positive, 8(8.8%) were IgM positive and 2 (1.7%) were IgM&IgG positive.We received patient in the range of 4 years to 60 years, Mean with SD was 27 +3 years. Out of14 NSL1 positive cases 8 were males and 6 females. 2 females were IgG positive. The spectrumof dengue in correlation with gender was significantly positive with p value .026. In two casesplatelet at first visit were 58000/cmm3 that were both IgM&IgG positive. Out of 24 positivedengue cases two cases were also positive for plasmodium vivax (ring tropozoites). 6 caseswere managed in hospital and discharged home with an average stay of 3 days and 4 casesreferred to Lady Reading Hospital Peshawar for repeated platelet transfusion. Mortality waszero in our cases. Conclusion: The suspicion rate of the clinician for dengue from fever clinicwas 1:7. The cause of poor rate can be contributed to the patient insist for doing the denguetest before they are screened for MP and FBC etc. NSL1 was positive in 6 cases that showsthat people reach the health care facility for screening well in time and patient are educatedabout the dengue. Females 50% positive cases were IGM and IGG positive that shows femalereceive the health care later than males as NSL1 positivity in female gender is less than males.The spectrum of dengue in correlation with gender was significantly positive with p value .025that shows mosquito has some affinity for specific gender, or dengue virus has it for differencein gender or the inside immunity of the both gender is involved that causes different mode ofpresentation and activation of antibodies.

Purpose: Purpose: To determine TEM-116 beta-lactamase gene prevalence in drug-resistant Pseudomonas aeruginosa isolates from Pakistan. Methods: Sequence analysis of TEM beta-lactamase isolates and their antibiotic susceptibility patterns were carried out. Quantitative bacteriostatic concentrations for commonly used antibiotics were measured against TEM-116 beta-lactamase isolates. Results: Among the 102 isolates of P. aeruginosa , 23 (22.5 %) were TEM beta-lactamase producers. Sequence analysis of TEM gene from selected isolates showed homology with TEM-116. Two mutations at positions 84 (p.Val84Ile) and 184 (p.Ala184Val) were documented. The TEM-116 isolates exhibited 100 % resistance to sulphamethoxazole/trimethoprim, amoxycillin/clavulanic acid and doxycycline, but showed sensitivity to levofloxacin, norfloxacin and amikacin. One TEM-116 P. aeruginosa (PA11) isolate was resistant to all available antibiotics. Conclusion: These results reveal increased antibiotic resistance in the TEM-116 P. aeruginosa isolates studied, a phenomenon which will be helpful in understanding the molecular mechanisms of antibiotic resistance in P. aeruginosa . Keywords: P. aeruginosa , Clinical isolates, Sequencing, TEM-116, Antibiotic susceptibility

BACKGROUND/AIM Extended spectrum beta lactamase (ESBL) production among E. coli is one of the principal mechanisms that augment resistance to antibiotics. In the current study the molecular detection of class A beta lactamases among uropathogenic Escherichia coli was evaluated. MATERIALS AND METHODS A total of 355 urine samples were collected from a tertiary care hospital in Peshawar. The ESBL production among E. coli isolates was detected by using the disc synergy diffusion method. Moreover, the molecular detection of bla TEM-1 and bla CTX-M-1 ESBLs, the antibiotic resistance pattern, and the minimum inhibitory concentrations (MICs) were also documented. RESULTS Among the 355 urine samples, 157 isolates were E. coli, and 23.56% of the isolates were ESBL E. coli. Among phenotypic ESBL producers, bla CTX-M-1 and bla TEM-1 were found in 59.45% and 40.54% of the isolates, respectively. A high resistance rate was observed against aztreonam (97.29%), while the lowest resistance was observed against imipenem (2.7%). The MICs of ESBLs E. coli for ceftriaxone, ciprofloxacin, and gentamicin was >512 µg/mL, 4 µg/mL to 128 µg/mL, and 1 µg/mL to 14 µg/mL respectively. CONCLUSION The present study showed that bla CTX-M-1 ESBL production is more prevalent in our clinical E. coli isolates. More often the ESBLs were resistant to commonly used antibiotics.

Pseudomonas aeruginosa is an important pathogen of both community and hospital acquired infections, and a major threat to public health for continuous emergence of multi-drug resistance. Current prevalence and pattern of multidrug resistance in the clinical isolates of P. aeruginosa is reported here. Samples were collected from September 2013 to January 2014 tertiary care hospital, Peshawar. Samples were subjected to phenotypic and molecular based detection of P. aeruginosa and were further processed for multidrug resistance pattern. Out of 3700 samples, 102 were identified as MDR P. aeruginosa. Prevalence of MDR isolates were found in pus (34.3%), wounds (28.4%), urine (19.6%), blood (14.7%) and sputum (2.9%) respectively. Isolates were more resistant to Sulphamethoxazole/Trimethoprim (98.04%), Amoxycillin/Clavulanic acid, Doxycycline and Chloramphenicol (95.1%) each, while least resistant to Imipenem (43.1%), Cefoperazone/Sulbactam (50.98%) and Amikacin (53.9%). Extensive MDR pattern was observed in P. aeruginosa was found as (n = 17, 16.6%) isolates were resistant to all four classes of antibiotics. Increased burden of MDR P. aeruginosa was documented in the study. Moreover, some isolates were even resistant to four classes of antibiotics. Findings of the study will be helpful to devise an appropriate antibiotic treatment strategy against MDR P. aeruginosa to cope the chances of evolving resistant pathogens.