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Paeniclostridium sordellii, a spore-forming anaerobic Gram-positive rod commonly found in soil samples, is rarely associated with human disease. The authors report a rare case of P. sordelli osteomyelitis of the left distal femur in a young male patient, which is the first reported case of P. sordelli from Pakistan. A 21-year-old male, laborer by profession, presented with low-grade fever, fatigue and lethargy since more than a month, which progressed in severity over the last 2 weeks. On CT scan, abnormal thickening of the cortical bone along with encroachment of the medullary cavity was observed in the left distal femur. A diagnosis of acute osteomyelitis was made and surgical intervention was performed to remove infected bone and soft tissue, which were sent for culture to the Microbiology laboratory. Bone and soft tissue cultures yielded no growth after 72 hours of aerobic incubation. However, bacterial growth was observed after anaerobic incubation, in bone culture, which was identified as P. sordellii using Vitek® 2 automated system. Penicillin, piperacillin-tazobactam, meropenem, vancomycin and metronidazole were susceptible whereas, clindamycin was resistant in the isolate. The patient was started on metronidazole and after he remained stable with a clean surgical wound and symptomatic management, was discharged on regular follow-up as an out-patient. Since, P. sordelli is rare and highly fatal in most cases, prompt reporting and insights from treated infections could pave the way for successful management.

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Introduction: Urinary tract infection (UTI) is the most common infection of the pediatric age group. Several factors linked to higher prevalence include poor personal hygiene, improper sanitation, lower socioeconomic status, and malnourishment. In addition to having a worse quality of life, the 1.8 million children who live in Karachi's Korangi district are routinely exposed to such factors. Objectives: The study aims to evaluate the frequency of UTI and distribution of uropathogens along with their antimicrobial susceptibility pattern in patients presenting to a pediatric tertiary care center in the Korangi district of Karachi, Pakistan. Design: The study employed an observational cross-sectional design. Methods: The study was conducted at the Microbiology laboratory of Sindh Institute of Child Health and Neonatology, Karachi, Pakistan from 1st January to 15th August 2023. Urine samples of patients 1 to 16 years of age were collected via midstream clean catch method and of patients from birth up to 1 year were collected in urine collection bags. The samples were cultured on Cystine Lactose Electrolyte Deficient (CLED) agar and antibiotic susceptibility testing was performed using the Kirby-Bauer Disc Diffusion method. Results: A total of 457 urine samples were collected, of which 90 (19.7%) were positive for significant uropathogens. With a mean age of 4.6 years, majority of the culture-positive patients were female (n = 72; 80%). Enterobacterales were the most frequently isolated (n = 88; 95.6%), of which Escherichia coli was the most common (73.9%; n = 68). Citrobacter (n = 7; 7.6%), Klebsiella (n = 6; 6.5%), Serratia (n = 4; 4.3%), Proteus (n = 2; 2.2%), Salmonella (n = 2; 2.2%), and Enterobacter (n = 1; 1.1%) were among the other Enterobacterales isolated. Meropenem and imipenem were the most effective in isolates from Enterobacterales (n = 88) followed by amikacin (n = 84), ciprofloxacin (n = 75), and piperacillin-tazobactam (n = 70). Ceftriaxone and cefixime exhibited moderate susceptibility (n = 69 and 52) whereas, amoxicillin-clavulanate was the least susceptible (n = 3). Conclusion: We report high frequency of UTI in our pediatric population with uropathogens and associated antimicrobial susceptibility pattern confirming to the existing trends of pediatric UTIs in Pakistan. In addition to valuable insights for treating patients under similar conditions, our study serves as a catalyst for further multi-center research in this area.

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Introduction: Blood culture is the gold standard for diagnosing bacteremia and direct the physicians to select appropriate antimicrobials. In hospitals, blood culture contamination (BCC) is a common problem that has a detrimental effect on patient outcomes. Hence, we implemented strategies in our tertiary care setup, for training phlebotomists and nurses in proper blood sampling techniques, and assessed their effectiveness in reducing BCC rates. Methods: This interventional study was conducted at the Indus Hospital, Karachi, Pakistan from 1st January 2021 to 30th June 2023. All blood cultures received from different departments of the hospital were included. The 2.5-year study period was divided into pre-intervention and intervention periods, with monthly monitoring of BCC. The BCC data between 1st January 2021 and 31st December 2021 was taken as the baseline pre-intervention period and the next 1.5 years comprised the intervention period (1st January 2022-30th June 2023). To improve compliance, various strategies were implemented, such as regular training sessions, didactic sessions, and re-competencies. Results: A total of 86 774 Blood cultures were received from all departments of the hospital, out of which n = 30 672 were received in the pre-intervention period whereas, n = 56 102 were received in the intervention period. Mean BCC rate in the pre-intervention period was found to be 4.6%. However, after the implementation of different measures to reduce BCC, the contamination rate decreased to a mean of 3.1% by the end of the intervention period. Emergency department accounted for the highest proportion of BCC in the pre-intervention and intervention periods. Conclusion: We decreased BCC in our tertiary care setup by implementing a simple and inexpensive collaborative intervention, and came to the conclusion that the higher incidence of BCC was probably caused by factors unique to the emergency department and provided measures to successfully address them.

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OBJECTIVE: To explore the distribution of daptomycin (DAP) minimum inhibitory concentrations (MICs) in Staphylococcus aureus isolated from complicated skin, soft tissue, and bloodstream infections collected from the Pakistani population using broth microdilution (BMD). STUDY DESIGN: Descriptive, cross-sectional study. Place and Duration of the Study: Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, from May to October 2021. METHODOLOGY: Through consecutive sampling techniques, 169 Staphylococcus aureus (S. aureus) isolated from clinical specimens including pus, tissue, and blood were collected. Patients' data including age, gender, geographical location, specimen site, and methicillin susceptibility were collected from the laboratory data. BMD was used to determine MICs of clinical isolates and S. aureus ATCC 29213. DAP MIC ≤1.0 µg/ml was considered susceptible according to the Clinical and Laboratory Standards Institute M100. RESULTS: Among all the clinical isolates, 144 (85%) and 25 (15%) were from skin and soft tissue and blood, respectively. All isolates were susceptible to DAP with MIC50, MIC90, and MIC range of 0.25 µg/ml, 0.5 µg/ml, and 0.06 - 0.5 µg/ml, respectively. CONCLUSION: These study findings demonstrated low in-vitro MICs for DAP against S. aureus in tested isolates from a diverse variety of patient specimens from across Pakistan. KEY WORDS: Daptomycin, Staphylococcus aureus, Broth microdilution, Minimum inhibitory concentrations.

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Pakistan, a subtropical nation, has seen a rapid rise in Arboviral transmission in the past decade. Environmental hazards such as intense monsoon rains and yearly floods in addition to unsanitary living conditions pose an increased risk of arboviral infections. In recent years, the emergence and spread of West Nile virus (WNV), which can lead to a life-threatening meningoencephalitis, in Pakistan has alarmed the health care authorities of an impending outbreak. Health professionals and policymakers should give paramount importance to prevent its transmission across Pakistan as another arboviral outbreak would wreak havoc on the already fragile health infrastructure of the country. Proactive surveillance and prompt reporting are crucial for mitigating this threat as there are no vaccines available to prevent WNV infection.

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