Changing trends in drug resistance among typhoid salmonellae in Rawalpindi, Pakistan

We analysed the record of blood cultures carried out at the Armed Forces Institute of Pathology, Rawalpindi between 1996 and 2003. We isolated 477 Salmonella typhi and 410 S. paratyphi A from blood of patients suffering from typhoid fever. We observed a significant shift in the distribution and antimicrobial susceptibility of typhoid salmonellae. The isolation rate of S. typhi fell significantly while S. paratyphi A is emerging as a major pathogen. Resistance to conventional antityphoid drugs in S. typhi decreased dramatically from 80% to 14%, while in S. paratyphi A resistance increased from 14% to 44%. Susceptibility to the fluoroquinolones decreased in both. No resistance to third generation cephalosporins was detected

Rapid detection of rifampicin susceptibility of mycobacterium tuberculosis in sputum specimens by mycobacteriophage assay

To evaluate the performance of FASTPlaqueTB-RIF TM, a newly introduced bacteriophage assay for rapid detection of rifampicin susceptibility of Mycobacterium tuberculosis in sputum specimens. A comparative study of 40 sputum specimens from patients of pulmonary tuberculosis, using FASTPlaqueTB-RIF TM and Bactec 460 TB system carried out at the Armed Forces Institute of Pathology, Rawalpindi between September and November 2001. Of the 40 clinical isolates of Mycobacterium tuberculosis tested for rifampicin [RIF] susceptibility using the Bactec 460 TB system, 28 isolates were resistant to RIF and 12 isolates were susceptible. FASTPlaqueTB-RIF TM identified 24 specimens as resistant to RIF. Three specimens that revealed susceptible isolates on Bactec 460, were resistant by FASTPlaqueTB-RIF' while four specimens which revealed resistant isolates on Bactec 460, demonstrated susceptibility to RIF by FASTPlaqueTB-RIF TM. The sensitivity and specificity of FASTPlaqueTB-RIF TM were 86% and 73% respectively. The predictive values of positive and negative tests were 0.89 and 0.67 respectively. The overall accuracy of the technique was 82%. The phage assay took 48 hours to perform. Early detection of rifampicin resistance by the mycobacteriophage technique direct from sputum specimens is a potentially useful new test which would allow decision regarding appropriate therapy to be made early thus having a positive impact on patient care and on prevention of spread of MDR TB