Objective: This study investigates resistance to a newly available drug Ceftazidime–Avibactam (CAZ-AVI) in carbapenem-resistant gram-negative organisms (GNOs) in the Pakistan’s pediatric population. Methods: This was a prospective study carried out in the Department of Microbiology at The Children’s Hospital, Lahore from May 2023 to July 2023. A sum of 7491 specimens of blood, cerebrospinal fluid (CSF), urine, pus, nasal swabs, central venous catheter (CVP) tips and tracheal secretion were analyzed for presence of carbapenem resistant gram-negative organisms which were then further screened for CAZ-AVI resistance. Analytical profile index and Kirby-Bauer disk diffusion methods were used for the identification of organisms. Results: A total of 217(n) carbapenem-resistant bacterial species, including 165(n) Klebsiella sp., 32(n) Pseudomonas sp., and 20(n) Escherichia coli (E. coli) strains, were tested for sensitivity against CAZ–AVI. Approximately, 70.5% (153 out of 217) of carbapenem-resistant bacteria exhibited resistance to CAZ-AVI. Among the resistant bacterial species, 80% (122/153) were Klebsiella sp., 14% (21/153) were Pseudomonas sp., and 6% (10/153) were E. coli. These findings suggest pre-existing resistance mechanisms may be responsible for exhibiting resistance to CAZ-AVI in these organisms. Conclusion: Taking into account the results of this study, which depicted high resistance rates to CAZ-AVI among carbapenem resistant GNOs, and the high cost of this drug, it is suggested that a cautious selection for its use as monotherapy in sepsis and other infections should be made. It should be made mandatory to check the resistance to CAZ-AVI before its empiric use. The findings of the study also emphasize the challenges of combating new drug resistance and further research to adapt treatment strategies to the evolving antimicrobial resistance in the region. doi: https://doi.org/10.12669/pjms.41.3.9978 How to cite this: Mehdi N, Majeed N, Ali F, Aroob I. High ceftazidime-avibactam resistance rate in carbapenem-resistant gram-negative organisms in Pakistan’s pediatric population. Pak J Med Sci. 2025;41(3):788-791. doi: https://doi.org/10.12669/pjms.41.3.9978 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Rifampicin is a primary anti-tuberculosis medication. Diagnosing multidrug-resistant tuberculosis (MDR-TB) remains a persistent challenge when examining both pulmonary and extra-pulmonary samples. Rapid detection of rifampicin resistance is essential for the timely treatment and prevention of the spread of tuberculosis. Recently, GeneXpert MTB/RIF assay has emerged as an advanced technique for the rapid diagnosis of Mycobacterium tuberculosis. Objectives: To assess the prevalence of rifampicin resistance in samples from pediatric patients in Pakistan, encompassing both pulmonary and extra-pulmonary cases using GeneXpert MTB/RIF assay. Methods: A cross-sectional study was conducted in the Children’s Hospital, Lahore for a duration of six months. Pulmonary and extra pulmonary samples of patients under age 16 were examined by GeneXpert MTB/RIF assay. Results: A total of 1320 samples were examined, and among them, 110 tested positive for M. tuberculosis (MTB) infection. Out of these 110 positive samples, 5 exhibited resistances to rifampicin, 18 showed indeterminate resistance, while rifampicin resistance was not detected in the remaining 87 samples. Additionally, 3 of the rifampicin-resistant samples displayed a very low load of MTB, and 2 samples exhibited a low MTB load. Conclusions: This study revealed 4.5% prevalence of MDR-TB in pediatric population. The study also showed that GeneXpert is a highly advanced technique for the diagnosis of rifampicin resistance in pulmonary and extra-pulmonary samples.

The current study was planned to report the frequency of tuberculosis meningitis in the paediatric population of Pakistan using the GeneXpert Mycobacterium tuberculosis/Rifampicin (MTB/RIF) assay. Data of 569 cerebrospinal fluid samples collected between October 2019 and October 2023 at a tertiary care children’s hospital was retrospectively analysed. Mycobacterium tuberculosis was detected in 101(17.7%) samples, with 57(56%) of them being from male patients. The highest tuberculous meningitis incidence 55(54.5%) was found in children aged 0-4 years, while those aged 10-14 years showed the lowest incidence 13(12.9%). Rifampicin resistance was present in 3(2.9%) cases. The findings highlighted the importance of incorporating GeneXpert MTB/RIF testing in clinical evaluation for suspected tuberculous meningitis cases in paediatric patients. Key Words: Tuberculosis meningitis, GeneXpert MTB/RIF assay, Rifampicin resistance, Paediatric TBM, Mycobacterium tuberculosis.