Abstract Multidrug resistance (MDR) in gram-negative pathogens is the emerging threat to clinicians. The current study was designed to determine the prevalence and pattern of multidrug resistance in gram-negative clinical isolates. It was conducted at the COMSATS Institute of Information Technology, Islamabad, Pakistan, from June to October 2014. Of the 8, 300 samples collected, 729(8.8%) clinically important gram-negative pathogens were retrieved. These pathogens were subjected to phenotypic and biochemical detection and were further processed for multidrug resistance pattern. It was observed that gram-negative pathogens were simultaneously resistant to many antibiotics. The prevalence of extended spectrum β-lactamase phenomenon was 220(100%) in Klebsiella pneumoniae, 195(75%) in Escherichia coli. Resistance to carbapenem was 174(79%) in Klebsiella pneumoniae and 14(5.4%) in Escherichia coli. Resistance against fluoroquinolones also displayed an escalating trend. The current study found that resistance against antibiotics was displaying a drastic increase in chronic renal patients. Keywords: Extended spectrum β-lactamase, Antibiotics, Multidrug-resistant pathogens, Klebsiella pneumonia, Escherichia coli. Introduction In late 20th century, resistance in gram-positive pathogens was displaying an alarming situation in the healthcare system. However, with control policies and development of new antibiotics, it is under good control now. But the situation against gram-negative pathogens has aggravated to such an extent that once neglected class of antibiotic (polymyxins) is in use. The resistance in gram-negative pathogens has invalidated all the available therapeutic options and there is no hope to have any new class of antibiotics in the near future. Colistin or polymyxin E was thought to be toxic for humans, but the current situation has raised its usage as a last treatment option to cure infections caused by multi-drug resistant (MDR) gram-negative pathogens. 1 Enterobacteriaceae are a large class of bacteria and most of the normal gastrointestinal (GI) flora are also included in it. Yet, many clinically important pathogens belong to this class, too. These pathogens usually cause gastrointestinal tract (GIT) infections, particularly diarrhoea. Most of the infections caused by them exhibit spontaneous recovery. Nonetheless, studies from the past few years are demonstrating an intimidating situation. Ultimately, diarrhoea would be difficult to treat because of the emergence of resistance to the treatment of last resort. 2 Many resistance mechanisms are described in enterobacteriaceae. Notable is the production of enzymes (beta [β]-lactamases) that cleave the β-lactam ring in the whole range of β-lactam antibiotics. A large variety of β- lactamases are available; however, the most significant from clinical perspective are extended spectrum beta lactamases (ESBL), oxacillinase, chromosomally encoded class C cephalosporinases (AmpC) and carbapenemases. 3,4 Most of these resistance genes in enterobacteriaceae are located on plasmids and thus easily spread between different species and across the genera. Infections caused by these MDR pathogens can only be treated with combination therapy and higher antibiotic doses and hence it is associated with numerous side effects. Therapeutic choices are limited to fosfomycin and colistin only. 5 Local epidemiology efforts can provide detection and timely response to MDR outbreaks. Surveillance studies can augment these efforts by recognising slower long-term resistance trends. Together, the information from these studies can support infection control interventions and antibiotic stewardship programmes. As chronic renal failure is always concomitant with immune system deficiencies, patients undergoing dialysis have an amplified threat for getting a healthcare-associated infection (HAI), too, because of the frequent use of urinary catheters, needles and injections. Bacterial infections represent a common and important health problem for patients with end-stage renal disease (ESRD) and in those J Pak Med Assoc 642 SHORT REPORT Multidrug resistance in Gram-negative pathogens isolated from patients with chronic kidney diseases and renal transplant Bushra Jamil, 1 Mohammad Tauseef Mukhtar Bokhari, 2 Azhar Saeed, 3 Mohammad Zahid Mukhtar Bokhari, 4 Zakir Hussain, 5 Ammar Ahmed, 6 Habib Bokhari, 7 Muhammad Imran, 8 Shahid Ahmad Abbasi 9 1 National University of Medical Sciences, Rawalpindi, 2-6,9 Al-Sayed Hospital (Pvt) Ltd., Rawalpindi, 7,8 Department of Biosciences, COMSATS Institute of Information Technology, Islamabad. Correspondence: Bushra Jamil. Email: bushrajamil2000@gmail.com