Nasal Carriage Rate of Methicillin Resistant Staphylococcus aureus among Health Care Workers at a Tertiary Care Hospital in Kathmandu, Nepal.

BACKGROUND: Methicillin-resistant Staphylococcus aureus is one of the most common causes of nosocomial infections. Due to its multidrug resistant nature; infections due to Methicillin-resistant Staphylococcus aureus are often very difficult to treat. Colonized health care workers are the important sources of Methicillin-resistant Staphylococcus aureus. The objectives of this study were to determine the nasal carriage rate of Methicillin-resistant Staphylococcus aureus among health care workers at Kathmandu Medical College and Teaching Hospital, Nepal and to assess their antimicrobial susceptibility patterns. METHODS: A cross sectional study was conducted among 252 health care workers from July to November 2013. Mannitol salt agar was used to culture the nasal swabs. Antimicrobial susceptibility testing was performed by Kirby-Bauer disc diffusion technique following Clinical and Laboratory Standards Institute guidelines. Methicillin-resistant Staphylococcus aureus strains were confirmed by using cefoxitin disc and by determining the minimum inhibitory concentration of oxacillin by agar dilution method. RESULTS: Of 252 healthcare workers, 46(18.3%) were positive for Staphylococcus aureus among which 19(41.3%) were Methicillin-resistant Staphylococcus aureus carriers. Overall rate of nasal carriage of Methicillin-resistant Staphylococcus aureus was 7.5% (19/252).The higher percentages of lab personnel were nasal carriers of S. aureus (31.6%) and Methicillin-resistant Staphylococcus aureus (10.5%).The percentages of nasal carriage of S. aureus (35.7%) and Methicillin-resistant Staphylococcus aureus (14.3%) were highest in the health care workers from post operative department. Higher percentage of Methicillin-resistant Staphylococcus aureus were susceptible toward amikacin (100%) and vancomycin (100%) followed by cotrimoxazole (84.2%). CONCLUSIONS: High rates of nasal carriage of S. aureus and Methicillin-resistant Staphylococcus aureus were observed among the healthcare workers, which indicate the need of strict infection control measures to be followed to control the nosocomial infections.

Studies on extended spectrum beta lactamase (ESBL) producing salmonella isolates from clinical samples of Nepal.

Present study was carried out among the patients of age 2-60 years from November 2009 to November 2011 to assess the production of Extended Spectrum Beta Lactamase (ESBL) by salmonella enterica serotype (Typhi and paratyphi A) at Kanti Children's Hospital (KCH), Nepal Medical College (NMC), Kathmandu Medical College (KMC), National Public Health Laboratory (NPHL) and Sankata Laboratory (SKL) of Nepal. Blood cultures were obtained from 4,820 patients with febrile illnesses. 400 strains of salmonella enterica were isolated. Antibiotic susceptibility testing was carried out using disk diffusion method by Kirby-Bauer technique and ESBL screening were done by Double Disk Synergy Test (DDST), following the Clinical and Laboratory Standard Institute (CLSI) recommendations for Escherichia coli. Male had higher infection (56%) than female (44%). Highest number of culture positive cases were (37%) in 10-19 years of age groups. Highest episodes of enteric fever cases occurred during April - June (45%) followed by July-September (35%). Among the total isolates 286 (72%) were Multidrug resistance (MDR). All the Multidrugs resistance salmonella, resistant to third generation Cephlospornis were ESBL producers.

Acute haemorrhagic conjunctivitis: an epidemic in August/September 2003.

OBJECTIVE: To clinically analyze 400 cases of red eye attending Nepal Eye Hospital in August/ September 2003 and to study the aetiology of the disease on the clinical basis with available laboratory resources. MATERIALS AND METHODS: It is a prospective study of 400 cases of acute conjunctivitis visiting Nepal Eye Hospital during the epidemic of acute haemorrhagic conjunctivitis in August/September 2003. RESULT: 30.5% presented in the age group of 20-29 years. Males presented predominantly (73.3%). Maximum number of patients presented at two days of onset of symptoms. All 400 cases had red eye, 89.8% had pain, 86.3% had foreign body sensation and 87.5% had discharge. Bilateral involvement was seen in 73.5% and unilateral involvement in 26.5%, 4.3 % of the total cases had corneal involvement and 20% of the cases had associated fever and preauricular lymphadenopathy. CONCLUSION: Based on clinical presentation and the report of available laboratory results, picorna virus was found to be responsible for this epidemic of acute haemorrhagic conjunctivitis.

Seasonal distribution of enteropathogens detected from diarrheal stool and water samples collected in Kathmandu, Nepal.

A total of 334 diarrheal fecal samples (from 210 males and 124 females) collected in Kathmandu, Nepal, were studied for various kinds of enteropathogens. Overall, 33% (111/334) fecal samples were positive for one or more enteropathogens. There was no difference in detection rates between males and females. Enteropathogen detection rates in summer, winter, spring, and autumn were 61% (40/66), 52% (45/87), 31% (25/81), and 25% (25/100), respectively. Altogether eight species of bacteria, three genera of viruses, and five species of protozoan parasites were detected with considerable seasonal variations. Among the bacterial isolates, enteropathogenic Escherichia coli topped the list followed by Vibrio sp. Only one sample had Shigella (S. sonnei). Rotavirus type A was the most frequently detected among the enteric viruses, followed by human enterovirus and human adenovirus, respectively. Among the enteric protozoan parasites, Giardia intestinalis was the most frequently detected followed by Cryptosporidium parvum. Detection of bacterial and protozoan pathogens showed a slightly high tendency in the summer season compared with that in the other seasons (p>0.05), whereas the detection of viruses was significantly high in the winter season (p<0.05). Of the total 57 water samples, 43 (75%) showed one or more bacterial species out of which 51% (22/43) were E. coli. Among the E. coli isolates, 68% were EPEC. Enterohemorrhagic E. coli (O157) was not detected.