Minimum Inhibitory Concentration of Tigecycline on Acinetobacter in Burn Patients.

BACKGROUND: Burn infection is a major cause of morbidity and mortality in spite of significant improvements in burn care and treatment. Pseudomonas aeruginosa, Acinetobacter spp., Staphylococcus aureus etc. are the commonest isolates in which rapid development of resistance to multiple drugs limits the therapeutic options for infections by Acinetobacter species. Hence, this study was done to find the occurrence of Acinetobacter and to determine the minimum inhibitory concentration of tigecycline against Acinetobacter isolates. METHODS:   This cross-sectional study was conducted in Phect-Nepal Hospital, Kirtipur, Nepal from September to December 2018. Total 205 samples were included for the isolation and identification of Acinetobacter and further minimum inhibitory concentration of isolates were done following the standard laboratory protocol. Collected data were analyzed by SPSS version 23.0. RESULTS: Among 155 culture positive samples, 27 isolates were Acinetobacter spp.  Antimicrobial Susceptibility Test revealed that 24 isolates were resistant to ceftriaxone and ceftazidime, but all isolates were susceptible to polymyxin B. For tigecycline, 19 isolates were resistant through dis diffusion test while 20 isolates cross the Minimum Inhibitory Concentration value from E test. The reliability of the E-test and disc diffusion was 0.920, which represent strong agreement between E- test and dis diffusion test. CONCLUSIONS: Tigecycline resistance is presenting as serious problem to the management of infection caused by Acinetobacter species. Therefore, minimum inhibitory concentration for the detection of resistance should be included in routine laboratory diagnosis.

Antimicrobial Sensitivity Trend in Blood Culture Positive Enteric Fever.

BACKGROUND: For diagnosis of enteric fever, the culture of the organism from different body fluids is the gold standard. After diagnosis, it is important to treat with the right antibiotic before any complications can occur. The retrospective study is designed to explore the antibiotic sensitivity trend in blood culture positive typhoid fever cases and the extent of drug resistance before treatment is administered. METHODS: A retrospective study was carried out for culture isolated enteric fever patients admitted in Kathmandu Model Hospital. The discharged records from January 2012 to December 2016 were analyzed. The patients above 15 years and with culture isolated enteric fever were included in the study. RESULTS: One hundred fifty-nine strains of Salmonella typhi and paratyphi were isolated from Jan 2012 to Dec 2016 at Kathmandu Model Hospital. Out of 159 isolated, 125 (78.6%) were Salmonella typhi and 34 (21.4%) were paratyphi. Among them co-trimoxazole, chloramphenicol, ceftriaxone, cefotaxime, cefixime, and ofloxacin demonstrated 100% sensitivity. Similarly, amoxicillin sensitivity was 98.1% (n=156) while ciprofloxacin was sensitive in 6.3% (n=10), intermediately sensitive in 49.1% (n=78) and resistance in 44.7% (n=71).The newer quinolone levofloxacin showed 78.5% (n=11) sensitivity. Azithromycin was sensitive in 99.2% (n=132) of total isolated Salmonella species both typhi and paratyphi. CONCLUSIONS: A high degree of sensitivity was noted to chloramphenicol and co-trimoxazole, showing sensitivity has returned to conventional antibiotics. The drug-like ofloxacin is still the best responding drug in our contest whereas ciprofloxacin resistance is still high, but five years patterns show a trend of rollback of sensitivity.

Antibiotic Susceptibility Pattern of Gram-negative Isolates of Lower Respiratory Tract Infection.

BACKGROUND: Lower respiratory tract infection is a common cause of morbidity and mortality worldwide. A cross-sectional study was carried out with an objective to study the antibiogram of Gram-negative isolates of patients with lower respiratory tract infection visiting Kathmandu Model Hospital. METHODS: A total of 274 specimens including sputum, endotracheal aspirates, suction tips were cultured as per standard microbiological technique. Antibiotic susceptibility and detection of Extended-spectrum beta- lactamases (ESBLs) were performed following Clinical Laboratory Standard Institute (CLSI 2014) guidelines. RESULTS: Respiratory pathogens were recovered from 24.6% (n=65) cases. Klebsiella pneumoniae (40%) was the commonest isolates. The highest prevalence of multidrug-resistance (69.23%) was observed in Acinetobacter calcoaceticus baumannii complex. Extended-spectrum beta- lactamases were detected in Escherichia coli (n=4), Klebsiella pneumoniae (n=4) and Acinetobacter calcoaceticus baumannii complex (n=1). CONCLUSIONS: High prevalence of multidrug-resistance and extended- spectrum beta- lactamase producers were observed in respiratory isolates. For effective management of lower respiratory tract infections, an ultimate and detailed microbiological diagnosis and susceptibility testing is required.

Apo B/Apo A-I Ratio is Statistically A Better Predictor of Cardiovascular Disease (CVD) than Conventional Lipid Profile: A Study from Kathmandu Valley, Nepal.

BACKGROUND: Apo B and Apo A-I, are structural and functional components of lipoprotein particles that serve as transporters of cholesterol. The apo B/apo A-I ratio reflects the cholesterol transport and has been shown to be strongly related to risk of Myocardial infarction, stroke and other Cardiovascular manifestations. MATERIALS AND METHODS: Forty five participants with Cardiovascular Disease (CVD) and forty four healthy participants were included from different locations of Kathmandu valley, Nepal. Fasting blood samples were collected from ante-cubital vein and serum samples were used for lipid parameters, apo B and apo A-I levels measurement. RESULTS: Statistically significant differences were found for apo B/apo A-I ratio, HDL-c and apo B between the groups. The other lipid parameters and lipid ratios such as total cholesterol, triglyceride, low density lipoprotein, TC/HDL-c, TG/HDL-c and LDL-c/HDL-c were not found to be significant. CONCLUSION: Apo B/apo A-I ratio seems to have better predictive value than that of classical lipid parameters in cardiovascular risk assessment.

Assessment of adiponectin level in obese and lean Nepalese population and its possible correlation with lipid profile: A cross-sectional study.

OBJECTIVE: Adiponectin- one of the most important adipokines plays a pivotal role in carbohydrate and lipid metabolism and vascular biology. Changing food trend and lifestyle has tremendously affected the health status of Nepalese population. Studies have shown that between 1996 and 2006 obesity in Nepal has increased from 1.6% to 10%. Studies have been conducted in Nepal on the prevalence of obesity and its correlation with lipid profile. But based on our knowledge, this is the first study correlating adiponectin with obesity and lipid profile in Nepal. This piece of work will certainly help to assess the impact of obesity in Nepalese population. MATERIALS AND METHODS: Fifty four obese and Thirty six normal/lean participants were included from different locations of Kathmandu Valley. Anthropometric measurements like age, BMI, Waist circumference, hip circumference, waist to hip ratio, mid thigh circumference and chest circumferences were taken from each participant. Blood glucose, lipid profile and serum adiponectin levels were measured from overnight fasting samples. RESULTS: Significant differences were observed in BMI, Waist Circumference, Hip Circumference, Waist to Hip Ratio (WHR) and Chest circumference between obese and normal groups. Fasting Blood Glucose, Serum Triglyceride, HDL Cholesterol, LDL Cholesterol, Total Cholesterol/HDL ratio, Non-HDL Cholesterol and Adiponectin Levels were significant between the groups. Inverse correlations were observed between adiponectin level and BMI, Waist Circumference, Hip Circumference, Waist to Hip ratio, Chest Circumference, Fasting Blood Glucose, Triglyceride, Total Cholesterol/HDL ratio, LDL/HDL Cholesterol ratio and Non-HDL Cholesterol levels. Positive correlation was found between adiponectin and HDL Cholesterol levels. CONCLUSION: Our study showed significant inverse association of serum adiponectin with obesity and lipid profile parameters except for Serum HDL Cholesterol level in Nepalese population.