Streptococcus pneumoniae infections in western Nepal.

We conducted a study to determine the prevalence of antibiotic resistance among clinical isolates of S. pneumoniae. This study was conducted from January 2000 to August 2007 at a tertiary care teaching hospital in Nepal. The isolates were identified based on standard bacteriological techniques. Antibiotic susceptibility testing used the Kirby-Bauer disc diffusion method; penicillin resistance was confirmed by agar dilution method. During the study period, there were 312 S. pneumoniae isolates. Penicillin, trimethoprim-sulfamethoxazole, erythromycin, tetracycline and chloramphenicol resistance were observed in 5, 34.3, 7.4, 11.1 and 0.4% of isolates, respectively. Resistance to all tested antibiotics declined with time except for penicillin, in which resistance increased. Penicillin-resistant S. pneumoniae were significantly co-resistant to erythromycin. Co-resistance to tetracycline and erythromycin were observed in trimethoprim-sulfamethoxazole resistant isolates. Penicillin resistance is increasing; therefore, measures to ensure judicious use of beta-lactams and macrolides (inducers of penicillin resistance) should be advocated to control the development of penicillin-resistant S. pneumoniae.

Candiduria-Study of Virulence Factors and Its Antifungal Susceptibility Pattern in Tertiary Care Hospital.

Background The increased incidence of candiduria in hospitalized patients is due to the use of indwelling devices, long-term antibiotics, parenteral nutrition, and immunocompromised status of the patient. In this study, an attempt was made to speciate, characterize, and determine the antifungal susceptibility pattern of Candida isolated from urinary tract infections (UTIs). Materials and Methods A total of 70 Candida isolates were obtained from urine samples. The isolated Candida species were studied for the production of virulence factors like phospholipase, protease activities, hemolysin, and biofilm production. Antifungal susceptibility testing of the isolated yeasts was done using Mueller-Hinton agar supplemented with 0.5 mg/mL methylene blue by E-test method for amphotericin B, fluconazole, caspofungin, and voriconazole. Results Out of 70 isolates, Candida tropicalis was the most frequently isolated species (65.7%), followed by Candida albicans (14.3%), Candida glabrata (7.1%), Candida krusei (5.7%), Candida parapsilosis (4.3%), and Candida dubliniensis (2.9%). A total of 37.1% were biofilm producers, 62.9% showed proteinase activity, 38.6% were phospholipase positive, and 58.6% isolates showed hemolytic activity. Antifungal susceptibility profile of Candida species showed 38.6, 25.7, 15.7, and 12.9% resistance to amphotericin B, fluconazole, caspofungin, and voriconazole, respectively. Conclusion A rising trend in isolation of non-albicans Candida from urinary isolates was noticed, which was statistically significant when comparing catheterized and noncatheterized urinary isolates from our study. However, there was no statistically significant difference when different virulence factor expressions were compared among Candida spp. isolated from catheterized and noncatheterized urinary samples. Due to this rise in non-albicans Candida species causing UTI that are intrinsically resistant to certain antifungal agents like azoles and increasing incidence of antifungal resistance, it is essential to monitor the antifungal susceptibility profile of Candida species causing candiduria.

Evaluation of interobserver reliability of Nugent score for diagnosis of bacterial vaginosis.

BACKGROUND: Vaginal discharge is the commonly narrated compliant of the female attendees of sexually transmitted infection clinic, among which bacterial vaginosis (BV) is responsible for one-third of the visits. BV is often diagnosed clinically which warrants laboratory confirmation. AIMS: The study aims to detect the reliability of the Nugent scoring system between observers for the diagnosis of BV. MATERIALS AND METHODS: This is a prospective study including 177 high vaginal swabs. The gram-stained smears were examined by three independent microbiologists, and the Nugent scoring was performed. Statistical analysis was performed using IBM-SPSS version-22 statistical package for kappa value. RESULTS: Concordant results were seen in 64.03% of smears, discordant results were given in 4.51% of smears, and partial agreement was observed in 31.63% of smears. CONCLUSION: Interobserver reliability is good for the Nugent score. The Nugent score is a simple and reliable method for the diagnosis of BV that can be adapted even in the resource poor settings.

Unfolding of a Clinically Suspected Case of Pulmonary Tuberculosis.

Pulmonary nocardiosis caused by Nocardia mimics pulmonary tuberculosis in many aspects. Here, we report a case of suspected pulmonary tuberculosis turning into pulmonary nocardiosis following microbiological evaluation. Sputum sample of the patient grew Nocardia otitidiscaviarum. Identification was done by conventional methods and matrix assisted laser desorption ionization-time of flight. He was given co-trimoxazole based on susceptibility reports. Even though Nocardia is a rare entity, pulmonary nocardiosis should be ruled out before starting antitubercular treatment to avoid unnecessary burden to the patient and community.

Unforeseeable presentation of Chryseobacterium indologenes infection in a paediatric patient.

BACKGROUND: We report for the first time a case of community acquired Chryseobacterium indologenes soft tissue infection in an immunocompetent patient. CASE PRESENTATION: A 11 year female child, from South-Asia of Indian origin presented with fever, pain and swelling in right leg for 3 days with no significant past history. Incision and drainage was done and pus was sent for culture and sensitivity. Radiological investigation showed subtle irregular soft tissue density. Pus culture grew multidrug resistant C. indologenes. CONCLUSION: Though of low pathogenicity, our case emphasises its unpredictable nature and the need to determine minimum inhibitory concentration breakpoints for therapy.

Prescribing patterns of antibiotics and sensitivity patterns of common microorganisms in the Internal Medicine ward of a teaching hospital in Western Nepal: a prospective study.

BACKGROUND: Information about antibiotic use and resistance patterns of common microorganisms are lacking in hospitals in Western Nepal. Excessive and inappropriate use of antibiotics contributes to the development of bacterial resistance. The parameter: Defined daily dose/100 bed-days, provides an estimate of consumption of drugs among hospital in-patients. This study was carried out to collect relevant demographic information, antibiotic prescribing patterns and the common organisms isolated including their antibiotic sensitivity patterns. METHODS: The study was carried out over a 3-month period (01.04.2002 to 30.06.2002) at the Manipal Teaching Hospital, Western Nepal. The median number of days of hospitalization and mean +/- SD cost of antibiotics prescribed during hospital stay were calculated. The use of antibiotics was classified for prophylaxis, bacteriologically proven infection or non-bacteriologically proven infection. Sensitivity patterns of the common organisms were determined. Defined daily dose/100 bed-days of the ten most commonly prescribed antibiotics were calculated. RESULTS: 203 patients were prescribed antibiotics; 112 were male. Median duration of hospitalization was 5 days. 347 antibiotics were prescribed. The most common were ampicillin, amoxicillin, metronidazole, ciprofloxacin and benzylpenicillin. Mean +/- SD cost of antibiotics was 16.5 +/-13.4 US dollars. Culture and sensitivity testing was carried out in 141 patients. The common organisms isolated were H. influenzae, E. coli, K. pneumoniae and S. aureus. CONCLUSIONS: Antibiotic resistance is becoming a problem in the Internal Medicine ward. Formulation of a policy for hospital antibiotic use and an educational programme especially for junior doctors is required.

Empyema caused by eikenella corrodens.

Eikenella corrodens is a fastidious, facultative anerobic, non-motile, gram-negative bacilli that is part of the normal flora of the mouth and upper respiratory tract. It is being increasingly recognized as a human pathogen and has been implicated in a variety of human infections, including, periodontitis, brain abscess, endocarditis, osteomyelitis, intra-abdominal infections, and pleuropulmonary infections. We report, for the first time, from the Himalayan Kingdom of Nepal, a case of left-sided empyema due to Eikenella corrodens, in an 83-year-old man. Eikenella corrodens was isolated as a pure growth from the pleural aspirate, proving its pathogenic potential. Surgical drainage and an appropriate antimicrobial therapy resulted in a therapeutic response. We have discussed the difficulties that can be encountered in isolating Eikenella corrodens and in choosing appropriate antibiotics for its treatment.

Emerging opportunistic protozoa and intestinal pathogenic protozoal infestation profile in children of western Nepal.

Intestinal parasitic infestation continues to be of public health importance in many tropical and subtropical countries for their high prevalence and effects on the morbidity in the population. This 5-year hospital-based retrospective analysis was aimed to find out the intestinal protozoal parasitic profile in 1790 pre-school and school-going children visiting the hospital with gastrointestinal illness. Giardia lamblia was the most prevalent pathogenic protozoan intestinal parasite (73.4%), followed by Entamoeba histolytica (24.4%). Interestingly, "newer" opportunistic pathogens like Cyclospora cayetanensis (1.0%) and Cryptosporidium sp. (1.0%) were detected from immunocompromised children below 2 years of age as a result of vertical transmission, which is alarming for a country like Nepal at the stage of 'concentrated epidemic' of HIV infection.

Salmonella bacteraemia in Pokhara: emergence of antibiotic resistance.

We undertook a retrospective hospital based study of 2,354 blood culture specimens from June 2000 to May 2003 in order to determine the isolation rates of Salmonella species and their antibiotic susceptibility patterns in western Nepal. Blood samples were cultured and identification of Salmonella species. and their antibiotic susceptibility testing were done as per standard protocol. Of the total 114 (4.8 %) yielded Salmonella species. Of them 76 (66.7%) Salmonella typhi and 38 (33.3%) S. paratyphi A. S. typhi was found to be the predominant species each year. Higher proportion of Salmonella bacteraemia was seen in adults, with a clearcut male to female preponderance (1.8:1). Monsoons enhanced the risk of acquiring enteric fever. There is also a rise in the number of multi-drug resistant strains in and around Pokhara Valley, with 40.7% S. typhi and 5.2% S. paratyphi A showing resistance to two or more antibiotics. These isolates were primarily resistant to the first line drugs namely Ampicillin, Chloramphenicol and Cotrimoxazole but susceptible to third generation Cephalosporins. Appearance of multi drug resistance poses considerable threat of increased morbidity and mortality in this region. This emphasizes the need for prudent use of antimicrobials.