Prevalence, antimicrobial susceptibility pattern and multidrug resistance of methicillin-resistant Staphylococcus aureus isolated from clinical samples at a tertiary care teaching hospital: an observational, cross-sectional study from the Himalayan country, Nepal.

OBJECTIVE: We sought to determine the prevalence and antimicrobial susceptibility pattern of methicillin-resistant Staphylococcus aureus (MRSA) isolated from the clinical samples at a tertiary care hospital in Nepal. METHODS: Cross-sectional, observational study design. STUDY SETTING: The study was carried out at a tertiary care facility, the largest public hospital, Tribhuvan University Teaching Hospital (TUTH), Nepal. PARTICIPANTS: A total of 7433 clinical samples from hospital inpatients and outpatients available in the TUTH microbiology laboratory were examined. The study included clinical samples from the patients of either sex and across all age groups that had been clinically determined to have S. aureus infections. RESULTS: Of 7433 clinical samples analysed, S. aureus was recovered from 499 (6.71%). The prevalence of MRSA was discovered to be 26.4% (95% CI 21.6% to 30.4%). The major sources of MRSA were pus, 71 (18.5%). MRSA isolates encountered 100% resistance to penicillin and cloxacillin, followed by ciprofloxacin (80.5%), erythromycin (79.8%), cephalexin (64.9%), cotrimoxazole (61.1%) and clindamycin (58.5%). Chloramphenicol (17.9%), and gentamicin (27.4%), on the other hand, exhibited minimal resistance. None of the isolates were resistant to vancomycin (0.0%). Prevalence of multidrug resistance (MDR) was markedly higher in MRSA, 94.05% (95% CI 89.4% to 98.6%), compared with methicillin-sensitive S. aureus, 52.12% (95% CI 46.2% to 57.8%). CONCLUSION: Our study indicated a high rate of MRSA and MDR-SA (Multidrug-resistant Staphylococcus aureus) prevalence in a Nepalese tertiary care hospital. Therefore, given the widespread burden of MRSA and the threat of the emergence of resistance to commonly used antibiotics, there is a need for the development, adoption and enforcement of appropriate control policies in these hospital settings. Regular surveillance, reporting mechanism as well as prudent use of antimicrobial agents are crucial to combating the progression of MDR-MRSA prevalence and antibiotic resistance.

Pattern of Adverse Drug Reactions Associated with the Use of Anticancer Drugs in an Oncology-Based Hospital of Nepal.

Introduction: Adverse drug reactions (ADRs) are among the leading causes of morbidity and mortality worldwide. ADRs of anticancer drugs are ubiquitous. However, in Nepal, studies on chemotherapy-induced ADRs are scarce. Thus, this study aimed to assess the ADRs associated with the use of anticancer drugs and their management along with causality assessment and severity of ADRs. Methods: A prospective cross-sectional observational and single-center study was conducted at Bhaktapur Cancer Hospital, Nepal, for 6 months. All the patients who fulfilled the study criteria were analyzed to identify ADRs occurring daily. In addition, all collected data were recorded and analyzed using descriptive statistics. Results: A total of 861 ADRs were detected among 102 cancer patients. The mean ± S.D. age of the patients was 49.93 ± 14.27 years, and each enrolled patient experienced one or more ADRs with a mean ± S.D. of 8.44 ± 3.27. The common ADRs observed were fatigue, anorexia, alopecia, constipation, nausea, vomiting, and neuropathy. Cyclophosphamide, either alone or in combination with other chemotherapeutic agents, was responsible for most ADRs. According to Naranjo's causality assessment algorithm, most of the ADRs belonged to the probable (47.1%) category. Majority (54.9%) of the ADRs were moderate in their severity. Proton pump inhibitors, antiemetic, mouth gargle, protein powders, iron tablets, and multivitamin and mineral tablets were commonly used for ADR management. Conclusions: The occurrence of chemotherapy-related ADRs in each enrolled patient is a crucial concern. The present study highlights the need for active monitoring of the patients to identify and manage ADRs promptly.