Antimicrobial Resistance in Bacterial Species Causing Orthopaedic Surgical Site Infections at a National Trauma Center, Kathmandu, Nepal.

Hospital-acquired infections, including surgical site infections (SSIs), pose a concerning challenge because of the growing resistance to multiple drugs, largely influenced by extensive prophylactic antimicrobial therapy. Although SSIs are well documented in advanced hospitals in developed nations, their prevalence and bacterial profiles are inadequately reported in low- and middle-income nations such as Nepal. This retrospective cohort study explored the prevalence of orthopaedic SSIs in relation to bacterial etiology and antimicrobial resistance. We examined the surgical and bacteriological records of patients suffering SSIs (clean or clean-contaminated wounds) within a month of their surgical procedures between January 2020 and June 2022 at the National Trauma Center, Kathmandu, Nepal. The prevalence of orthopaedic SSIs among hospital-visiting patients was 31.2% (448/1,438; 95% CI: 28.8-33.5). There were 341 (76.1%) males and 361 (80.6%) adults with SSIs. Knee/joint infections (n = 141, 31.5%) were predominant. An SSI typically occurs 7 days after surgery. Enterobacterales were dominated by Escherichia coli (n = 54, 40.9%), whereas nonfermenters gram-positive cocci (GPC) were dominated by Pseudomonas aeruginosa (n = 69, 81.2%) and Staphylococcus aureus (n = 216, 93.5%), respectively. Enterobacterales, nonfermenters, and GPC exhibited penicillin resistance at 74.5%, 29.8%, and 65.1%, respectively, whereas cephalosporin resistance was exhibited at 48.3%, 57.1%, and 49.6%; fluoroquinolone resistance at 25.9%, 40.5%, and 25.7%; and aminoglycoside resistance at 21.5%, 43.2%, and 17.3%. One-third of orthopaedic surgeries resulted in SSIs, mainly caused by S. aureus. Fluoroquinolones and aminoglycosides were moderately effective in treating bacterial SSIs, whereas penicillins and cephalosporins were the least effective. Nonfermenters exhibited higher antimicrobial resistance compared with Enterobacterales and GPC.

Panton-Valentine leucocidin gene in methicillin resistant Staphylococcus aureus isolated from tertiary care hospital in Nepal.

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) expresses the Panton-Valentine leukocidin (PVL) virulence gene, which is associated with community and hospital-acquired severe MRSA infections. The objective of this study was to determine the prevalence and antibiotic susceptibility profile with a focus on the presence of the PVL gene among MRSA isolates in healthcare settings. METHODOLOGY: A total of 1,207 clinical specimens and 304 hospital environment swabs were collected in a tertiary care hospital in Nepal, and investigated following basic microbiological techniques. S. aureus was confirmed with the coagulase test. An antibiotic susceptibility test (AST) was performed by the Kirby-Bauer method and screening for MRSA was carried out by the cefoxitin disc diffusion method guided by the Clinical and Laboratory Standards Institute (CLSI), 2020. DNA was extracted and used in a polymerase chain reaction (PCR) to detect mecA and PVL genes. RESULTS: Of the 1,511 samples, 45 (2.9%) S. aureus (23 clinical and 22 environmental) were isolated. Among them, 69.6% (16/23) and 27.3% (6/22) were MRSA in clinical and environmental isolates, respectively. Twelve (52.2%) clinical isolates and seven (31.8%) environmental isolates were multidrug resistant. The majority of isolates were susceptible to vancomycin and linezolid. The PVL gene was detected in 18.2% (n = 4/22) of the MRSA isolates, of which three were from clinical sources and one was from an environmental swab. CONCLUSIONS: The prevalence of MRSA, and PVL-producing S. aureus were higher in the hospital setting. Hence, immediate and urgent implementation of infection control and sanitation measures are needed in the hospital.

Antimicrobial Susceptibility Pattern in Opportunistic Pathogens Isolated from Immunocompromised Patients.

BACKGROUND:  Brought with the advancements in transplantation science and the development of immunosuppressive agents, immunocompromised patients characterized with defective immunity have increased throughout the world with increased risk for opportunistic infections. This study provides an overview of the antimicrobial susceptibility pattern among opportunistic pathogens isolated from immunocompromised patients.  Methods: Clinical and laboratory records of immunocompromised patients [patients with chronic kidney disease neutropenia, diabetes, rheumatic heart disease acquired immune deficiency syndrome hepatitis B, hepatitis C, who were subjected to microbiological culture analysis in the Department of Clinical Microbiology, KIST Medical College and Teaching Hospital, for 2 years (January 2019 and December 2020) were analyzed. RESULTS:  Out of 8,402 immunocompromised patients, 954 (11.4%) patients were subjected to microbiological culture analysis. Among 954 patients, 253 (26.5%) patients [median(interquartile range) age: 52(31-67) years; male 138 (54.5%)] were infected. A total of 295 pathogens were isolated from 1,331 cultured samples. Infections due to Escherichia coli (n=71, 24.1%), Klebsiella spp. (n=55, 18.6%), Acinetobacter calcoaceticus-baumannii complex (n=35, 11.9%), Candida albicans (n=30, 10.2%), and Staphylococcus aureus (n=28, 9.5%) were frequently observed. Among the bacterial isolates (n=239), 81.6% (n=195) of bacteria were ß-lactamase producers, 51.0% (n=122) were multi-drug resistant, 9.2% (n=195) were extensively-drug resistant, 0.8% (n=195) were pan-drug resistant, and 35.7% (n=10) of S. aureus were methicillin-resistant Staphylococcus aureus. CONCLUSIONS:  The majority of infection in immunocompromised patients is caused by Gram-negative bacteria, and is often associated with a higher number of ß-lactamase producers and multi-drug resistant organisms. Prescriptions of antibiotics on the grounds of antimicrobial stewardship might help to reduce the burden of antimicrobial resistance.

Positive Bacterial Culture among Lower Respiratory Tract Specimens of Patients in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Lower respiratory tract infection accounts for a great burden of disease worldwide. The problem has further increased due to increasing antimicrobial resistance. This study was done to find out prevalence of positive bacterial culture among lower respiratory tract specimens of patients in a tertiary care centre. Methods: A descriptive cross-sectional study was done in the Laboratory of Clinical Microbiology in a tertiary care centre from May, 2021 to October, 2021. Ethical approval was received from the Institutional Review Committee (Reference number: 045-077/078). A total of 635 specimens were collected by convenience sampling. The specimens were cultured as per standard microbiological techniques. Antibiotic susceptibility was performed following Clinical and Laboratory Standards Institute (2020) guidelines. Microsoft Excel was used for data entry and analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion. Results: Among the 635 lower respiratory specimens, 112 (17.63%) (111.97 to 112.03 at 95% Confidence Interval) showed positive bacterial culture. Klebsiella pneumoniae 44 (37.93%) was the commonest isolate followed by Acinetobacter calcoaceticus baumannii complex 34 (29.31%). Conclusions: The prevalence of positive bacterial culture among lower respiratory specimens was lower when compared to other studies done in similar settings. Keywords: antibiotic resistance; gram negative bacteria; respiratory tract infections.

Ampicillinase C Beta-lactamase Producers among Isolates of Enterobacteriaceae in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Ampicillinase C beta-lactamase-producing organisms are often resistant to multiple antimicrobial agents, and therapeutic options against these pathogens are limited. Limited information is available regarding Ampicillinase C beta-lactamase producers. The aim of this study was to find out the prevalence of Ampicillinase C beta-lactamase producers among isolates of Enterobacteriaceae in a tertiary care centre. Methods: A descriptive cross-sectional study was carried out in the Clinical Microbiology Laboratory of a tertiary care centre from May 2021 to October 2021. Ethical approval was received from the Institutional Review Committee (Reference number: 044-077/078). Isolates of Enterobacteriaceae from various clinical samples were collected by convenience sampling. Ampicillinase C screening for beta-lactamase producers among the Enterobacteriaceae isolates was done using cefoxitin (30 µg) disc. Detection of Ampicillinase C beta-lactamase producers among the screen-positive isolates was done by cefoxitin-cloxacillin double-disc synergy test. An increase in the zone size of ≥4 mm was considered as Ampicillinase C beta-lactamase producers. Point estimate and 95% Confidence Interval were calculated. Results: Among the total 481 isolates of Enterobacteriaceae, 49 (10.19%) (7.50-12.90, 95 % Confidence Interval) were detected as Ampicillinase C beta-lactamase producers among isolates of Enterobacteriaceae. Conclusions: The prevalence of Ampicillinase C beta-lactamase producers was lower than in other studies done in similar settings. Meropenem could be a drug of choice for the treatment of infections due to Ampicillinase C beta-lactamase-producing gram-negative bacteria. Keywords: antibiotic; beta-lactamase; Enterobacteriaceae; gram-negative bacteria.

The perfect storm: Disruptions to institutional delivery care arising from the COVID-19 pandemic in Nepal.

BACKGROUND: The COVID-19 pandemic has led to system-wide disruption of health services globally. We assessed the effect of the pandemic on the disruption of institutional delivery care in Nepal. METHODS: We conducted a prospective cohort study among 52 356 women in nine hospitals to assess the disruption of institutional delivery care during the pandemic (comparing March to August in 2019 with the same months in 2020). We also conducted a nested follow up cohort study with 2022 women during the pandemic to assess their provision and experience of respectful care. We used linear regression models to assess the association between provision and experience of care with volume of hospital births and women's residence in a COVID-19 hotspot area. RESULTS: The mean institutional births during the pandemic across the nine hospitals was 24 563, an average decrease of 11.6% (P < 0.0001) in comparison to the same time-period in 2019. The institutional birth in high-medium volume hospitals declined on average by 20.8% (P < 0.0001) during the pandemic, whereas in low-volume hospital institutional birth increased on average by 7.9% (P = 0.001). Maternity services halted for a mean of 4.3 days during the pandemic and there was a redeployment staff to COVID-19 dedicated care. Respectful provision of care was better in hospitals with low-volume birth (ß = 0.446, P < 0.0001) in comparison to high-medium-volume hospitals. There was a positive association between women's residence in a COVID-19 hotspot area and respectful experience of care (ß = 0.076, P = 0.001). CONCLUSIONS: The COVID-19 pandemic has had differential effects on maternity services with changes varying by the volume of births per hospital with smaller volume facilities doing better. More research is needed to investigate the effects of the pandemic on where women give birth and their provision and experience of respectful maternity care to inform a "building-back-better" approach in post-pandemic period.

Prevalence of Methicillin Resistant Staphylococcus aureus and Antibiotic Susceptibility Pattern in a Tertiary Hospital in Nepal.

BACKGROUND: Methicillin resistant Staphylococcus aureus is a global health challenge nowadays creating problem in antibiotic therapy. This study was aimed to generate resistance pattern of Methicillin resistant Staphylococcus aureus to various antibiotics in order to formulate antibiotic policy for control of Methicillin resistant Staphylococcus aureus in Nepal. METHODS: This was a cross-sectional study conducted at the department of Clinical Microbiology, Nepal Medical College Teaching Hospital, from April 2015 to March 2016. A total of 142 S. aureus isolated from various clinical specimens. were screened for Methicillin resistant Staphylococcus aureus by cefoxitin disc method according to Clinical and Laboratory Standards Institute guidelines. RESULTS: Out of 142 S. aureus isolates, 30 (21.1%) were detected as Methicillin resistant Staphylococcus aureus by cefoxitin disc method. Most of the Methicillin resistant Staphylococcus aureus (25/30) were isolated from pus which were collected from OPD patients. Antibiotic sensitivity pattern showed all Methicillin resistant Staphylococcus aureus isolates were sensitive to vancomycin. CONCLUSIONS: Prevalence of Methicillin resistant Staphylococcus aureus was found to be 21.1%, and all Methicillin resistant Staphylococcus aureus appear 100% sensitive to vancomycin.