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Background: Urinary tract infections are the primary factors that cause mortality and morbidity in patients with underlying comorbid conditions and are responsible for most hospital admissions worldwide. Objectives: The study aims to identify the common bacterial uropathogens and determine their antimicrobial susceptibility pattern, including multidrug-resistant/extensively drug-resistant bacteria. Methods: The descriptive cross-sectional study was conducted among inpatients provisionally suspected of urinary tract infections in the medical ward of Koshi Hospital, Biratnagar, Nepal. Samples were inoculated in a cystine lysine electrolyte-deficient medium, and pure growth of significant bacteria was further subjected Gram staining, biochemical identification, and antimicrobial susceptibility testing as per laboratory standard procedure and Clinical Laboratory Standards Institute guidelines, respectively. Descriptive and inferential statistical analysis was performed to analyze the outcomes and a p-value < 0.05 was considered statistically significant. Results: A total of 305 patients urine specimens were examined, of which 251 (82.29%) samples resulted in significant bacterial growth in the culture. Escherichia coli (62.94%) was the most predominantly isolated organism, followed by Klebsiella pneumoniae (12.35%), Staphylococcus aureus (9.16%), and Pseudomonas aeruginosa (8.76%). Among antimicrobials, colistin had shown absolute susceptibility (100%) toward gram-negative uropathogens followed by carbapenem and aminoglycosides in a majority of uropathogens. Escherichia coli was found to be the leading drug-resistant bacteria (70%) among uropathogens. The presence of multidrug-resistant/extensively drug-resistant bacteria uropathogens was found to be significantly associated with diabetes mellitus and those with combined antimicrobial therapies. Diabetic patients were twice (OR~2) more likely to colonize and develop uropathogens as compared to non-diabetics. Conclusion: Escherichia coli was the most common uropathogens followed by Klebsiella pneumoniae in urinary tract infection patients. The polymyxin group (colistin) of antimicrobials was found to be effective in all multidrug-resistant and extensively drug-resistant uropathogens. The study recommends the need of optimized antimicrobial stewardship program to develop effective strategies in the management of urinary tract infections in diverse healthcare settings.
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BACKGROUND: Community pharmacies are easily accessible outlets providing medicines to the general public in Nepal, but it is known that irrational dispensing of antibiotics from such outlets contributes to antimicrobial resistance. OBJECTIVE: To assess the understanding of community pharmacy personnel around antibiotic-dispensing in Eastern Nepal and the relationship between this understanding and their personal characteristics. METHODS: A cross-sectional survey was conducted on 312 pharmacy personnel working in community pharmacies of three districts within Eastern Nepal using a self-administered questionnaire. Descriptive statistics were used to analyze participants' characteristics and their understanding of antibiotic dispensing. The relationships between their understanding of antibiotic dispensing and their characteristics were determined using Chi-square tests. RESULTS: Most of the pharmacy personnel considered that dispensing antibiotics without a valid prescription is a problem (76.9%), and that it would not be legal to do so (86.9%). In the survey, 34.9% of participants agreed that they had dispensed antibiotics without prescription, and 26.9% disagreed with the assertion that inappropriate dispensing of antibiotics could promote antimicrobial resistance. Most (94.5%) reported that they would advise patients to follow their antibiotic dosage regimen, but 34.3% reported that they believed antibiotics to reduce pain and inflammation. Bivariate analysis showed that the level of understanding about antibiotic indication was significantly associated with age (p<0.001), work experience (p<0.001) and qualifications (p=0.017) of the pharmacy personnel. Work experience and qualifications also had significant but independent relationships with the level of understanding that irrational dispensing of antibiotics promotes antimicrobial resistance (p=0.018 and p=0.004) and is on the need for patient follow-up after dispensing antibiotics (p<0.001 and p=0.042). CONCLUSION: The understanding of community pharmacy personnel about antibiotic dispensing in Eastern Nepal requires significant improvement. Degree of understanding of some aspects of antibiotic dispensing was influenced by age, work experience and qualifications.
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Background: Pharmaceutical care (PC) has a significant impact on optimizing pharmacotherapy and improving patients' quality of life. We aimed to determine the attitudes and perceived barriers of final year pharmacy undergraduates towards provision of PC services in Nepal. Methods: A cross-sectional study was conducted among 232 students using a 13-item-standard PC attitude survey (PCAS) questionnaire and 12-itemed PC barrier questionnaires. Mann-Whitney U test and Kruskal-Wallis tests were used to measure the median difference between groups, at alpha=0.05, and Spearman's rho test was used to measure the strength of the correlation. Results: Majority of students were self-motivated in undertaking the current pharmacy education (178, 76.7%) and had no previous incomplete grades that could delay their graduation (177, 76.3%). Over 80% of students had a positive attitude toward all items of PCAS (agreed and strongly agreed) except for two items. Whereas, 61 (26.3%) disagreed and strongly disagreed that providing PC takes too much time and effort. The major barriers perceived were inadequate PC training (176, 75.9%), inadequate drug information resources in the pharmacy (170, 73.3%), and lack of access to patient medical records in the pharmacy (165, 71.1%). A significant relationship was noticed between positive attitude towards PC and three factors; source of motivation, current employment in pharmacy job, and incomplete grades delaying graduation. Age factor was significant but negatively correlated with the scores of positive attitudes namely "I would like to perform PC as a pharmacist practitioner", "Providing PC is professionally rewarding" and "I feel that the PC is the right direction for the provision to be headed". Conclusion: Nepalese undergraduate pharmacy students had positive attitudes toward PC. Exercising proper pharmacy practice regulations and educational efforts to overcome the perceived barriers may lead to better delivery of PC.
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BACKGROUND: In Nepal, introduction of GeneXpert MTB/RIF assay (Xpert assay) as an initial confirmation test for tuberculosis (TB) has been considered to have impact as a significant decrease in number of clinically diagnosed pulmonary tuberculosis (PTB) cases than previous years. This study aims to find out the distribution profile of suspected tuberculosis cases according to patients age, gender, treatment history and HIV status as well as to evaluate the utility of the Xpert assay over conventional acid-fast bacilli (AFB) staining method for the proper diagnosis of M. Tuberculosis in respiratory specimens from the tuberculosis (TB) suspected patient samples. METHODS: The prospective cross-sectional analytical study was conducted in National Anti-Tuberculosis Center (NATA) center- Biratnagar and Primary Healthcare Center (PHC) - Manglabare, Morang District, of eastern Nepal from January 2014 to August 2014. Laboratory investigation was done by conventional AFB staining followed by Xpert assay. RESULTS: A total of 1549 sputum samples were initially analyzed. AFB staining resulted in 1441 AFB smear negative samples and 88 AFB smear positive samples, whereas 20 samples were directly processed for Xpert assay. The male: female smear positive ratio was 2.8:1 and was higher among age groups (21-40) years. Tuberculosis among HIV patients was found 22.22%. Xpert assay demonstrates that out of 1441 smear negative AFB cases, 258 were found to have TB positive, whereas out of 88 smears positive AFB cases 12 were found to have TB negative. The sensitivity of the Xpert assay in patients classified as AFB smear positive was found 85.4% and the specificity in smear negative patients was 81%. CONCLUSION: The study concluded that implementation of Gene Xpert MTB/RIF assay is a helpful tool for early and rapid detection of tuberculosis with greater sensitivity and specificity over traditional AFB staining techniques.