Large amounts of antibiotics used for human therapy has resulted in the selection of pathogenic b... more Large amounts of antibiotics used for human therapy has resulted in the selection of pathogenic bacteria resistant to multiple antimicrobial drugs. This has created problems in the treatment of patients. So, this study was carried out to determine multidrug resistant (MDR) bacterial pathogens and their antibiogram in patients with clinically suspected pneumonia attending a tertiary care centre in central Nepal. Specimens representing lower respiratory tract were processed using standard protocol. Antibiotic susceptibility test was performed on bacterial pathogens by Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. Fifty-four percent of the total bacterial isolates were MDR. Multidrug resistance was found in Klebsiella pneumoniae (23.4%), Pseudomonads (20.5%), Acinetobacter calcoaceticus baumannii complex (20.6%), Escherichia coli (11.6%), Staphylococcus aureus (9.1%) and others. Non-fermentative bacteria were more multidrug resistan...
Purpose Inappropriate use of broad-spectrum antibiotics contributes to the emergence of multidrug... more Purpose Inappropriate use of broad-spectrum antibiotics contributes to the emergence of multidrug-resistant (MDR) bacteria. Finding novel antimicrobial agents and strategies based on synergistic combinations are essential to combat MDR infections. This study was designed to determine in vitro synergy of different antimicrobials against extensively drug-resistant (XDR) Gram-negative clinical isolates. Methods A descriptive, cross-sectional study was conducted at Human Organ Transplant Center, Nepal, for five months. Clinical isolates were checked for their drug-resistance properties including extended-spectrum beta-lactamase- (ESBL-) and metallo-beta-lactamase- (MBL-) production. The XDR isolates were further tested for antimicrobial synergy, and the results were interpreted as synergistic, additive, indifferent or antagonistic determining fractional inhibitory concentration of the antibiotics. Results Out of total 1155 clinical samples, 308 showed significant growth. Escherichia col...
Multidrug-resistant Gram-negative bacteria are associated with higher mortality and morbidity amo... more Multidrug-resistant Gram-negative bacteria are associated with higher mortality and morbidity among solid organ transplant recipients. Carbapenems, the broad spectrum β lactam agents are frequently used as a drug of last resort for the treatment of the infections caused by MDR Gram negative bacteria. They are the cause of production of β lactamases (Klebsiella pneumoniae Carbapenemase-KPC and Metallo β lactamases-MBL) among Gram negatives. The objective of this study was to explore the present scenario of β-lactamases mainly KPC along with MBL productions in Gram negative clinical samples. This hospital based cross sectional study was conducted from January 2016 to June 2016 at Human Organ Transplant Center, Kathmandu, Nepal. The standard microbiological methods were used for the isolation and identification of all the isolates and screening the meropenem resistant isolates by Kirby Bauer Disc Diffusion method. The confirmatory detection of KPC and MBL was done by the β-lactamase inhibition disc method. The inhibiting compound Phenyl Boronic Acid (PBA) and Ethylenediamine tetra-acetic Acid (EDTA) were used. Out of 1500 different clinical samples processed, only 10% (15/1500) Gram-negative organisms were isolated and identified. MDR was detected in 77.3% isolates. Majority of the Meropenem resistant (50%) isolates being E. coli (69.3%) followed by K. pneumoniae (18.6%). Carbapenemase MBL was prevalent among 29% of the isolates while KPC was reported among 12.6% isolates. The study demonstrated the increase in trend of carbapenemase production is creating turmoil in treatment options in health centers. This study put forward a prospective need for the development of such drugs or other mechanisms which could better work to overcome the resistance due to carbapenemase production.
This was a descriptive study conducted in Nepal for the first time. The place of study was in and... more This was a descriptive study conducted in Nepal for the first time. The place of study was in and around the ring road of Kathmandu Nepal for a period of six months starting from August 2008 to January
International Journal of Infectious Diseases, 2009
Objectives: AmpC beta-lactamases are clinically important cephalosporinases that confer resistanc... more Objectives: AmpC beta-lactamases are clinically important cephalosporinases that confer resistance to wide variety of beta-lactam drugs, which result in considerable treatment failure and cannot be detected by routine antibiotic sensitivity screening methods. Research was designed to estimate emergence of AmpC beta-lactamase (AmpC) producing strains among multi-drug resistant (MDR) urinary tract isolates in Nepal. Methods: 2837 urine samples were obtained for culture from clinically suspected urinary tract infection (UTI) patients from July, 2005 to March, 2007. Isolates were tested to detect antibiotic susceptibility. MDR gram negative isolates were screened for AmpC producers by modified double disk approximation method (MDMM) and confirmed by three dimensional extract method as described by American Society for Microbiology (ASM) and National Committee for Clinical Laboratory Standard (NCCLS). Results: Among 2837 urine samples, 31.4% (891/2837) had significant bacterial growth with 825 (92.6%) non-repeat gram-negative isolates. Out of gram-negative isolates 67.1% (554/825) were MDR. 5.41% (30/554) of MDR were AmpC positive. Among Individual MDR isolates species, 6.1% E. coli, 8.33% Klebsiella, 3.12% Pseudomonas and 4.0% Proteus were AmpC producing. Conclusion: These data confirm that AmpC is emerging cause of MDR in Nepal. We need to subject these strains for genetic study to acquire genetic make up. Failure to detect AmpC can contribute their uncontrolled nosocomial transmission, therapeutic failures and increased cost of management. Our results suggest to start screening of AmpC among MDR gram negative isolates in routine hospital practices in order to guide the choice of empirical therapy for such infections.
Large amounts of antibiotics used for human therapy has resulted in the selection of pathogenic b... more Large amounts of antibiotics used for human therapy has resulted in the selection of pathogenic bacteria resistant to multiple antimicrobial drugs. This has created problems in the treatment of patients. So, this study was carried out to determine multidrug resistant (MDR) bacterial pathogens and their antibiogram in patients with clinically suspected pneumonia attending a tertiary care centre in central Nepal. Specimens representing lower respiratory tract were processed using standard protocol. Antibiotic susceptibility test was performed on bacterial pathogens by Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. Fifty-four percent of the total bacterial isolates were MDR. Multidrug resistance was found in Klebsiella pneumoniae (23.4%), Pseudomonads (20.5%), Acinetobacter calcoaceticus baumannii complex (20.6%), Escherichia coli (11.6%), Staphylococcus aureus (9.1%) and others. Non-fermentative bacteria were more multidrug resistan...
Introduction Clinical laboratory services are expanding day by day especially in the town areas o... more Introduction Clinical laboratory services are expanding day by day especially in the town areas of Nepal. Laboratory medicine services are vital component of health care services. Laboratory professionals must provide accurate, specific and reliable information using state-of-the-art technology to facilitate evidence-based patient care decisions. Laboratory information, they provide, has a direct impact on patient diagnosis, treatment, health maintenance, and safety, length of stay, as well as resource utilization, and patient satisfaction. Thus, the quality laboratory practice is essential to protect the public from substandard laboratory services and possibly misleading information; by assuring that only adequately educated and qualified individuals perform testing in adequately managed laboratory. In recent years laboratory services are expanding especially in the town. Laboratory sign board can be seen every street of the cities. What is exact scenario? Who is providing the labo...
Large amounts of antibiotics used for human therapy has resulted in the selection of pathogenic b... more Large amounts of antibiotics used for human therapy has resulted in the selection of pathogenic bacteria resistant to multiple antimicrobial drugs. This has created problems in the treatment of patients. So, this study was carried out to determine multidrug resistant (MDR) bacterial pathogens and their antibiogram in patients with clinically suspected pneumonia attending a tertiary care centre in central Nepal. Specimens representing lower respiratory tract were processed using standard protocol. Antibiotic susceptibility test was performed on bacterial pathogens by Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. Fifty-four percent of the total bacterial isolates were MDR. Multidrug resistance was found in Klebsiella pneumoniae (23.4%), Pseudomonads (20.5%), Acinetobacter calcoaceticus baumannii complex (20.6%), Escherichia coli (11.6%), Staphylococcus aureus (9.1%) and others. Non-fermentative bacteria were more multidrug resistan...
Purpose Inappropriate use of broad-spectrum antibiotics contributes to the emergence of multidrug... more Purpose Inappropriate use of broad-spectrum antibiotics contributes to the emergence of multidrug-resistant (MDR) bacteria. Finding novel antimicrobial agents and strategies based on synergistic combinations are essential to combat MDR infections. This study was designed to determine in vitro synergy of different antimicrobials against extensively drug-resistant (XDR) Gram-negative clinical isolates. Methods A descriptive, cross-sectional study was conducted at Human Organ Transplant Center, Nepal, for five months. Clinical isolates were checked for their drug-resistance properties including extended-spectrum beta-lactamase- (ESBL-) and metallo-beta-lactamase- (MBL-) production. The XDR isolates were further tested for antimicrobial synergy, and the results were interpreted as synergistic, additive, indifferent or antagonistic determining fractional inhibitory concentration of the antibiotics. Results Out of total 1155 clinical samples, 308 showed significant growth. Escherichia col...
Multidrug-resistant Gram-negative bacteria are associated with higher mortality and morbidity amo... more Multidrug-resistant Gram-negative bacteria are associated with higher mortality and morbidity among solid organ transplant recipients. Carbapenems, the broad spectrum β lactam agents are frequently used as a drug of last resort for the treatment of the infections caused by MDR Gram negative bacteria. They are the cause of production of β lactamases (Klebsiella pneumoniae Carbapenemase-KPC and Metallo β lactamases-MBL) among Gram negatives. The objective of this study was to explore the present scenario of β-lactamases mainly KPC along with MBL productions in Gram negative clinical samples. This hospital based cross sectional study was conducted from January 2016 to June 2016 at Human Organ Transplant Center, Kathmandu, Nepal. The standard microbiological methods were used for the isolation and identification of all the isolates and screening the meropenem resistant isolates by Kirby Bauer Disc Diffusion method. The confirmatory detection of KPC and MBL was done by the β-lactamase inhibition disc method. The inhibiting compound Phenyl Boronic Acid (PBA) and Ethylenediamine tetra-acetic Acid (EDTA) were used. Out of 1500 different clinical samples processed, only 10% (15/1500) Gram-negative organisms were isolated and identified. MDR was detected in 77.3% isolates. Majority of the Meropenem resistant (50%) isolates being E. coli (69.3%) followed by K. pneumoniae (18.6%). Carbapenemase MBL was prevalent among 29% of the isolates while KPC was reported among 12.6% isolates. The study demonstrated the increase in trend of carbapenemase production is creating turmoil in treatment options in health centers. This study put forward a prospective need for the development of such drugs or other mechanisms which could better work to overcome the resistance due to carbapenemase production.
This was a descriptive study conducted in Nepal for the first time. The place of study was in and... more This was a descriptive study conducted in Nepal for the first time. The place of study was in and around the ring road of Kathmandu Nepal for a period of six months starting from August 2008 to January
International Journal of Infectious Diseases, 2009
Objectives: AmpC beta-lactamases are clinically important cephalosporinases that confer resistanc... more Objectives: AmpC beta-lactamases are clinically important cephalosporinases that confer resistance to wide variety of beta-lactam drugs, which result in considerable treatment failure and cannot be detected by routine antibiotic sensitivity screening methods. Research was designed to estimate emergence of AmpC beta-lactamase (AmpC) producing strains among multi-drug resistant (MDR) urinary tract isolates in Nepal. Methods: 2837 urine samples were obtained for culture from clinically suspected urinary tract infection (UTI) patients from July, 2005 to March, 2007. Isolates were tested to detect antibiotic susceptibility. MDR gram negative isolates were screened for AmpC producers by modified double disk approximation method (MDMM) and confirmed by three dimensional extract method as described by American Society for Microbiology (ASM) and National Committee for Clinical Laboratory Standard (NCCLS). Results: Among 2837 urine samples, 31.4% (891/2837) had significant bacterial growth with 825 (92.6%) non-repeat gram-negative isolates. Out of gram-negative isolates 67.1% (554/825) were MDR. 5.41% (30/554) of MDR were AmpC positive. Among Individual MDR isolates species, 6.1% E. coli, 8.33% Klebsiella, 3.12% Pseudomonas and 4.0% Proteus were AmpC producing. Conclusion: These data confirm that AmpC is emerging cause of MDR in Nepal. We need to subject these strains for genetic study to acquire genetic make up. Failure to detect AmpC can contribute their uncontrolled nosocomial transmission, therapeutic failures and increased cost of management. Our results suggest to start screening of AmpC among MDR gram negative isolates in routine hospital practices in order to guide the choice of empirical therapy for such infections.
Large amounts of antibiotics used for human therapy has resulted in the selection of pathogenic b... more Large amounts of antibiotics used for human therapy has resulted in the selection of pathogenic bacteria resistant to multiple antimicrobial drugs. This has created problems in the treatment of patients. So, this study was carried out to determine multidrug resistant (MDR) bacterial pathogens and their antibiogram in patients with clinically suspected pneumonia attending a tertiary care centre in central Nepal. Specimens representing lower respiratory tract were processed using standard protocol. Antibiotic susceptibility test was performed on bacterial pathogens by Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. Fifty-four percent of the total bacterial isolates were MDR. Multidrug resistance was found in Klebsiella pneumoniae (23.4%), Pseudomonads (20.5%), Acinetobacter calcoaceticus baumannii complex (20.6%), Escherichia coli (11.6%), Staphylococcus aureus (9.1%) and others. Non-fermentative bacteria were more multidrug resistan...
Introduction Clinical laboratory services are expanding day by day especially in the town areas o... more Introduction Clinical laboratory services are expanding day by day especially in the town areas of Nepal. Laboratory medicine services are vital component of health care services. Laboratory professionals must provide accurate, specific and reliable information using state-of-the-art technology to facilitate evidence-based patient care decisions. Laboratory information, they provide, has a direct impact on patient diagnosis, treatment, health maintenance, and safety, length of stay, as well as resource utilization, and patient satisfaction. Thus, the quality laboratory practice is essential to protect the public from substandard laboratory services and possibly misleading information; by assuring that only adequately educated and qualified individuals perform testing in adequately managed laboratory. In recent years laboratory services are expanding especially in the town. Laboratory sign board can be seen every street of the cities. What is exact scenario? Who is providing the labo...
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