Papers by Shyam Kumar Mishra
Candida auris: an emerging antimicrobial-resistant organism with the highest level of concern Can... more Candida auris: an emerging antimicrobial-resistant organism with the highest level of concern Candida auris is an emerging multidrug-resistant ovalshaped fungus causing life-threatening health-careassociated outbreaks. This fungal pathogen has been rated as an urgent threat by the US Centres for Disease Control and Prevention and classified in the Critical Priority group by WHO. Since the fungus' discovery in 2009 from the external ear discharge of a female patient aged 70 years in Japan, it has been reported in over 47 countries worldwide. 1 A report 2 from a multicentre retrospective case-control study from three hospitals in Brooklyn, New York (NY, USA), on the outcomes of Lancet Microbe 2023
Antimicrobial resistance and infection control, 2017
Healthcare associated infections (HCAI) and antimicrobial resistance are principal threats to the... more Healthcare associated infections (HCAI) and antimicrobial resistance are principal threats to the patients of intensive care units and are the major determining factors for patient outcome. They are associated with increased morbidity, mortality, excess hospitalization and financial costs. The present study is an attempt to investigate the spectrum and antimicrobial resistance of bacterial isolates involved in healthcare associated infections (HCAI) in the patients of a critical care unit at a tertiary care university hospital in Kathmandu, Nepal. A laboratory based study was conducted over the period of 15 months (January 2014 to March 2015) among the patients of intensive care unit of Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Clinical specimens from patients with suspected healthcare-associated infection were processed and bacterial isolates were identified with standard microbiological methods. Antimicrobial susceptibilities of the isolated strains were determined...
Diarrheal diseases are major problem of developing countries. Though precise data on childhood mo... more Diarrheal diseases are major problem of developing countries. Though precise data on childhood mortality associated with diarrheal diseases in Nepal is not available, it has been estimated that approximately 25% of child death are associated with diarrheal disease, particularly acute diarrhea. The purpose of this study was to assess the incidence of parasitic pathogens causing acute diarrhea in children under 5 years of age. A total of 525 children with acute diarrhea in a children's hospital of Kathmandu, Nepal were enrolled between April 2011 and September 2011. The higher prevalence of diarrhea was in the age group of less than 2 years. Out of total 525 enrolled cases, protozoal parasites were found in 10.7% (56/525) of cases and helminthic parasites were found in 1.3% (7/525) of cases. Highest prevalence of 60.3% (38/63) of parasitic infection was found in the age group of 6-24 months followed by 7.9% (5/63) in the age group of less than 6 months. Of the total enrolled cases E. histolytica were 6.7% (35/525) followed by Giardial lamblia 3.4% (18/525) and the least frequency was due to A. lumbricoides constituting 0.6% (3/525). The aim of this study was to know the parasitic agents causing acute diarrhea in children.
European Respiratory Journal
ABSTRACT
Journal of the Institute of Medicine
Introduction: Nosocomial infections caused by multi-drug resistant pathogens are major threat to ... more Introduction: Nosocomial infections caused by multi-drug resistant pathogens are major threat to the hospitalized patients. Extended spectrum beta-lactamase (ESBL) and metallo-beta-lactamase (MBL) producing bacterial strains causing hospital acquired lower respiratory tract infection are increasing in numbers. Only a limited number of studies related to MBL producers have been done in Nepal.
BACKGROUND: Extended-spectrum beta-lactamase (ESBL)-producing bacteria have resulted in vexatious... more BACKGROUND: Extended-spectrum beta-lactamase (ESBL)-producing bacteria have resulted in vexatious problem to combat lower respiratory tract infection (LRTI). However, no detailed studies have been done in Nepal exploring the status of such pathogens from LRTI. Therefore, this study was carried out to assess the current levels of antimicrobial resistance with special reference to ESBL-producing respiratory bacterial pathogens in Nepal.
METHODS: A prospective study was conducted at Tribhuvan University Teaching Hospital in the capital city of Nepal. Specimens representing lower respiratory tract were received from 1120 patients suspected of LRTI. The specimens were collected and processed according to standard methodology. Combination disk (CD) and disk synergy test (DST) methods were used for the detection of ESBL-producing isolates.
RESULTS: Of the total 314 isolates belonging to Enterobacteriaceae and nonfermentative bacteria, 24.2% were ESBL-producers which included 42.2% of Klebsiella pneumoniae, 8.8% of Pseudomonas species, 41.9% of Escherichia coli, 12.9% of Acinetobacter species, 13.3% of Citrobacter species and 66.7% of Morganella morganii. ESBL-producers were more common among hospitalized patients. For ESBL-producers, the most effective drug was found to be imipenem, meropenem, followed by cefoperazone-sulbactam and amikacin.
CONCLUSIONS: One-fourth of the isolates belonging to Enterobacteriaceae and non-fermentative bacteria were ESBL-producer. It is quite essential to have effective antimicrobial and infection control policy in the hospital and special steps should be taken to prevent clonal dissemination of the resistant strains. Further studies should be done in other hospitals of Nepal to know the phenotype and genotype of ESBL-producing isolates prevailing in our country.
Serratia marcescens IOMTU115 has a novel 6′-N-aminoglycoside acetyltransferase-encoding gene, aac... more Serratia marcescens IOMTU115 has a novel 6′-N-aminoglycoside acetyltransferase-encoding gene, aac(6′)-Ial. The encoded protein AAC(6′)-Ial has 146 amino acids, with 91.8% identity to the amino acid sequence of AAC(6′)-Ic in S. marcescens SM16 and 97.3% identity to the amino acid sequence of AAC(6′)-Iap in S. marcescens WW4. The minimum inhibitory concentrations of aminoglycosides for Escherichia coli expressing AAC(6′)-Ial were similar to those for E. coli expressing AAC(6′)-Ic or AAC(6′)-Iap. Thin-layer chromatography showed that AAC(6′)-Ial, AAC(6′)-Ic, or AAC(6′)-Iap acetylated all the aminoglycosides tested, except for apramycin, gentamicin, and lividomycin. Kinetics assays revealed that AAC(6′)-Ial is a functional acetyltransferase against aminoglycosides. The aac(6′)-Ial gene was located on chromosomal DNA.
SCI-MET, Aug 2015
The genus Staphylococcus which belongs to the family Staphylococcaceae comprises 51 validly descr... more The genus Staphylococcus which belongs to the family Staphylococcaceae comprises 51 validly described species (1). The genus includes not only a potent pathogen, Staphylococcus aureus, type species of the genus, there are other bacteria which are regarded as commensals and also those which are regarded as animal isolate only. Now, these "commensals" and the non-human isolates are no longer uncommon as an etiological agent of human infections.
Journal of Institute of Medicine, Dec 2014
Introduction: Nosocomial infection is a global problem with multi facet outcomes. At
present, t... more Introduction: Nosocomial infection is a global problem with multi facet outcomes. At
present, the emergence of resistance to antimicrobial agents is a global public health problem
which is well pronounced in developing countries.
Methods: The aim of this study was to determine the prevalence of bacteria causing nosocomial
infections and their antibiotics resistant pattern among the patients admitted at Tribhuvan
University Teaching Hospital (TUTH), Kathmandu, Nepal. The study was conducted during
a period of March 2011 to February 2012. Nine hundred clinical specimens which included
urine, sputum, endotracheal aspirates, pus & blood were subjected for bacterial culture and
their antibiotics sensitivity test at the Department of Microbiology with the use of standard
method as described by American Society for Microbiology (ASM).
Results: Prevalence of bacteria causing nosocomial infection was 34.4% (n=310). Out of 310
specimens, urine 122 (39.30%), sputum 78(25.2%), pus 78(25.2%), endotracheal secreation
24 (7.7%) and blood 8(2.6%). Three hundred thirty three bacteria were isolated from
three hundred ten specimens. The most common isolates were Escherichia coli followed
by Acinetobacter species, Klebsiella pneumonia and Staphylococcus aureus. In-vitro
antibiotic susceptibility tests revealed that the Gram-negatives bacilli were only sensitive
to fluroquinolones, ceftrixone, cefepime carbapenem, polymyxin B and colistin sulphate
while the Gram-positive cocci were sensitive to fluroquinolones, Ceftroxone, cefepime and
vancomycin.
Conclusion: The findings suggested the need for constant monitoring of susceptibility of
specific pathogens in different populations to commonly used anti-microbial agents to cope
up this alarming situation in the hospital for the management of such patients and prevent the
dissemination of such strains.
Key words: Nosocomial infections, Bacteria and Antibiotics
The methanolic extract of the leaves of Smilax lanceifolia Roxb. (Family-Smilacaceae) was subject... more The methanolic extract of the leaves of Smilax lanceifolia Roxb. (Family-Smilacaceae) was subjected to pharmacological investigation to ascertain analgesic and antibacterial activity.. The phytochemical screening demonstrated the presence of different types compound like anthraquinone glycoside, alkaloids, terpenoids, tannins, carbohydrate,flavone aglycone, saponin, phenolic compound, reducing sugar, and phlobotannin. The methanolic extract of the plant was tested for analgesic activity using chemical writhing method (0.6% acetic acid) and antibacterial activity against Staphylococcus aureus, Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa and Salmonella typhi bacteria using cup diffusion method. The extract significantly(p<0.05) inhibited in a dose dependent fashion analgesia(nociception) induced by acetic acid as indicated by the reduction in number of writhing movement in mice. Antibacterial activity was observed against S.aureus, S.typhi, E.faecalis, and E.coli in dose dependent manner.
Springer Link, Sep 20, 2014
Microbial biofilms pose great threat for patients requiring indwelling medical devices (IMDs) as ... more Microbial biofilms pose great threat for patients requiring indwelling medical devices (IMDs) as it is difficult to remove them. It is, therefore, crucial to follow an appropriate method for the detection of biofilms. The present study focuses on detection of biofilm formation among the isolates from IMDs. We also aimed to explore the antibiogram of biofilm producers. This prospective analysis included 65 prosthetic samples. After isolation and identification of bacteria following standard methodology, antibiogram of the isolates were produced following Kirby–Bauer disc diffusion method. Detection of biofilms was done by tube adherence (TA), Congo red agar and tissue culture plate (TCP) methods. Out of 67 clinical isolates from IMDs, TCP detected 31 (46.3 %) biofilm producers and 36 (53.7 %) biofilm non-producers. Klebsiella pneumoniae, Pseudomonas aeruginosa and Burkholderia cepacia complex were found to be the most frequent biofilm producers. The TA method correlated well with the TCP method for biofilm detection. Higher antibiotic resistance was observed in biofilm producers than in biofilm non-producers. The most effective antibiotics for biofilm producing Gram-positive isolates were Vancomycin and Tigecycline, and that for biofilm producing Gram-negative isolates were Polymyxin-B, Colistin Sulphate and Tigecycline. Nearly 46 % of the isolates were found to be biofilm producers. The antibiotic susceptibility pattern in the present study showed Amoxicillin to be an ineffective drug for isolates from the IMDs. For the detection of biofilm production, TA method can be an economical and effective alternative to TCP method.
Antimicrobial agents and chemotherapy, 2014
Stenotrophomonas maltophilia IOMTU250 has a novel 6&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;a... more Stenotrophomonas maltophilia IOMTU250 has a novel 6&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;-N-aminoglycoside acetyltransferase-encoding gene, aac(6&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;)-Iak. The encoded protein, AAC(6&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;)-Iak, consists of 153 amino acids and has 86.3% identity to AAC(6&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;)-Iz. Escherichia coli transformed with a plasmid containing aac(6&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;)-Iak exhibited decreased susceptibility to arbekacin, dibekacin, neomycin, netilmicin, sisomicin, and tobramycin. Thin-layer chromatography showed that AAC(6&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;)-Iak acetylated amikacin, arbekacin, dibekacin, isepamicin, kanamycin, neomycin, netilmicin, sisomicin, and tobramycin but not apramycin, gentamicin, or lividomycin.
Asian Pacific Journal of Tropical Disease
The emergence of extended-spectrum beta-lactamase (ESBL)-and metallobeta-lactamase (MBL)-producin... more The emergence of extended-spectrum beta-lactamase (ESBL)-and metallobeta-lactamase (MBL)-producing bacteria causing lower respiratory tract infection (LRTI) has resulted in fewer therapeutic options in treatment modalities. No studies regarding MBLs had been done so far in Nepal and a few researches on ESBLs were also just pilot studies. Therefore, this study was carried out to determine the bacterial etiology of LRTI and to assess the current levels of antimicrobial resistance in Nepal. Combination disk and Double disk synergy test methods were used for the detection of ESBLand MBL-producing bacteria. A high level of antibiotic resistance was seen. One-fourth of the gram-negative bacterial isolates were ESBL-producer. The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was also relatively higher. Moreover, MBL-producing bacteria were reported for the first time in Nepal. It is concluded that the problem of antimicrobial resistance is high in our set-up. It is essential to have effective antimicrobial and infection control policy in the hospital and special care should be taken to prevent the dissemination of the resistant clones to the community.
American Journal of Epidemiology and Infectious Disease, Jan 15, 2014
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 resistant (MDR) than Enterobacteriaceae (77.8% vs. 68.9%) whereas extended-spectrum beta-lactamase (ESBL) was considerably higher among Enterobacteriaceae (37.27% vs. 10.46%). Resistance was seen even against carbapenems. Only polymyxins were effective against multidrug resistant gram-negative bacterial isolates. This study shows an emergence of MDR bacterial pathogens at an alarmingly high level as the isolates were resistant to almost all antibiotics commonly used in our set-up. There must be prudent use of antibiotics to prevent the emergence of MDR bacterial isolates.
"
Journal of Institute of Medicine
Introduction: Ventilator Associated Pneumonia (VAP) is the most common nosocomial infection among... more Introduction: Ventilator Associated Pneumonia (VAP) is the most common nosocomial infection among intensive care unit (ICU) patients and lack of much information in Nepal. 6R WKH DLP RI WKLV VWXG\ ZDV WR GHWHUPLQH SUHYDOHQFH DQG EDFWHULRORJLFDO SUR¿OH RI 9$3 with special reference to multi-drug resistant (MDR), Methicillin-resistant Staphylococcus DXUHXV056$0HWDOORȕ/DFWDPDVH0%/ ([WHQGHG6SHFWUXP ȕ/DFWDPDVH(6%/ producing bacterial strains.
The purpose of this study was to investigate the actual conditions of nosocomial infection contro... more The purpose of this study was to investigate the actual conditions of nosocomial infection control in Kathmandu City, Nepal as a basis for the possible contribution to its improvement. The survey was conducted at 17 hospitals and the methods included a questionnaire, site visits and interviews. Nine hospitals had manuals on nosocomial infection control, and seven had an infection control committee (ICC). The number of hospitals that met the required amount of personal protective equipment preparation was as follows: gowns (13), gloves , surgical masks . Six hospitals had carried out in-service training over the past one year, but seven hospitals responded that no staff had been trained. Eight hospitals were conducting surveillance based on the results of bacteriological testing. The major problems included inadequate management of ICC, insufficient training opportunities for hospital staff, and lack of essential equipment. Moreover, increasing bacterial resistance to antibiotics was recognized as a growing issue. In comparison with the results conducted in 2003 targeting five governmental hospitals, a steady improvement was observed, but further improvements are needed in terms of the provision of high quality medical care. Particularly, dissemination of appropriate manuals, enhancement of basic techniques, and strengthening of the infection control system should be given priority.
International journal of antimicrobial agents, 2013
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Papers by Shyam Kumar Mishra
METHODS: A prospective study was conducted at Tribhuvan University Teaching Hospital in the capital city of Nepal. Specimens representing lower respiratory tract were received from 1120 patients suspected of LRTI. The specimens were collected and processed according to standard methodology. Combination disk (CD) and disk synergy test (DST) methods were used for the detection of ESBL-producing isolates.
RESULTS: Of the total 314 isolates belonging to Enterobacteriaceae and nonfermentative bacteria, 24.2% were ESBL-producers which included 42.2% of Klebsiella pneumoniae, 8.8% of Pseudomonas species, 41.9% of Escherichia coli, 12.9% of Acinetobacter species, 13.3% of Citrobacter species and 66.7% of Morganella morganii. ESBL-producers were more common among hospitalized patients. For ESBL-producers, the most effective drug was found to be imipenem, meropenem, followed by cefoperazone-sulbactam and amikacin.
CONCLUSIONS: One-fourth of the isolates belonging to Enterobacteriaceae and non-fermentative bacteria were ESBL-producer. It is quite essential to have effective antimicrobial and infection control policy in the hospital and special steps should be taken to prevent clonal dissemination of the resistant strains. Further studies should be done in other hospitals of Nepal to know the phenotype and genotype of ESBL-producing isolates prevailing in our country.
present, the emergence of resistance to antimicrobial agents is a global public health problem
which is well pronounced in developing countries.
Methods: The aim of this study was to determine the prevalence of bacteria causing nosocomial
infections and their antibiotics resistant pattern among the patients admitted at Tribhuvan
University Teaching Hospital (TUTH), Kathmandu, Nepal. The study was conducted during
a period of March 2011 to February 2012. Nine hundred clinical specimens which included
urine, sputum, endotracheal aspirates, pus & blood were subjected for bacterial culture and
their antibiotics sensitivity test at the Department of Microbiology with the use of standard
method as described by American Society for Microbiology (ASM).
Results: Prevalence of bacteria causing nosocomial infection was 34.4% (n=310). Out of 310
specimens, urine 122 (39.30%), sputum 78(25.2%), pus 78(25.2%), endotracheal secreation
24 (7.7%) and blood 8(2.6%). Three hundred thirty three bacteria were isolated from
three hundred ten specimens. The most common isolates were Escherichia coli followed
by Acinetobacter species, Klebsiella pneumonia and Staphylococcus aureus. In-vitro
antibiotic susceptibility tests revealed that the Gram-negatives bacilli were only sensitive
to fluroquinolones, ceftrixone, cefepime carbapenem, polymyxin B and colistin sulphate
while the Gram-positive cocci were sensitive to fluroquinolones, Ceftroxone, cefepime and
vancomycin.
Conclusion: The findings suggested the need for constant monitoring of susceptibility of
specific pathogens in different populations to commonly used anti-microbial agents to cope
up this alarming situation in the hospital for the management of such patients and prevent the
dissemination of such strains.
Key words: Nosocomial infections, Bacteria and Antibiotics
"
METHODS: A prospective study was conducted at Tribhuvan University Teaching Hospital in the capital city of Nepal. Specimens representing lower respiratory tract were received from 1120 patients suspected of LRTI. The specimens were collected and processed according to standard methodology. Combination disk (CD) and disk synergy test (DST) methods were used for the detection of ESBL-producing isolates.
RESULTS: Of the total 314 isolates belonging to Enterobacteriaceae and nonfermentative bacteria, 24.2% were ESBL-producers which included 42.2% of Klebsiella pneumoniae, 8.8% of Pseudomonas species, 41.9% of Escherichia coli, 12.9% of Acinetobacter species, 13.3% of Citrobacter species and 66.7% of Morganella morganii. ESBL-producers were more common among hospitalized patients. For ESBL-producers, the most effective drug was found to be imipenem, meropenem, followed by cefoperazone-sulbactam and amikacin.
CONCLUSIONS: One-fourth of the isolates belonging to Enterobacteriaceae and non-fermentative bacteria were ESBL-producer. It is quite essential to have effective antimicrobial and infection control policy in the hospital and special steps should be taken to prevent clonal dissemination of the resistant strains. Further studies should be done in other hospitals of Nepal to know the phenotype and genotype of ESBL-producing isolates prevailing in our country.
present, the emergence of resistance to antimicrobial agents is a global public health problem
which is well pronounced in developing countries.
Methods: The aim of this study was to determine the prevalence of bacteria causing nosocomial
infections and their antibiotics resistant pattern among the patients admitted at Tribhuvan
University Teaching Hospital (TUTH), Kathmandu, Nepal. The study was conducted during
a period of March 2011 to February 2012. Nine hundred clinical specimens which included
urine, sputum, endotracheal aspirates, pus & blood were subjected for bacterial culture and
their antibiotics sensitivity test at the Department of Microbiology with the use of standard
method as described by American Society for Microbiology (ASM).
Results: Prevalence of bacteria causing nosocomial infection was 34.4% (n=310). Out of 310
specimens, urine 122 (39.30%), sputum 78(25.2%), pus 78(25.2%), endotracheal secreation
24 (7.7%) and blood 8(2.6%). Three hundred thirty three bacteria were isolated from
three hundred ten specimens. The most common isolates were Escherichia coli followed
by Acinetobacter species, Klebsiella pneumonia and Staphylococcus aureus. In-vitro
antibiotic susceptibility tests revealed that the Gram-negatives bacilli were only sensitive
to fluroquinolones, ceftrixone, cefepime carbapenem, polymyxin B and colistin sulphate
while the Gram-positive cocci were sensitive to fluroquinolones, Ceftroxone, cefepime and
vancomycin.
Conclusion: The findings suggested the need for constant monitoring of susceptibility of
specific pathogens in different populations to commonly used anti-microbial agents to cope
up this alarming situation in the hospital for the management of such patients and prevent the
dissemination of such strains.
Key words: Nosocomial infections, Bacteria and Antibiotics
"