Efflux-pump system and biofilm formation are two important mechanisms Pseudomonas aeruginosa deploys to escape the effects of antibiotics. The current study was undertaken from September 2019 to March 2020 at a tertiary-care hospital in Kathmandu in order to ascertain the burden of P. aeruginosa in clinical specimens, examine their biofilm-forming ability and determine their antibiotic susceptibility pattern along with the possession of two efflux-pump genes-mexA and mexB. Altogether 2820 clinical specimens were collected aseptically from the patients attending the hospital and processed according to standard microbiological procedures. Identification of P. aeruginosa was done by Gram stain microscopy and an array of biochemical tests. All the P. aeruginosa isolates were subjected to in vitro antibiotic susceptibility testing and their biofilm-forming ability was also examined. Presence of mexA and mexB efflux-pump genes was analyzed by Polymerase Chain Reaction (PCR) using specific primers. Out of 603 culture positive isolates, 31 (5.14%) were found to be P. aeruginosa, of which 55% were multi-drug resistant (MDR). Out of 13 commonly used antibiotics tested by Kirby-Bauer disc diffusion method, greatest resistance was shown against piperacillin-tazobactam 15 (48.4%) and ceftazidime 15 (48.4%), and least against meropenem 6 (19.4%) and ofloxacin 5 (16.2%). Of all 17 MDR isolates subjected to biofilm detection, strong biofilm formation was exhibited by 11 (65%) and 14 (82%) isolates with microtiter plate method and tube method respectively. Out of 17 isolates tested, 12 (70.6%) isolates possessed mexA and mexB genes indicating the presence of active efflux-pump system. Higher number of the isolates recovered from sputum 7 (58.3%) and pus 5 (41.7%) possessed mexA/mexB genes while the genes were not detected at all in the isolates recovered from the urine (p<0.05). This study assessed no significant association between biofilm production and multi-drug resistance (p>0.05). Adoption of stern measures by the concerned authorities to curb the incidence of multi-drug resistant and biofilm-forming isolates is recommended to prevent their dissemination in the hospital settings.

Staphylococcus aureus is both a frequent commensal and a leading cause of endocarditis, bacteremia, osteomyelitis and skin and soft tissue infections and device-related infections. We performed this minireview to summarize the prevalence of Staphylococcus aureus among clinical samples and estimate the proportion of methicillin-resistant Staphylococcus aureus. The prevalence of Staphylococcus aureus among clinical isolates in Nepal is 34.5%. On average, the proportion of multi-drug resistance in Staphylococcus aureus is 57.1%. Methicillin-resistant Staphylococcus aureus accounts for a total of 41.7%. Inducible clindamycin resistance was detected in about 35% of the isolates. A regular antimicrobial resistance surveillance mechanism is necessary to mitigate the development of resistance among organisms and further spread of superbugs like methicillin-resistance Staphylococcus aureus.

Introduction Immune and inflammatory responses developed by the patients with Coronavirus Disease 2019 (COVID-19) during rapid disease progression result in an altered level of biomarkers. Therefore, this study aimed to analyze levels of blood-based biomarkers that are significantly altered in patients with COVID–19. Methods A cross-sectional study was conducted among COVID-19 diagnosed patients admitted to the tertiary care hospital. Several biomarkers–biochemical, hematological, inflammatory, cardiac, and coagulatory–were analyzed and subsequently tested for statistical significance at P<0.01 by using SPSS version 17.0. Results A total of 1,780 samples were analyzed from 1,232 COVID-19 patients (median age 45 years [IQR 33–57]; 788 [63.96%] male). The COVID-19 patients had significantly (99% Confidence Interval, P<0.01) elevated levels of glucose, urea, alanine transaminase (ALT), aspartate aminotransaminase (AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), white blood cell (WBC), C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), ferritin, D-Dimer, and creatinine phosphokinase-MB (CPK-MB) compared to the control group. However, the levels of total protein, albumin, and platelets were significantly (P<0.01) lowered in COVID-19 patients compared to the control group. The elevated levels of glucose, urea, WBC, CRP, D-Dimer, and LDH were significantly (P<0.01) associated with in-hospital mortality in COVID-19 patients. Conclusions Assessing and monitoring the elevated levels of glucose, urea, ALT, AST, ALP, WBC, CRP, PCT, IL-6, ferritin, LDH, D-Dimer, and CPK-MB and the lowered levels of total protein, albumin, and platelet could provide a basis for evaluation of improved prognosis and effective treatment in patients with COVID-19.

Introduction: Simultaneous infection of antibiotic-resistant uropathogens in patients with COVID-19 has necessitated the revision of the prescription of broad-spectrum antibiotics on the grounds of evidence-based studies and antimicrobial stewardship principles. The objective of this study was to find out the prevalence of uropathogenic Escherichia coli co-infection among hospital-admitted COVID-19 patients of a tertiary care centre. Methods: This descriptive cross-sectional study was conducted in urinary tract infection suspected COVID-19 patients admitted to a tertiary care hospital, from 25th June to 24th December 2021 after ethical clearance from the Institutional Review Committee with registration number 207707860. Convenience sampling was used. Serum procalcitonin levels were also measured. Data analysis was performed using the Statistical Package for the Social Sciences software version 17.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data, and mean and standard deviation for continuous data. Results: Among the 49 hospital-admitted COVID-19 patients, 3 (6.12%) (0.59-12.83 at 95% Confidence Interval) were co-infected with uropathogenic Escherichia coli. Absolute non-susceptibility of Escherichia coli to antibiotics such as ceftriaxone, cotrimoxazole, nalidixic acid, gentamicin, and ampicillin was observed. All isolates were multidrug-resistant. All co-infected patients were female and had a median age of 35 years. Mean±SD value for procalcitonin in patients with co-infection (6.13±7.88 ng/ml) was six times higher than for the patients without co-infection (0.95±1.11 ng/ml). Conclusions: Escherichia coli co-infection in hospitalised COVID-19 patients was less frequent as compared to published literature. The serum procalcitonin value in patients with co-infection was substantially higher than that of patients without co-infection.