BackgroundEscherichia coli and Klebsiella pneumoniae are the major bacterial pathogens being isolated and reported from mid stream urine (MSU) specimens, globally. These uropathogens are mostly implicated as the major extended spectrum beta-lactamase (ESBL) producers, severely limiting the therapeutic management in cases of urinary tract infections. Limited studies had been reported from Nepal investigating the ESBL producers among uropathogens. This study was designed to assess the prevalence of ESBL producing E.coli and K. pneumoniae in urinary isolates at a centrally located major tertiary care hospital in Kathmandu valley, Nepal.MethodsBetween September 2011 and May 2012, during the nine months period, 6308 MSU specimens were collected aseptically from the same number of clinically suspected patients of urinary tract infections. The samples were cultured on MacConkey agar and blood agar. The isolates with significant bacteriuria (105 CFU / ml) were identified based on standard laboratory procedures. Antimicrobial susceptibility tests were carried out using various antimicrobial discs alongwith ceftriaxone on E.coli and K. pneumoniae isolates by Kirby Bauer disc diffusion method as per the recommendations of CLSI. On initial screening with ceftriaxone (30 μg) disc showing resistance was then confirmed for ESBL production by phenotypic confirmatory disc diffusion test (PCDDT) using ceftazidime (30 ug) and ceftazidime + clavulanic acid (30 μg + 10ug) disc as per guidelines of CLSI (2011).ResultsOut of a total of 6308 MSU specimens investigated for significant bacteriuria, E.coli isolates were 444 (7.04%) and K.pneuminiae were 145 (2.3%) making a total of 589 (9.34%). Initial screening with ceftriaxone disc revealed 155 isolates of E.coli and 70 isolates of K.pneumoniae to be resistant. Further testing by PCDDT method showed 60/444 (=13.51%) of E. coli and 24/145 (=16.55%) of K. pneumoniae isolates to be confirmed ESBL producers. These ESBL – producer uropathogens showed high degree of resistance to ceftriaxone (100.0%), amoxycillin, fluoroquinolones and co-trimoxazole.ConclusionAn emerging and moderately high prevalence of ESBL-producing E. coli and K. pneumoniae was observed and confirmed in the urinary isolates investigated. It is essential to have a regular and routine monitoring of ESBL producing clinical isolates in laboratory practice.

To the best of our knowledge, this outbreak is the largest single-point source outbreak of multidrug-resistant typhoid fever yet reported, and it was molecularly traced to the city's single municipal water supply. Isolates were uniformly resistant to nalidixic acid, there was a decrease in their susceptibility as measured by MIC of fluoroquinolones, and 90% of isolates obtained were resistant to >1 antibiotic.

. Mannitol salt agar was used to culture the nasal swabs. Antimicrobial susceptibility testing was performed by KirbyBauer disc diffusion technique following Clinical and Laboratory Standards Institute guidelines. Methicillin-resistant Staphylococcus aureus strains were confirmed by using cefoxitin disc and by determining the minimum inhibitory concentration of oxacillin by agar dilution method. Results:Of 252 healthcare workers, 46(18.3%) were positive for Staphylococcus aureus among which 19(41.3%) were Methicillin-resistant Staphylococcus aureus carriers. Overall rate of nasal carriage of Methicillin-resistant Staphylococcus aureus was 7.5% (19/252).The higher percentages of lab personnel were nasal carriers of S. aureus (31.6%) and Methicillin-resistant Staphylococcus aureus (10.5%).The percentages of nasal carriage of S. aureus (35.7%) and Methicillinresistant Staphylococcus aureus (14.3%) were highest in the health care workers from post operative department. Higher percentage of Methicillin-resistant Staphylococcus aureus were susceptible toward amikacin (100%) and vancomycin (100%) followed by cotrimoxazole (84.2%). Conclusions:High rates of nasal carriage of S. aureus and Methicillin-resistant Staphylococcus aureus were observed among the healthcare workers, which indicate the need of strict infection control measures to be followed to control the nosocomial infections.

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A hospital based cross sectional study was carried out in stool samples collected from cases of diarrhoea in children admitted to Oral Rehydration Therapy (ORT) ward, Kanti Children Hospital, Maharajgung. A total of 204 stool samples collected from children below 15 years were processed at Department of Microbiology, Bir hospital during the study period, February 2004 to June 2004.The stool specimens were investigated for Vibrio cholerae, as well as E. coli O157. Bloody stools were more focused for isolation of E. coli O157. Out of 204 patients, 60.3% were male and 39.7% were female. The largest number of diarrhoeal patients belong to age group 0-5 years i.e. 112 (54.9%). Vibrio cholerae O1 was found in 86 (42.2%) cases. All V. cholerae O1 belong to Ogawa serovar and El Tor biotype. Out of 86 isolates, 52.3% were from male patient and 47.7% were from female patient. Highest incidence of V. cholerae O1 was found in age groups 5-10 (46.5%) Isolation of V. cholerae in 10 cases even in age group 0-2 was remarkable feature. Incidence of V. cholerae O1 was highest in the month of April (61.5%). E. coli O157 could not be detected in this study. Predominant or pure growth of sorbitol non fermenting (SNF) strains which were biochemically identified as E. coli but not agglutinated with E.coli antiserum were found in five cases. Tetracycline was 100 percent effective antibiotic followed by Norfloxacin and Ciprofloxacin to V. cholerae O1. In this study, patients suffering with cholera were mostly from Kalanki. People using municipal tap water were mostly affected (51.8%) Out of 30 isolates of processed, 22 isolates showed toxin production.