Introduction Moraxella catarrhalis are part of the normal flora of the human respiratory tract and are known to have low pathogenic potential. The organism is rarely reported in the literature as the causative agent of meningitis. We report the first case of early-onset neonatal meningitis associated with M. catarrhalis from Nepal. Case Report A 3-day-old baby with fever and yellowish discolouration of the body since 48 hrs was admitted to the neonatal ward. The baby developed 3 episodes of seizures in the form of uprolling of eyes on the first day of admission during phototherapy course for raised serum bilirubin. Sepsis screen was positive, and meningitis was confirmed as the cerebrospinal fluid culture grew M. catarrhalis. Cranial ultrasound scan was normal. The baby received a 21-day course of intravenous cefotaxime and amikacin. Recovery has been uneventful to date. Conclusion Neonatal meningitis is a life-threatening infection. This case report presents an uncommon aetiology of neonatal meningitis which can be misidentified in the diagnostic bacteriology laboratory in resource constraints area like ours.

Background:: Surgical site infections (SSIs) are the leading nosocomial infections and important cause of morbidity and mortality in surgical patients. Objective:: The present study was conducted to investigate the bacterial etiology of SSIs and determine the antibiotic susceptibility patterns of the isolates. Methodology:: A cross-sectional study was conducted between July to November 2019 on 105 patients suspected of having SSIs. Wound swabs were collected aseptically using sterile cotton swabs and processed in suitable culture media following the standard operative protocols. Antibiotic susceptibility testing was done by Kirby-Bauer disc diffusion technique following Clinical and Laboratory Standards Institute (CLSI) guidelines. Results:: Out of 105 samples collected, 69 showed the growth and 77 bacterial isolates were documented altogether. The most frequently isolated bacteria were Staphylococcus aureus 46 (59.74%) followed by E. coli 9 (11.68%). Antimicrobial profile of the isolates revealed that 61.04% were MDR, 25.80% were ESBL producers and 9.68% were carbapenemase producers. Conclusion:: High prevalence of antibiotic resistant bacterial isolates associated with SSIs warrants the need for aseptic techniques during and after surgical procedures and judicious use of antibiotics.

Background: Candida albicans remains the most common and are responsible for various clinical infections ranging from mucocutaneous infection to life threatening invasive diseases. But recent epidemiological data shift from C.albicans to non albicans Candida species and also increased resistance to antifungal drugs made the scenario a serious concern. Methods: A total of 156 Candida isolates from various clinical specimens received in the department of Microbiology were taken up for the study over a period of one year i.e. from March 2019 to February 2020. The Candida were grown on Sabouraud dextrose agar to be  evaluated for colony  appearance, macroscopic examination, Gram staining, germ tube, urea hydrolysis etc. The Candida isolates were speciated by using CHROMagar medium. Antifungal susceptibility testing was performed as recommended by Clinical and Laboratory Standards Institute (CLSI) M44-A document. Results: The isolation of non albicans Candida (54.5%) predominated over Candida albicans (45.5%). Non albicans Candida isolated were Candida tropcalis 40(25.6%), Candida krusei 21(13.4%), Candida glabrata 17(10.8%) and Candida dublinensis 07(4.4%) each. Candida species were all susceptible to Amphotericin B, followed by fluconazole (67.4%), miconazole (51.9%) and ketoconazole (22.5%). Conclusions: The accurate species identification of Candida is important for the treatment because not all species respond to the same treatment and also because of the increasing antifungal resistance. CHROMagar is a convenient and rapid method of identification of Candida species specially in resource limited poor settings.   Keywords: antifungal susceptibility testing; Candida albicans; CHROMagar; non albicans Candida

Background: The patients with head injury have reduced consciousness, they are prone to aspirations of oral secretions. The tracheotomized patients are colonized mostly by gram negative bacteria and are likely develop pneumonia causing life threatening consequences due to severe, persistent, resistant infections. This study was undertaken to identify the common organisms which cause respiratory tract infection and their Antibiogram of ventilated patients in Neurosurgical Intensive Care Unit.  Methods: A cross-sectional study was conducted to determine the prevalence and antibiotisc susceptibility analysis of Endotracheal aspirates of the patients who were admitted in Neurosurgical intensive care unit, College of medical sciences, teaching hospital, Bharatpur, for a period from October 2019 to July 2020. Aspirates were cultured onto Blood agar, McConkey and Chocolate agar. Isolation and identification was done using conventional techniques and Biochemical reactions. Antibiotic susceptibility was done by Kirby-Bauer disc diffusion method as per CLSI guidelines. Results: Out of 163 samples, 147(90.18%) were culture positive. 78 samples were found to be polymicrobial. 16 samples showed no growth. Acinetobacter baumanii (36.05%) was the most common isolate followed by Enterobacter sp (25.85%), Klebsiella pneumoniae (15.65%), Pseudomonas aeruginosa (13.61%), Escherichia coli (5.44%), Citrobacter freundii (2.04%), and Staphylococcus aureus (1.36%). The gram negative bacilli were all sensitive to colistin. Comparatively, they were also sensitive to Imipenem, Meropenem, Cefaperozone/sulbactam. Staphylococcus aureus is sensitive to Vancomicin. Conclusions: Respiratory tract infection in intubated patients is risk factors which lead to morbidity and mortality. Inappropriate and inadequate antibiotic treatment causes emergence of drug resistance in pathogens and poor prognosis in patients. The study reported the alarming condition of MDR in tracheal aspirates. Hence, surveillance for source of multi drug resistant bacteria would be beneficial for intervention of infection related to it.

The transmission of healthcare-associated infections (HCAIs) in healthcare settings is a serious challenge in the medical fraternity. Medical devices, such as stethoscopes used by healthcare workers (HCWs), are likely to harbor a considerable number of pathogenic microbes, which may result in the transmission of HCAIs. This study sought to investigate bacterial contamination of stethoscopes used by HCWs at Bharatpur Hospital, Nepal. During the study period of 3 months from December 2019 to February 2020, a total of 87 stethoscopes were examined; bacterial pathogens were isolated and identified by culture and biochemical tests, and their susceptibilities against different antibiotics were determined using standard protocols of the Clinical and Laboratory Standards Institute (CLSI). The disc diffusion method was used primarily to screen for extended-spectrum beta-lactamase (ESBL)- and metallo-beta-lactamase (MBL)-producing isolates, followed by their confirmation using cephalosporin/clavulanate combination discs and the disc potentiation methods, respectively. In addition, molecular detection of blaCTX-M and blaVIM genes was performed using conventional polymerase chain reaction (PCR). Of the 87 stethoscopes examined, more than a quarter (28.7%) were colonized with different pathogenic bacteria. Bacterial contamination of stethoscopes was found to be significantly associated with various factors, such as disinfecting routine, method of disinfection, and department of the hospital (p < 0.05). A higher rate of bacterial contamination was observed on the diaphragm of the stethoscope (12.64%) and among HCWs who overlooked hand hygiene practices (45.45%). The prevalence of methicillin-resistant S. aureus (MRSA) was 44.44%, and approximately half of the Gram-negative isolates (47%) were multidrug resistant (MDR). Imipenem (81.25%) and chloramphenicol (83.33%) were found to be the most effective antibiotics for Gram-negative and Gram-positive bacteria, respectively. Phenotypic screening showed that 43.75% of isolates were ESBL producers, and 18.75% were MBL producers, but blaCTX-M and blaVIM genes were detected in only 31.25% and 6.25% of isolates, respectively. The results of the study call for effective stethoscope disinfection practices along with the judicious use of antibiotics by HCWs in order to minimize cross-contamination, emergence of resistance, and spread of nosocomial infections in clinical settings.