Background: Clindamycin is regarded as a reserve drug in the treatment of staphylococcal infections. Among few therapeutic alternatives available for treatment of erythromycin-resistant Staphylococcus aureus infections, clindamycin has several advantages but major limitation in its use is the development of resistance resulting in treatment failure. Routine clindamycin susceptibility test may fail to detect such inducible resistance which can be detected by Double disc diffusion test (D-test). The present study was undertaken to determine the incidence of inducible clindamycin resistance among clinical isolates of S. aureus in a tertiary care hospital in central Nepal. Methods: A cross-sectional study was carried out among the patients visiting Bharatpur Hospital from September to November 2019. A total of 1279 clinical samples were examined for the identification of S. aureus by standard microbiological procedures. Antibiotic susceptibility testing of the isolates was done by Kirby-Bauer disc diffusion method and all the erythromycin-resistant isolates were subjected to D-test for the phenotypic detection of inducible clindamycin resistance according to CLSI guidelines (2016). Results: S. aureus was recovered from 4.5% (58/1279) samples of which 35 isolates were Methicillin-Resistant Staphylococcus aureus (MRSA) and 23 were multi-drug resistant (MDR). Tetracycline was found to be the most effective antibiotic whereas erythromycin was the least effective. D-test revealed that 39.7% isolates showed iMLSB phenotype, 3.5% showed cMLSB phenotype and 56.8% showed MS phenotype. The percentage of inducible and constitutive resistance was seen higher amongst MRSA isolates compared to Methicillin-Sensitive Staphylococcus aureus (MSSA) isolates. Incidence of S. aureus was found higher among females and in the age group 20-30 years and in pus samples (p<0.01). Conclusions: Routine testing of inducible clindamycin resistance is suggested among the clinical isolates of erythromycin-resistant Staphylococci to avoid treatment failure.

Introduction: Patients with malignancies frequently develop infections as a result of surgical procedures and fungating wounds leading to pus formation. This cross-sectional study was conducted to explore the bacteriological spectra of infections of various cancer sites and their antibiotic sensitivity patterns among the patients visiting minor operation theatre (OT) of B.P. Koirala Memorial Cancer Hospital (BPKMCH), Chitwan, Nepal. Methods: Over a period of 3 months from September to November 2018, a total of 183 wound exudates and pus samples were collected and analyzed by standard microbiological procedures. Isolates were identified based on the colony characters, Gram staining and an array of biochemical tests. Antibiotic susceptibility testing was performed by Kirby-Bauer disc diffusion technique according to criteria set by CLSI, 2016. Methicillin resistance in Staphylococcus aureus was tested with the help of cefoxitin using disc diffusion method. Results: Out of the 183 samples, 149 (81.4%) were culture positive. Among 13 different isolates identified, S. aureus (43.0%) was predominant followed by E. coli (14.0%). Higher incidence of bacteria was seen among the males (52.3%), in the age group 51 to 60 years (26.8%) and among the patients undergoing surgical intervention to deal with cancer (34.2%). The prevalence of wound infection was significantly affected by gender, age, and treatment regimen ( P < .01). Out of the total 68 S. aureus isolates, 38 (44.1%) were deemed as Methicillin-resistant Staphylococcus aureus (MRSA). Among the 158 isolates, 85 (53.8%) were multi-drug resistant (MDR). Cefepime was the most effective antibiotic for Gram positive isolates whereas both imipenem and meropenem were found to be equally more effective for Gram negative isolates. Conclusion: This study suggests that patients with malignancies harbor pathogenic bacteria; therefore, prudent use of antibiotics is essential to prevent the emergence of MDR pathogens.

Mobile phones widely used in our day-to-day lives are potential reservoir for a number of bacteria including Staphylococcus aureus. The study was carried out from February to May 2017 with a major objective of screening methicillin-resistant S. aureus (MRSA) from mobile phones used by the staffs and students of Birendra Multiple Campus, Bharatpur, Nepal. Out of 212 swabbed samples of mobile phones analysed by standard microbiological technique, 112 (56.0%) showed the presence of S. aureus. Gentamicin 101 (90.2%) was the most effective antibiotic whereas cefoxitin 42 (37.5%) was the least effective antibiotic. MRSA 30 (26.8%), Vancomycin Intermediate S. aureus (VISA) 58 (51.8%) and MDR S. aureus 24 (21.4%) were detected. Significant associations were noted between the rate of occurrence of MRSA and MDR S. aureus with various attributes such as the gender of the user, the way of handling the mobile phones and also with the length of use of mobile phones (P-value < 0.01). Our findings indicate the mobile phones can carry potentially threatening species of S. aureus which can cause severe health hazards to humans. Awareness about regular disinfection of mobile phones, hand hygiene, restricting the use of mobile phones in contaminating areas and proper place for storing mobile phones can be suggested.

Objectives: The study was designed to isolate and identify Candida species from high vaginal swab, and to determine the antifungal susceptibility pattern of Candida spp. among women of reproductive age group i.e. 15- 50 years old. Methods: High vaginal swabs were processed to isolate Candida species and identified by Gram’s stain, germ tube formation test, carbohydrate (glucose, sucrose, maltose, lactose) fermentation tests and antifungal susceptibility test were performed as recommended by Clinical Laboratory Standard Institute. Results: Out of total 261 samples, 42.1% (110/261) were found to be culture positive for Candida spp. Candida albicans was the most common (56.4%) and among non-albicans, predominate species was C. krusei (19.1%) isolated from high vaginal swab specimens All the isolates of Candida species were sensitive to Nystatin and Miconazole and resistant to Itraconazole. Fluconazole, Itraconazole and Clotrimazole are widely used drug against vaginal candidiasis but showed high resistance which leads to treatment failure. Conclusion: This study on the infection rate of Candida and its antifungal susceptibility pattern may help in the choice of appropriate therapy in the clinical setting.