Nepal suffers from high burden of antimicrobial resistance (AMR) due to inappropriate use of antibiotics. The main objective of this study was to explore knowledge, attitude and practices of antibiotics uses among patients, healthcare workers, laboratories, drug sellers and farmers in eight districts of Nepal. A cross-sectional survey was conducted between April and July 2017. A total of 516 individuals participated in a face-to-face interview that included clinicians, private drug dispensers, patients, laboratories, public health centers/hospitals and, livestock and poultry farmers. Out of 516 respondents, 62.8% (324/516) were patients, 16.9% (87/516) were clinicians, 6.4% (33/516) were private drug dispensers. A significant proportion of patients (42.9%; 139/324) thought that fever could be treated with antibiotics. Majority (79%; 256/324) of the patients purchased antibiotics over the counter. The knowledge of antibiotics used among patients increased proportionately with the level of education: literate only [AOR = 1.4 (95% Cl = 0.6–4.4)], versus secondary education (8–10 grade) [AOR = 1.8 (95% Cl = 1.0–3.4)]. Adult patients were more aware of antibiotic resistance. Use of antibiotics over the counter was found high in this study. Knowledge, attitude and practice related to antibiotic among respondents showed significant gaps and need an urgent effort to mitigate such practice.

Introduction: Opportunistic bacterial and fungal infections are the major cause of morbidity and mortality among immune suppressed HIV-positive patients. The main objective of this study was to determine bacterial and fungal organisms causing respiratory infections and their susceptibility to commonly prescribed antimicrobials among HIV patients attending a tertiary infectious disease hospital in Kathmandu. Methods: Sputum samples were collected from the HIV-positive patients attending Sukraraj Tropical and Infectious Disease Hospital (STIDH) from August 2017 to March 2018. A total of 100 sputum samples were cultured on conventional bacterial and fungal culture media. Bacterial and fungal isolates were identified based on their colony characteristics, microscopic morphology and various biochemical tests. Antibiotic susceptibility test (AST) of bacterial isolates was performed by modified Kirby Bauer disc diffusion method. Results: Out of 100 sputum samples cultured, 24% (n=24) showed bacterial growth, 42% (n=42) showed fungal growth and 10% (n=10) had both bacterial and fungal growth. Among bacteria, 91.6% (n=22) were monomicrobial and 8.4% (n=2) were polymicrobial in growth, of which, Klebsiella pneumoniae (37.5%) were predominant isolates, followed by Pseudomonas aeruginosa (29.2%), and Escherichia coli (16.7%). The antibiotic susceptibility test (AST) showed 68% (17/25) of bacterial isolates were multi-drug resistant (MDR) and among them 41.2% (7/17) were found to be extended spectrum β lactamase (ESBL) producers. Fungal growth was observed in 42% of samples (42/100). A total of six different species of Candida and four different genera of molds were identified. On species differentiation, Candida albicans (20%) were followed by Candida parapsilosis (4%), and Candida dubliniensis (3%); and various molds were Aspergillus fumigatus (4%), Aspergillus flavus (2%), and Penicillium species (5%). CD4 count was inversely associated with bacterial and fungal infections. Fifty percent of the patients with the fungal infections had a CD4 count below 200. No fungal organisms were isolated from HIV-positive patients under antifungal drug treatment. Conclusion: HIV-positive patients with a CD4 count less than 200 cells/µL are more vulnerable to opportunistic infections of bacterial and fungal origin. Early isolation, identification and appropriate treatment can reduce mortality due to co-infections. Routine screening of opportunistic pathogens is critical to contain the disease progression.

Background: The emergence of SARS-CoV 2 pandemic is the greatest public health concern of the century. Healthcare workers are the front liners of pandemic management. Their knowledge, attitudes and practices can influence the outcome of pandemic. The study aims to determine the knowledge, attitude and practices among healthcare workers.Methods: Knowledge, attitude and practice related questionnaire based online survey through Google forms was conducted from Healthcare workers, following ethical approval from NHRC (ERB protocol registration number: 297/2020 P). Online forms were disseminated via Facebook, Instagram, Whatsapp, Viber and personal messaging. Responses containing anonymized data was collected analyzed in using SPSS-version 26, (Year: 2019). The results were interpreted in terms of percentage response, knowledge score, and practice and discussed on the possible solutions in improving the infection prevention and control practice.Results: 473 HCWs responded to the questionnaire, out of which 426 responses met inclusion criteria which is 90% of the total responses. The mean score for knowledge was 3.20 + 1.15 out of maximum seven; with 45.7% correct answers. 70.4 % (300) participants felt that Nepal will be unable to contain the pandemic, 64 % of the total employed participants felt that there was inadequate institutional preparedness to protect HCWs from exposure. 91% participants reported practicing hand hygiene after every patient encounter; whereas 31.7% (77) and 22.1% (59) participants did not know how to check sealing of the N95 masks and use personal protective equipment’s respectively.Conclusions: The survey findings showed deficiencies in knowledge and appropriate practice among the HCWs, in prevention of SARS-CoV-2 transmission. Attitudes towards COVID19 were a mix of both positive and negative viewpoints. Even in health care workers with access to internet, there is significant gap in universal infection prevention and control practices required for self-protection and limiting untoward transmission. Keywords: Attitude and practice; COVID-19; healthcare workers; infection prevention and control; knowledge, Nepal; SARS CoV 2

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