BackgroundThe increasing and rapid spread of metallo-beta-lactamase (MBL) producing Enterobacteriaceae, particularly Escherichia coli and Klebsiella pneumoniae represents an emerging public health threat. However, limited data is available on MBL production in clinical isolates of E. coli and K. pneumoniae from Nepal. We have therefore undertaken this study to ascertain the incidence of MBL production in clinical isolates of E. coli and K. pneumoniae at a tertiary care teaching hospital in central Nepal.MethodsA total of 401 consecutive, non-duplicate isolates of E. coli (n = 216) and K. pneumoniae (n = 185) were recovered from various clinical samples between July and December, 2012. These isolates were screened for the detection of carbapenemase production on the basis of their reduced susceptibility to meropenem or ertapenem by the disc diffusion method. The screened isolates were further phenotypically studied for carbapenemase production by modified Hodge test (MHT). MBL production was detected by performing combined disc test by using imipenem discs with and without ethylenediaminetetraacetic acid (EDTA), which chelates zinc required for MBL activity.ResultsOut of 216 E. coli isolates, a total of 41 isolates (18.98%) and out of 185 K. pneumoniae isolates, a total of 39 isolates (21.08%) were suspected to be carbapenemase- producers on the basis of their reduced susceptibility to meropenem or ertapenem. Interestingly, all the initially suspected isolates of E. coli and K. pneumoniae for carbapenemase production were found to be positive in both MHT and combined disc test. However, few weakly positive reactions were observed in MHT. All the MBL producing isolates were multidrug-resistant (MDR). In addition, 75.60% E. coli and 71.79% of K. pneumoniae isolates producing MBL were found to be “pandrug- resistant”.ConclusionsOur findings showed MBL production in a considerable number of E. coli and K. pneumoniae isolates with MDR and pandrug-resistant phenotypes. Combined disc method can provide a sensible choice for phenotypic detection of MBL production in clinical microbiology laboratories as detection of MBL in bacterial isolates is indispensable for establishing the effective antibiotic policies and infection control strategies in the hospital setting.

Background: Acinetobacter species has emerged as a significant hospital pathogen, and are becoming        increasingly drug resistance. They cause outbreaks in intensive care units and health care units. Methods: A cross-sectional study was conducted to determine the prevalence and antibiotic susceptibility pattern of Acinetobacter spp isolated from various clinical samples collected from patients admitted in various wards and intensive care units of the hospital over a period of one year (March 2018 to Feb 2019).   Results: Out of 2,623 samples, 1,201(45.78%) yielded significant growth and out of these positive cultures, 138(11.49%) Acinetobacter spp were isolated. Majority of isolates 24(17.39%) were isolated from General intensive care unit (GICU). Maximum sensitivity of Acinetobacter spp was seen towards polymyxin B 138(100%) and colistin 138(100%), followed by tigecycline 127(92.02%). Hundred and one (80.43%) isolates were found to be multidrug resistant.   Conclusions: Acinetobacter isolates showed multidrug resistant pattern mostly in inpatients. To avoid resistance, antibiotics should be used judiciously. There is also an urgent need for emphasizing the       importance of hand washing and use of disinfectants in prevention of transmission of infection in health care setup. Keywords: Acinetobacter spp; prevalence; antibiotic resistance; intensive care units; multidrug           resistance.

Introduction: Bacteremia and septicemia is a life threatening condition resulting in major cause of morbidity and mortality in patients. The aim of this study was to determine prevalence of bacteremia and septicemia among surgical ICU patients and its antibiotic susceptibility pattern. Methods: A cross-sectional study was carried out among the suspected cases from surgical ICUs of COMS-TH from July 2017 to December 2020. Blood samples were collected, processed, isolated and identified according to standard methodology. Multidrug resistance in Gram negative bacterial (MDR) and methicillin resistant S.aureus (MRSA) screening was done by following the standard protocol. Results: A total number of 450 samples were processed, 48(10.7%) bacterial isolates from patients’ blood sample showed positive by culture from department of surgical ICUs, College of Medical Sciences Teaching Hospital, Nepal. This study showed more incidences of gram negative isolates which are responsible for septicemia as compared to gram positive isolates. Most frequently used drugs like Ciprofloxacin (83.9%), Gentamycin (74.2%), Ceftrixone and Ampicillin (71.0%), Cefazolin and Chloramphenicol (67.7%), Ofloxacin (67.7%), Amikacin (64.5%), Amoxyclave (61.3%), showed high rate of resistance among the isolates. Cefotaxime and Co-Trimoxazole (58.1%) showed second highest resistance pattern among GNB isolates from ICU patients. The least resistance pattern among the GPC was found in drugs like Amikacin and Azithromycin (47.1%) and Vancomycin (35.3%) Meropenem (29.4%). Coagulase negative Staphylococcus (CONS) had shown MDR 66.6% showed highest resistance pattern among Enterococcus spp, CoNS and S.aureus. This indicates most of the organisms were either moving towards resistance or already acquired resistance against antibiotics. Conclusions : Blood culture positive rate of the isolates from surgical ICUs of COMS-TH was 48(10.7%) of the total 450 samples. Pseudomonas aeruginosa and S.aureus were most common pathogen causing bacteremia and septicemia. None of the antibiotics were 100% sensitive for P.aeruginosa, even Meropenem showed reduced sensitivity. Among all antibiotics Ampicillin and Amikacin followed by Ciprofloxacin has lowest sensitivity towards the organisms.