Escherichia coli and Klebsiella spp. are two important uropathogens showing resistance to beta-lactams by producing extended spectrum beta lactamase (ESBL), leading to difficulty in treating infections with these bacteria. Majority of the ESBLs are of TEM, CTXM and SHV types reported from Nepal. This study was conducted in Clinical Microbiology Department of Nepal Medical College Teaching Hospital from November 2021 to mid-January 2022 to determine prevalence of ESBL and antimicrobial susceptibility pattern among two common uropathogens. A total of 402 E. coli and Klebsiella spp. isolated from urine samples were included in the study. ESBL producing strains were identified by combination disc method and antibiotic susceptibility testing was done by Kirby Bauer’s disc diffusion method. PCR was done to detect the TEM and CTXM genes. Prevalence of ESBL among E. coli and Klebsiella spp. was found to be 14.9% (60/402). Among the E. coli, 16.1% (58/360) and only 4.8% (2/42) of Klebsiella spp. were ESBL producers. Antibiogram showed, 56.7% ESBL producers were susceptible to ciprofloxacin, 46.7% to co-trimoxazole, 96.7% to nitrofurantoin. However, all isolates were susceptible to amikacin, piperacillin-tazobactam, and carbapenems (both meropenem and imipenem). Among total 30 ESBL isolates selected by systematic random sampling, 3 isolates (all three E. coli) showed presence of TEM and 3 other isolates (two E. coli and one Klebsiella spp.) showed CTXM genes.
Introduction: Lower respiratory tract infection accounts for a great burden of disease worldwide. The problem has further increased due to increasing antimicrobial resistance. This study was done to find out prevalence of positive bacterial culture among lower respiratory tract specimens of patients in a tertiary care centre. Methods: A descriptive cross-sectional study was done in the Laboratory of Clinical Microbiology in a tertiary care centre from May, 2021 to October, 2021. Ethical approval was received from the Institutional Review Committee (Reference number: 045-077/078). A total of 635 specimens were collected by convenience sampling. The specimens were cultured as per standard microbiological techniques. Antibiotic susceptibility was performed following Clinical and Laboratory Standards Institute (2020) guidelines. Microsoft Excel was used for data entry and analysis. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion. Results: Among the 635 lower respiratory specimens, 112 (17.63%) (111.97 to 112.03 at 95% Confidence Interval) showed positive bacterial culture. Klebsiella pneumoniae 44 (37.93%) was the commonest isolate followed by Acinetobacter calcoaceticus baumannii complex 34 (29.31%). Conclusions: The prevalence of positive bacterial culture among lower respiratory specimens was lower when compared to other studies done in similar settings.
Introduction: Ampicillinase C beta-lactamase-producing organisms are often resistant to multiple antimicrobial agents, and therapeutic options against these pathogens are limited. Limited information is available regarding Ampicillinase C beta-lactamase producers. The aim of this study was to find out the prevalence of Ampicillinase C beta-lactamase producers among isolates of Enterobacteriaceae in a tertiary care centre. Methods: A descriptive cross-sectional study was carried out in the Clinical Microbiology Laboratory of a tertiary care centre from May 2021 to October 2021. Ethical approval was received from the Institutional Review Committee (Reference number: 044-077/078). Isolates of Enterobacteriaceae from various clinical samples were collected by convenience sampling. Ampicillinase C screening for beta-lactamase producers among the Enterobacteriaceae isolates was done using cefoxitin (30 μg) disc. Detection of Ampicillinase C beta-lactamase producers among the screen-positive isolates was done by cefoxitin-cloxacillin double-disc synergy test. An increase in the zone size of ≥4 mm was considered as Ampicillinase C beta-lactamase producers. Point estimate and 95% Confidence Interval were calculated. Results: Among the total 481 isolates of Enterobacteriaceae, 49 (10.19%) (7.50-12.90, 95 % Confidence Interval) were detected as Ampicillinase C beta-lactamase producers among isolates of Enterobacteriaceae. Conclusions: The prevalence of Ampicillinase C beta-lactamase producers was lower than in other studies done in similar settings. Meropenem could be a drug of choice for the treatment of infections due to Ampicillinase C beta-lactamase-producing gram-negative bacteria.
Resistance shown by Staphylococcus aureus to methicillin; mediated by mecA, and vancomycin; mediated by vanA, has led to difficulty in treatment of related infections. Despite reports showing methicillin resistant S. aureus (MRSA) and vancomycin resistant S. aureus (VRSA) in Nepal, and need for their regular surveillance, no study has been conducted on it in our hospital. So, this study is aimed to determine prevalence of MRSA, VRSA and their molecular characterization along with antibiogram. A descriptive cross-sectional study was conducted from August to December, 2022 in Clinical Microbiology Laboratory of NMCTH among S. aureus (n=160) isolated from various clinical specimens after receiving ethical approval from NMC-IRC. AST was done by modified Kirby-Bauer’s disc diffusion method. MRSA and VRSA were detected by cefoxitin disc method and agar dilution method respectively. Inducible clindamycin resistance was detected by D-test. Resistant genes (mecA, PVL, and vanA) were detected using conventional PCR. Prevalence of MRSA was found to be 31.2% (50/160) but none of the isolates were resistant to vancomycin. Total 7 (46.6%) mecA and 7 (46.6%) PVL genes were detected among 15 selected MRSA isolates but vanA was not found. All the MRSA isolates were susceptibile to co-trimoxazole, tigecycline, chloramphenicol, vancomycin, teicoplanin and linezolid. The resistance rate against ciprofloxacin, ofloxacin, and clindamycin was 52.0%, 44.0%, and 68.0% (20.0% iMLSB, 28.0% cMLSB and 16.0% MS-phenotypes) respectively. Prompt implementation of hospital antibiotic policy and AMR Act by government along with regular surveillance of MRSA and VRSA seems essential to contain MRSA infections. Co-trimoxazole could be treatment option against MRSA in our setting, keeping vancomycin in reserve. However, large scale studies are required to establish this conclusion.
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