Changing Antimicrobial Resistance Trends in Kathmandu, Nepal: A 23-Year Retrospective Analysis of Bacteraemia

Abstract

A comprehensive longitudinal understanding of the changing epidemiology of the agents causing bacteraemia and their AMR profiles in key locations is crucial for assessing the progression and magnitude of the global AMR crisis. We performed a retrospective analysis of routine microbiological data from April 1992 to December 2014, studying the time trends of non-Salmonella associated bacteraemia at a single Kathmandu healthcare facility. The distribution of aetiological agents, their antimicrobial susceptibility profiles, and the hospital ward of isolation were assessed. Two hundred twenty-four thousand seven hundred forty-one blood cultures were performed over the study period, of which, 30,353 (13.5%) exhibited growth for non-contaminant bacteria. We observed a significant increasing trend in the proportion of MDR non-Salmonella Enterobacteriaceae (p < 0.001), other Gram-negative organisms (p = 0.006), and Gram-positive organisms (p = 0.006) over time. Additionally, there was an annual increasing trend in the proportion of MDR organisms in bacteria-positive blood cultures originating from patients attending the emergency ward (p = 0.006) and the outpatient department (p = 0.006). This unique dataset demonstrates that community acquired non-Salmonella bacteraemia has become an increasingly important cause of hospital admission in Kathmandu. An increasing burden of bacteraemia associated with MDR organisms in the community underscores the need for preventing the circulation of MDR bacteria within the local population.

Phenotypic Detection of Methicillin and Inducible Clindamycin Resistant Staphylococcus Aureus: An Effort to Combat Antimicrobial Resistance and Improve Patient Safety in Gombe, Nigeria

“…The prevalence of MRSA in this study (68.5%) is higher than earlier studies of 12.5% and 8.0% from Gombe/North-eastern Nigeria (12,13). This could be attributable to variation in time/methodology and changes in prescribing habits of clinicians and pattern of resistance among the microorganisms as reported in other studies across the globe (15,16). However, differences (both higher and lower prevalence) with other Nigerian (9, 11) and foreign (5, 10, 17) studies have been observed in both MRSA and inducible clindamycin resistance.…”

Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries: Progress and Challenges in Eight South Asian and Southeast Asian Countries

“…However, individual antibiotic susceptibilities were not reported (125). In this study, the MDR non-Salmonella Enterobacterales, other Gram-negative organisms, and Gram-positive organisms accounted for 80%, 69%, and 70% of the isolates, respectively, in 2014.…”

The emergence of azithromycin-resistant Salmonella Typhi in Nepal

“…Typhoid fever is frequently managed in the outpatient department (OPD) of the hospital and blood culture is routinely performed following routine microbiological procedures when enteric fever is suspected. 6 Antimicrobial susceptibility testing is performed by a modified Bauer-Kirby disc diffusion, with Etests Ò to determine MICs (bioMérieux, France); results are interpreted using CLSI guidelines. 7 In August and September 2019, routine microbiological diagnostic procedures identified three patients with Azith R S. Typhi attending the OPD.…”