<p>Trend and Characteristics of <em>Acinetobacter baumannii</em> Infections in Patients Attending Universal College of Medical Sciences, Bhairahawa, Western Nepal: A Longitudinal Study of 2018</p>

Abstract

Background: Acinetobacter baumannii is one of the major organisms causing nosocomial infections and is intrinsically resistant to multiple classes of antibiotics. The main objective of this study was to investigate the trend and characteristics of A. baumannii infections including its resistance pattern among patients attending Universal College of Medical Sciences, Teaching Hospital (UCMSTH) in Western Nepal, between January and December 2018. Patients and Methods: A total of 4862 clinical samples received at the microbiology laboratory of UCMSTH over a period of a year were analyzed. Following bacterial culture on the samples, culture-positive isolates were tested for antibiotic susceptibility using a modified Kirby-Bauer method. The demographic profile of the patient, information about samples, and the antibiotic profile of the A. baumannii isolated from different samples were recorded and analyzed. Results: A total of 1180 (24.2%; 1180/4862) organisms were isolated from the total samples. Acinetobacter baumannii (12.4%; 147/1180) was the third most common organism. Prevalence of A. baumannii was found to be high in late summer/early winter (July: 15.9%; 18/113 and December: 18.8%; 13/69). The majority 71.4% (n=105) of A. baumannii isolates were multidrug resistant (MDR). None of the isolate was pan-drug resistant. Colistin, polymyxin B, and tigecycline were 100% sensitive to A. baumannii. MDR bacteria were significantly associated with the gender of the patients [female: 51.4% (54/105) versus male: 48.6% (51/105); p=0.05], clinical specimens [swab: 40% (42/105) sputum: 21.9% (23/105) and urine: 10.5% (11/105); p=0.02] and different wards of the hospital [surgery: 30.5% (32/ 105); ICU: 21.9% (23/105) and medicine: 19.0% (20/105); p< 0.03]. Conclusion: The high burden of MDR Acinetobacter isolates in clinical specimens shows an alarming presence of antimicrobial resistance. Two-thirds of the specimens showed MDR and were associated with demographic and clinical characteristics of the patients. In the management of infectious diseases at UCMSTH, there should be a high suspicion of Acinetobacter infection, and isolation and treatment should be carried out based on an antibiotic susceptibility test.

<p>Plasmid-Mediated AmpC β-Lactamase <em>CITM</em> and <em>DHAM</em> Genes Among Gram-Negative Clinical Isolates</p>

“…Of the total (253) bacterial growth, more than ninety percent were Gram-negative bacteria, E. coli was the most predominant isolates among them. Our findings are consistent with previous studies reported from Everest Hospital, Baneshwor, 14 Alka Hospital, Jawlakhel, 31 National Public Health Laboratory, Teku, 32 Universal College of Medical Sciences, Bhairahawa, 33 B.P Koirala Institute of Health Sciences, Dharan, 34 Nobel Medical College, Biratnagar, 35 New Delhi, India, 36 Al-Najaf City, Iraq, 37 Shashemene Referral Hospital, Ethiopia, 38 and Mexico City, Mexico. 39 Slightly higher rate of Gram-negative bacterial infections were observed among female patients and could be due to higher prevalence of urinary tract infections among females.…”

Plasmid mediated colistin resistant mcr-1 and co-existence of OXA-48 among Escherichia coli from clinical and poultry isolates: first report from Nepal

“…The increased and variable rate of colistin resistance may be due to quality, concentration and extensive use of colistin in the livestock farming [ 34 ]. In clinical samples, E. coli remains as the most frequently isolated organisms which is consistent with several previous studies from Nepal [ 35 – 38 ]. The higher load of E. coli in urine samples may be due to their main role in urinary tract infections [ 35 ].…”

Detection of TEM and CTX-M Genes in Escherichia coli Isolated from Clinical Specimens at Tertiary Care Heart Hospital, Kathmandu, Nepal

“…In this study, urine constituted the highest frequency (28.2%) among all of the clinical samples. Our samples echo previous studies conducted in the International Friendship Hospital, Kathmandu [3], Universal College of Medical Sciences Bhairahawa [10], Human Organ Transplant Center [33], and Nobel Medical College, Biratnagar [35]. This may be due to the high association of Gram-negative bacteria with UTI, which is the most common among patients attending a hospital in Nepal [16].…”

“…Infections mediated by Gram-negative bacteria (GNB) constitute the major burden in low- and middle-income countries (LMICs) due to acquisition of various resistant genotypes. In particular, E. coli , K. pneumoniae , E. cloacae , and non-fermentative bacteria, such as P. vulgaris , A. baumannii , and Salmonella species, represent the major members of GNB that are associated with frequent and more severe forms of clinical manifestations, including urinary tract infection, bacteremia, and pneumonia [ 10 , 32 ]. More specifically, E. coli and K. pneumoniae represent the most predominant pathogens isolated from such infections [ 15 , 33 ].…”

“…The emergence and spread of these drug-resistant genes can limit therapeutic options, increase morbidities and mortalities, prolong hospital stays, and cost massive economic loss [ 9 ]. Most of the low and middle income countries (LMICs), including Nepal, have poor infection control strategies, and lack of diagnostic facilities, routine monitoring, and surveillance systems for AMR [ 10 , 11 , 12 ]. In addition to this, wide availability and use of over-the-counter (OTC) antimicrobials are further aggravating the AMR in LMIC settings, including Nepal [ 13 ].…”