Prevalence and Antibiograms of Uropathogens from the Suspected Cases of Urinary Tract Infections in Bharatpur Hospital, Nepal

Adhikari, Sanjib; Khadka, Sujan; Rana, Jid Chani; Khanal, Santosh; Neupane, Asmita; Sharma, Babita

doi:10.3126/jcmsn.v15i4.20856

Cited by 10 publications

(14 citation statements)

References 18 publications

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“…Among the total isolates, E. coli 37 (77.08%) was the most prevalent one. This result is in commensurate with some previous studies [ 4 , 32 , 33 ]. The higher prevalence of E. coli in UTIs might be due to the higher binding affinity to the glycoconjugate receptor of the uroepithelial cells [ 34 ].…”

Section: Discussionsupporting

confidence: 94%

“…It has been estimated that at least 40% to 50% of women will experience a minimum of one symptomatic UTI with roughly 27% to 48% of affected women experiencing recurrent UTIs [ 3 ]. A UTI is a severe public health problem caused by a variety of pathogens, but most frequently by Escherichia coli followed by Klebsiella pneumoniae , Proteus mirabilis , Enterococcus faecalis , Staphylococcus saprophyticus , Staphylococcus aureus , and Pseudomonas aeruginosa [ 4 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of Urine Dipstick Test in Diagnosing Urinary Tract Infection and Detection of the blaCTX-M Gene among ESBL-Producing Escherichia coli

Gurung

Adhikari

et al. 2021

Diseases

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A urine dipstick test used for prompt diagnosis of urinary tract infection (UTI) is a rapid and cost-effective method. The main objective of this study was to compare the efficacy of the urine dipstick test with culture methods in screening for UTIs along with the detection of the blaCTX-M gene in extended spectrum β-lactamase (ESBL)-producing Escherichia coli. A total of 217 mid-stream urine samples were collected from UTI-suspected patients attending Bharatpur Hospital, Chitwan, and tested by dipstick test strip (COMBI-10SL, Germany) prior to the culture. E. coli isolates were identified by standard microbiological procedures and subjected to antimicrobial susceptibility testing by Kirby Bauer disc diffusion method following CLSI guideline. Primary screening of ESBL-producing E. coli isolates was conducted using ceftriaxone, cefotaxime and ceftazidime discs and phenotypically confirmed by combined disk diffusion test. Plasmid DNA of ESBL-producing strains was extracted by phenol-chloroform method and subjected to PCR for detection of the blaCTX-M gene. Out of 217 urine samples, 48 (22.12%) showed significant bacteriuria. Among 46 (21.20%) Gram negative bacteria recovered, the predominant one was E. coli 37 (77.08%) of which 33 (89.19%) were multidrug resistant (MDR). E. coli isolates showed a higher degree of resistance towards cefazolin (62.16%) while 81.08% of the isolates were sensitive towards amikacin followed by nitrofurantoin (70.27%). Among 14 (37.84%) phenotypically confirmed ESBL isolates, only eight (21.62%) isolates carried the blaCTX-M gene. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of urine dipstick test were 43.75%, 77.51%, 35.59% and 82.91%, respectively. Besides, the use of dipstick test strip for screening UTI was associated with many false positive and negative results as compared to the gold standard culture method. Hence, dipstick nitrite test alone should not be used as sole method for screening UTIs.

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Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Efficacy of Urine Dipstick Test in Diagnosing Urinary Tract Infection and Detection of the blaCTX-M Gene among ESBL-Producing Escherichia coli

Gurung

Adhikari

et al. 2021

Diseases

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“…Several studies in Nepal have reported the prevalence of MDR [ 22 , 23 ] and ESBL producers [ 8 – 10 ]. Despite knowing the fact, in Nepal, the literature regarding ESBL production among MDR isolates and their responsible genes are poorly stated than other developed nations; the present study would help to investigate the prevalence of CTX-M β -lactamases producing MDR E. coli and K. pneumoniae among patients.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of CTX-M β-Lactamases Producing Multidrug Resistant Escherichia coli and Klebsiella pneumoniae among Patients Attending Bir Hospital, Nepal

Koirala

Khadka

Sharma

et al. 2021

BioMed Research International

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The emergence of multidrug resistant (MDR) bacteria which is attributable to extended spectrum β-lactamases (ESBLs) production of CTX-M types is an obvious problem worldwide. This study is aimed at determining the prevalence of CTX-M β-lactamases producing multidrug resistant Escherichia coli and Klebsiella pneumoniae among patients attending Bir Hospital. A cross-sectional study was conducted between April and September 2019 at Bir Hospital, Kathmandu, and Department of Microbiology, National College, Kathmandu, Nepal. A total of 5,690 different clinical specimens were subjected to cultural, microscopic, and biochemical analyses for the identification of the isolates. Antimicrobial susceptibility testing of the isolates was done, and MDR isolates were selected and processed for further ESBL confirmation by the combination disks method. All confirmed ESBL isolates were screened for CTX-M type β-lactamases (blaCTX-M) by PCR. Of the total 345 isolates (227 Escherichia coli and 118 Klebsiella pneumoniae), 232 were MDR. All 232 (67.24%) MDR isolates were suspected as ESBL producers on the screening test. However, on the phenotypic test, 135 (58.18%) of total MDR bacteria were confirmed as ESBL producers with the highest proportion in K. pneumoniae (59.37%). The major source of ESBL producers was urine. ESBL producing isolates were mostly identified from outpatients and patients belonging to age group 41-60. Gentamicin was found to be effective against ESBL producers. The prevalence of blaCTX-M was (89.62%) with the highest frequency for E. coli (93.81%). High prevalence of ESBL of CTX-M types among MDR E. coli and K. pneumoniae was detected from clinical specimens of patients in Bir Hospital. This study warrants the need for the judicious use of antibiotics as well as emphasize the use of modern diagnostic tools for the early detection of MDR and ESBL producers to curb the emergence and spread of MDR and ESBL producing bacteria in the clinical settings of Nepal.

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“…Several microorganisms such as Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus, Acinetobacter, Streptococcus pneumoniae, Escherichia coli, Enterobacter, Haemophilus influenzae, Moraxella, Citrobacter, Nocardia, and many others have been reported from BAL fluid (Magazine et al, 2013). The drug resistance among the clinical (Adhikari et al, 2019;Duwadi et al, 2020;Gyawali et al, 2020; and non-clinical isolates (Adhikari et al, 2020;Khadka et al, 2018;Sapkota et al, 2019Sapkota et al, , 2020 have been widely reported in many studies and bacterial isolates present in the BAL fluid have also been found resistant to the arrays of commonly used antibiotics (Magazine et al, 2013) (Kim et al, 2012). ESBL-producing bacteria have also been abundantly isolated from both clinical samples (Önnberg et al, 2011;Nasrin et al, 2010) and non-clinical samples (Sapkota et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Bacterial Etiology of Bronchoalveolar Lavage Fluid in Tertiary Care Patients and Antibiogram of the Isolates

Adhikari

Regmi

Pandey

et al. 2021

J. Inst. Sci. Tech.

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Bronchoalveolar Lavage (BAL) is a medical technique by which cells and fluids from bronchioles and lung alveoli are withdrawn for diagnosis of disease or evaluation of treatment. Patients with various pulmonary infections follow the procedure of BAL for the disease diagnosis as it has high sensitivity and reliability in diagnosis. To examine the bacterial etiology of BAL fluids among tertiary care patients with pulmonary infections, a cross-sectional study was conducted over a period of three months from August to November 2018. A total of 149 BAL fluid samples were examined and the bacterial agents were isolated and identified by conventional microbiological methods. Out of the 149 samples, 142 samples were culture positive. Among 6 different isolates (4 Gram-negative and 2 Gram-positive), Pseudomonas aeruginosa (45 %) was predominant followed by Klebsiella pneumoniae (25.3 %). A higher infection rate was seen among males (62.4 %) and in the age group 60-70 years (30.0 %). In addition, 25.4 % (36/149) samples were positive in Acid Fast staining. Bacterial recovery from the BAL fluid was significantly associated with the gender and age of the patients (p<0.05). Gentamycin was the least resisted (1.5 %) by Gram-negative isolates followed by Polymyxin-B (3 %). For Gram-positive isolates, Ofloxacin was the most effective drug resisted by none of the isolates followed by Gentamycin. Among the 157 isolates, 125 (79.6 %) were MDR and 35.0 % of Enterobacteriaceae were ESBL producers. Detection of bacterial agents from BAL fluid can be a basis for successful antimicrobial therapy for patients with pulmonary infections.

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Prevalence and Antibiograms of Uropathogens from the Suspected Cases of Urinary Tract Infections in Bharatpur Hospital, Nepal

Cited by 10 publications

References 18 publications

Efficacy of Urine Dipstick Test in Diagnosing Urinary Tract Infection and Detection of the blaCTX-M Gene among ESBL-Producing Escherichia coli

Efficacy of Urine Dipstick Test in Diagnosing Urinary Tract Infection and Detection of the blaCTX-M Gene among ESBL-Producing Escherichia coli

Prevalence of CTX-M β-Lactamases Producing Multidrug Resistant Escherichia coli and Klebsiella pneumoniae among Patients Attending Bir Hospital, Nepal

Bacterial Etiology of Bronchoalveolar Lavage Fluid in Tertiary Care Patients and Antibiogram of the Isolates

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