Background: Antibiotic prophylaxis is routinely administered in laparoscopic cholecystectomy but its role is debatable.

The occurrence of antibiotic resistant and metal tolerant coliform organisms was investigated in unpolluted upstream and polluted downstream Gomati River water. Increased levels of antibiotic resistance were found among downstream thermotolerant coliforms which included many multiple antibiotic-resistant (MAR) strains. Transmissibility of antibiotic resistance was demonstrated in 55.7°c of MAR isolates and the rate of transfer was between 1.36 x l0_4 and 1.8 x 10-11. Upstream coliform isolates were more tolerant to aluminium and copper than downstream isolates. Downstream coliform isolates exhibited tolerance to mercury which occurred frequently among MAR strains. The isolation rate of MAR coliforms and mercury-tolerant MAR strains was highest during the winter months.

This study, a first of its kind which was done in Nepal, was carried out by using the WHONET software to monitor, analyze and share the antimicrobial susceptibility data at various levels. This study was also aimed at building a surveillance network in Nepal, with the National Public Health Laboratory, Nepal, acting as a nodal centre. This would help in the formulation of antibiotic policies and in identifying hospital and community outbreaks at the nodal centre, as well as in sharing information with the clinicians at the local level.

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