Multidrug resistant organisms are increasing day by day and the cause is poorly known. This study was carried out from June 2011 to May 2012 at National Institute of Neurological and Allied Sciences Kathmandu, Nepal, with a view to determining drug resistant pathogens along with detection of extended spectrum β-lactamase (ESBL), AmpC β-lactamase (ABL), and metallo-β-lactamase (MBL) producing bacteria causing infection to ICU patients. A standard methodology was used to achieve these objectives as per recommendation of American Society for Microbiology. ESBL was detected by combined disc assay using cefotaxime and cefotaxime clavulanic acid, ABL by inhibitor based method using cefoxitin and phenylboronic acid, and MBL by imipenem-EDTA combined disk method. Two hundred and ninety-four different clinical samples such as tracheal aspirates, urine, pus, swabs, catheter tips, and blood were processed during the study. Most common bacteria were Acinetobacter spp. Of the total 58 Acinetobacter spp., 46 (79%) were MDR, and 27% were positive for ABL and 12% were for MBL. Of the 32 cases of Staphylococcus aureus, 18 (56%) were MDR. Findings of this study warrant routine β-lactamase testing in clinical isolates.

Introduction: Emergency Department (ED) revisit shortly after discharge not only increases the workload but also impacts healthcare cost and quality of patient care. The main aim of this study was to determine the rates, causes, and outcome of revisits within 72 h of ED. Method: A cross-sectional study over six months was carried out in the ED of Patan Hospital, Patan Academy of Health Science (PAHS). All patients who revisited an ED within 72 h of the initial visit were included. Variables studied were age-group, gender, chief complaints, diagnosis of initial and revisit. Study was ethically approved by the Institutional Review Committee of PAHS. Data were analyzed descriptively using MS Excel and SPSSversion20. Result: Out of 23,879 cases, 280(1.2%) revisited the ED within 72 h. Fever was the most common symptom accounting for 109(38.9%) patients of total revisit cases. In 190(67.9%) patients, the main reason for the visit was due to the symptoms not getting better. Around two-third i.e. 177(63.2%) of revisits were discharged and 103(36.8%) were admitted. Maximum revisits were found to be done among the 20-59y age group. Conclusion: The main reason for the revisit to ED was due to the persistence of the previous symptoms.