Introduction: This study had two objectives: 1) to determine the clinical and microbiological profiles of patients developing intravascular catheter-related local (localized catheter colonization and exit site) and systemic infections and their predisposing factors; 2) to study the antibiotic sensitivity patterns of the organisms isolated. Methodology: This case-control study was conducted over 19 months involving 232 patients at a tertiary care hospital. Non-tunneled central venous catheters and midline catheters were the two types studied. Catheter tips were processed using Maki's roll plate and endoluminal flush techniques. Blood cultures were drawn under strict aseptic precautions and processed by the BacT ALERT system. A "case" was any patient with proven localized catheter colonization, exit site infection or blood-stream infection and a "control" was any patient from whom the intravascular catheter yielded no organism in semi-quantitative cultures. Results and Conclusions: The incidence of catheter-related blood-stream infections (CRBSI) in our institute was 8.75 per 1,000 catheter days. The commonest organisms causing local infections were coagulase-negative Staphylococci, and those causing CRBSI were Staphylococcus aureus. Multidrug-resistant organisms accounted for 30.2% of the infections. Risk factors for development of catheter-related infections included an immune compromised state, duration of the catheter in situ, femoral venous cannulation, and triple lumen catheters. Choice of venous cannulation to minimize the risk of catheter-related infection in ascending order for risk of infection is the subclavian vein, jugular vein, basilic vein and then the femoral vein. There was no role for empirical antibiotic therapy to prevent intravascular catheter-related local or systemic infections.

Background: The intestinal coccidian protozoa Cyclospora cayetanensis has emerged as an important cause of parasitic diarrhea among children living in developing countries. This study aimed to determine the prevalence of Cyclospora among the school children of Kathmandu with reference to various associated risk factors.Methodology: A total of five hundred and seven stool samples from students between the age of 3–14 years, studying in 13 different schools in Kathmandu were collected during the study period (May–November, 2014) and processed at the Public Health Research Laboratory, Institute of Medicine, Kathmandu, Nepal. A modified acid fast staining technique (Kinyoun’s method) was used to detect oocyst of Cyclospora from the formal-ether concentrated stool samples.Results: Cyclospora was detected in 3.94% (20/507) of the stool samples examined. The prevalence was found to be highest among the students in the 3–5 year age group i.e. 10.15% (13/128), peaking during the rainy season (June–August). The detection rate was found to be significantly higher (p < 0.05) among children presenting with diarrheal symptoms, household keeping livestock and consumers of raw vegetables/fruits, showing a prevalence of 10.57% (11/104), 10.11% (9/89) and 7.25% (14/193) respectively.Conclusion: Consumption of untreated drinking water, fresh produce (raw fruits/vegetables) without proper washing and the presence of livestock at home were found to be predisposing factors for higher susceptibility of infection due to Cyclospora. This finding confirms the existence of a public-health issue with potentially serious consequences whereby children can be infected through exposure to oocysts in contaminated food and water and get ill as a result.

f Recently, CTX-M-type extended-spectrum-␤-lactamase (ESBL)-producing Escherichia coli strains have emerged worldwide. In particular, E. coli with O antigen type 25 (O25) and sequence type 131 (ST131), which is often associated with the CTX-M-15 ESBL, has been increasingly reported globally; however, epidemiology reports on ESBL-producing E. coli in Asia are limited. Patients with clinical isolates of ESBL-producing E. coli in the Tribhuvan University teaching hospital in Kathmandu, Nepal, were included in this study. Whole-genome sequencing of the isolates was conducted to analyze multilocus sequence types, phylotypes, virulence genotypes, O25b-ST131 clones, and distribution of acquired drug resistance genes. During the study period, 105 patients with ESBL-producing E. coli isolation were identified, and the majority (90%) of these isolates were CTX-M-15 positive. The most dominant ST was ST131 (n ‫؍‬ 54; 51.4%), followed by ST648 (n ‫؍‬ 15; 14.3%). All ST131 isolates were identified as O25b-ST131 clones, subclone H30-Rx. Three ST groups (ST131, ST648, and non-ST131/648) were compared in further analyses. ST648 isolates had a proportionally higher resistance to non-␤-lactam antibiotics and featured drug-resistant genes more frequently than ST131 or non-ST131/648 isolates. ST131 possessed the most virulence genes, followed by ST648. The clinical characteristics were similar among groups. More than 38% of ESBL-producing E. coli isolates were from the outpatient clinic, and pregnant patients comprised 24% of ESBL-producing E. coli cases. We revealed that the high resistance of ESBL-producing E. coli to multiple classes of antibiotics in Nepal is driven mainly by CTX-M-producing ST131 and ST648. Their immense prevalence in the communities is a matter of great concern. E scherichia coli is a part of the normal human and animal gastrointestinal flora; it is the most common cause of urinary tract infections and also causes various other infectious conditions, such as intra-abdominal infections, neonatal meningitis, and septicemia (1-3).Recently, extended-spectrum-beta-lactamase (ESBL) producing E. coli strains, particularly strains producing CTX-M-type ESBLs, have emerged worldwide (4). In particular, E. coli with O antigen type 25 (O25) and sequence type 131 (ST131) is often associated with the CTX-M-15 ESBL and has been increasingly reported globally. These bacteria are resistant to classes of antibiotics distinct from ␤-lactams, such as fluoroquinolones and trimethoprim-sulfamethoxazole (5, 6). Epidemiology reports on ESBLproducing E. coli in Asia are limited to date. To the best of our knowledge, there has been no report on the prevalence of pandemic ESBL-producing E. coli ST131, or other potentially dominant ESBL-producing E. coli STs, or clinical and microbiological information pertaining to their isolation in Nepal. Nepal is located in south Asia and adjacent to India, where a high proportion of resistant Gram-negative bacteria has been reported (7); understanding the epidemiology of ESBL-producing E. coli in t...

Introduction: Cyclospora cayetanensis is a coccidian parasite that causes recurrent gastroenteritis among children living under poor sanitary condition and adults from industrialized countries who lived or traveled in endemic developing countries. Methods: A total of 1842 stool specimens from gastroenteritis patients were examined between March 2006 to February 2007 and collected various types of faecal specimens from human, animals and samples of water and green leafy vegetables. Results: Of 1842 stool specimens collected from different areas of Nepal, 146 (7.9 %) were found to be positive for Cyclospora cayetanensis. with the majority were from children 2-9 years of age. The highest rate of infections was found in the month of June; (31.6%). Cyclospora cayetanensis were found to be contaminated in green vegetables including leaves of basil, mint leaves, water sources and feces of domestic animals and these findings were presented in the paper. Conclusion: Cyclospora-like oocysts were detected in vegetables leaves, feces of domestic animals and water sources. The results suggest that water, vegetables and domestic animals are possible sources of infection in Nepal. The study also obtained more information on Cyclospora cayetanensis a coccidian parasite that infect humans especially children and causes prolonged diarrhea and life threatening infestation. Key words: Cyclospora cayetanensis, source, Nepal DOI: 10.3126/jnps.v30i1.2456 Journal of Nepal Paediatric Society Vol.30(1) 2010 23-30

A B S T R A C TObjectives: The aim of this study was to describe the emergence in Nepal of clinical isolates of Klebsiella pneumoniae harboring both bla NDM-5 and bla OXA-181/-232 . Methods: Six clinical isolates of K. pneumoniae highly resistant to carbapenems and aminoglycosides were obtained from inpatients in Nepal. Their whole genomes were sequenced by a next generation sequencer.Results: The minimum inhibitory concentrations of meropenem, amikacin and ciprofloxacin were 128 m g/ml, >1024 mg/ml and 256 mg/ml, respectively. All six isolates co-harbored bla NDM-5 , bla OXA-181 or -232 and rmtB. Of them, 1 also harbored rmtF. The bla NDM-5 , bla OXA-232 and rmtB in all six isolates were located on plasmids. Of the six isolates tested, one isolate harbored two copies of bla OXA-181 and rmtF on the chromosome. Conclusions: This is the first report of clinical isolates of K. pneumoniae co-harboring bla NDM-5 , bla OXA-181 or -232 and rmtB in Nepal. These strains were highly carbapenem-and aminoglycoside-resistant, and belonged to ST147 or ST395. Of them, ST147 isolate harbored two copies of bla OXA-181 on the chromosome.