Aims: Nosocomial infection is a major problem in the world today. Methicillin-resistant Staphylococcus aureus (MRSA) strains, usually resistant to several antibiotics and also intrinsic resistance to ß-lactam antibiotics, shows a particular ability to spread in hospitals and now present in most of the countries. The present study was carried out to investigate the prevalence of MRSA and their rate of resistance to different antistaphylococcal antibiotics. Materials and methods: Between April 2007 and December 2009, the clinical specimens submitted at the microbiology laboratory were processed and all Staphylococcus aureus (S. aureus) isolates were included in this study. All isolates were identified morphologically and biochemically by standard laboratory procedures and antibiotic susceptibility pattern including oxacillin was determined by modified Kirby Bauer disc diffusion method. Results: Out of a total of 348 Staphylococcus aureus strains isolated from various clinical samples, 138 (39.6%) were found to be Methicillin-resistant. Among MRSA isolates, 86(62.3%) were from different inpatient departments, whereas, 52(37.7%) of the isolates were from outpatients. All MRSA were resistant to penicillin. More than 70% of the MRSA strains were resistant to cephalexin, ciprofloxacin and cloxacillin, while less than 10% of them were resistant to azithromycin, amikacin and tetracycline. Many MRSA strains were multidrug resistant. However, no strains were resistant to vancomycin. Conclusion: This preliminary report showed a high prevalence of MRSA in our hospital. To reduce the prevalence of MRSA, regular surveillance of hospital acquired infection and isolation is the need of the hour. Key words: Nosocomial infection; methicillin-resistant Staphylococcus aureus (MRSA); multidrug resistant. DOI: 10.3126/jcmsn.v6i1.3595 Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 1, 1-6

Objective The present study has been undertaken to detect the presence of ESBLs producing Klebsiella species in various clinical specimens and their antibiotic susceptibility pattern. Materials and methods The study consists of 60 clinical isolates of Klebsiella species from various clinical specimens submitted to the microbiology laboratory, Kasturba Medical College Teaching Hospital Mangalore over a period of one year, between 1st January 2007 to 31st December, 2007. All isolates were identified morphologically and biochemically by standard procedures and ESBLs production was detected by re-arranging routine discs in a novel predictor disc approximation method. Antimicrobial susceptibility was performed using Kirby-Bauer disc-diffusion method where Imipenem disc, an inducer was placed in center and on either side of it at 15mm distance were placed ceftazidime and cefotaxime (indicator of induction). In addition, another inducer cefoxitin was placed 15mm from cefotaxime (indicator). This was placed opposite to that of ceftazidime + clavulanic acid to avoid any affect of inducible beta-lactamase on the zone of inhibition of the latter. Results A total of 16 out of 60 Klebsiella isolates (26.66%) were found to be ESBL producers. Conclusions Imipenem was found to be the most effective antibiotic (46.66%) followed by Cefoxitin (31.66%) and Cefotaxime (30.00%). Key words: Klebsiella species; clinical specimens; ESBLs DOI: 10.3126/jcmsn.v6i3.4070Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 3 pp.19-23

ObjectivesScrub typhus is an emerging neglected tropical disease, reported from many parts of Asia including Nepal. This study aims to determine the seroepidemiology of scrub typhus among febrile patients attending Chitwan Medical College Teaching Hospital (CMC-TH), Bharatpur, Nepal.Study design and settingThis was a hospital laboratory-based prospective study conducted in CMC-TH (a 750-bed hospital) located in Bharatpur, Chitwan district of Nepal.ParticipantsA total of 1797 patients visiting CMC-TH with acute febrile illness (temperature more than 38°C) were enrolled in this study.MethodsA total of 1797 blood samples were collected from patients presenting with acute febrile illness. The samples were processed for detection of antibody for scrub typhus by ELISA for specific IgM antibody and Weil-Felix test.ResultsOut of 1797 serum sample of febrile patients, 524 (29.2%) were scrub typhus positive. Maximum seropositive cases were from Chitwan district, 271 (51.7%) with predominance among women, 314 (35.9%). Scrub typhus was common among age group 51–60 years (37.2%) and farmers, 182 (37.8%). Highest seropositivity was found in July, 60 (57.7%). Fever was common clinical symptom. Thrombocytopenia was seen in 386 (73.7%) and raised transaminase aspartate aminotransferase, 399 (76.1%) among seropositive cases. Weil-Felix test positive were 397 (22.1%) and IgM ELISA positive were 524 (29.2%). The correlation between IgM ELISA and Weil-Felix test showed statistically significant association (r=0.319, p<0.001).ConclusionHigh prevalence of scrub typhus implies that patients with acute febrile illness should be investigated for scrub typhus with high priority. There is utmost need of reliable diagnostic facilities at all levels of healthcare system in Nepal. Infection with scrub typhus was found high and this calls for an urgent need to introduce vaccine against scrub typhus. More sustain and vigorous awareness programmes need to be promoted for early diagnosis, treatment and control.

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