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

Abstract

Bronchoalveolar Lavage (BAL) is a medical technique by which cells and fluids from bronchioles and lung alveoli are withdrawn for diagnosis of disease or evaluation of treatment.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.

Beta-Lactamase-Producing Gram-Negative Bacterial Isolates Among the Patients Attending a Tertiary Care Hospital, Kathmandu, Nepal

“…The increase in antibiotic resistance is an intimidating major concern in Gram positive cocci, non-Enterobacteriaceae bacilli and Enterobacteriaceae family in clinical as well as non-clinical settings. [2][3][4][5][6] Among Gram negative bacteria, production of beta-lactamase remains the important contributing factor to beta lactams resistance as enzyme β-lactamase hydrolyses the β-lactam ring present in the antibiotics. 7 Classification of β-lactamases enzymes has usually been based on either the functional characteristics of the enzymes or their primary structure.…”

Antibiotic Susceptibility, Biofilm Production, and Detection of mecA Gene among Staphylococcus aureus Isolates from Different Clinical Specimens

“…In Nepal, the most common methods for detecting methicillin resistance are disc-diffusion with cefoxitin and oxacillin, with fewer reports on MIC determination and mec A gene identification by PCR [ 11 ]. In the past, various research in Nepal looked on the phenotypic prevalence of MRSA infections [ 12 , 13 , 14 , 15 ]. MRSA frequency has been found to range from 15 to 69% in different hospitals and laboratory settings in Nepal [ 13 , 14 , 15 , 16 , 17 , 18 , 19 ].…”

“…In the past, various research in Nepal looked on the phenotypic prevalence of MRSA infections [ 12 , 13 , 14 , 15 ]. MRSA frequency has been found to range from 15 to 69% in different hospitals and laboratory settings in Nepal [ 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. This study explores antimicrobial susceptibility patterns of clinical isolates of S. aureus from a tertiary hospital, examines their biofilm-forming capacity along with the detection of mec A gene.…”

Bacterial Assessment of Stethoscopes Used by Healthcare Workers at a Tertiary Care Government Hospital in Bharatpur, Nepal

“…Bacterial pathogens chiefly found on stethoscope swabs include Staphylococcus aureus , Enterobacteriales , Clostridium difficile , Pseudomonas spp., Acinetobacter spp., Bacillus spp., Corynebacterium spp., etc. [ 7 , 8 , 9 ]. Besides these organisms, contaminated stethoscopes can act as vectors for the transmission of an array of antibiotic-resistant bacteria, such as methicillin-resistant staphylococci and gentamicin-resistant Pseudomonas aeruginosa [ 2 ].…”

“…Besides these organisms, contaminated stethoscopes can act as vectors for the transmission of an array of antibiotic-resistant bacteria, such as methicillin-resistant staphylococci and gentamicin-resistant Pseudomonas aeruginosa [ 2 ]. The emergence of ESBL-producing microorganisms is increasing at an alarming rate, and this does not stop in current clinical settings, as various studies of clinical samples [ 7 , 8 , 9 , 10 ], as well as hospital equipment [ 11 , 12 ], have revealed a high prevalence of multidrug-resistant ESBL- and MBL-producing organisms. Beta-lactamase production is a method bacteria employ to resist drugs such as the penicillins and cephalosporins [ 13 ].…”