Nosocomial Isolates and Their Drug Resistant Pattern in ICU Patients at National Institute of Neurological and Allied Sciences, Nepal

Abstract

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.

Carbapenem-Resistant Acinetobacter baumannii and Enterobacteriaceae in South and Southeast Asia

“…Carbapenem resistance among AB isolates ranged from 17% to 98% in hospitals in Kathmandu (98)(99)(100). In a single university hospital study where the AB isolates from 2013 and 2014 underwent a molecular workup, all isolates were positive for OXA carbapenemases, with OXA-23 found in all isolates (98).…”

Microbiological profile of infection in intensive care unit and their antimicrobial susceptibility pattern with special reference to metallo beta-lactamases and AmpC

“…In similar such study by Al-Jebouri [25] quoted 28.1% and Patel and Garala [26] quoted 34.14% of nosocomial UTI. Ranjan et al [27] reported 57.14% of device-related nosocomial pneumonia, in a similar study by Bhandari et al [19] it was 74.3%. A similar study by Deep and Ghildiyal et al cited male to female ratio of the incidence of nosocomial infection as 3:2.…”

“…[5] Bhandari et al from Kathmandu, Nepal, had 60.88% of HAIs rate in ICU patients at National Institute of Neurological and Allied Sciences, Nepal. [19] In a study by Zaveri et al the infection rate among ICU patients due to various organism was 31.33%, the predominantly isolated organism was E. coli (25%), coagulasenegative Staphylococci (16.4%), Acinetobacter spp. (15.62%), Klebsiella spp.…”

“…High prevalence of overall weak and strong AmpC-β-lactamase produced was detected in Acinetobacter baumannii 87.5%, followed by Klebsiella pneumonia 66.67%, Escherichia coli 37.5%, Enterobacter aerogenes 33.33%, and Pseudomonas aeruginosa 33.33%. Bhandari et al [19] reported 31.28 % of isolate were AmpC producers. Moreover, the high prevalence of AmpCβ-lactamase was detected in Acinetobacter spp.…”

“…High level of AmpC production is typically associated with the resistance to all β-lactam antibiotics except carbapenems and limits the therapeutic use. Bhandari et al [19] cited 64.7% of prevalence of MBL producer organism. Moreover, among them 63.63 % were Acinetobacter spp.…”