The Resistance Patterns in E. coli Isolates among Apparently Healthy Adults and Local Drivers of Antimicrobial Resistance: A Mixed-Methods Study in a Suburban Area of Nepal

Abstract

Evidence-based decision-making to combat antimicrobial resistance (AMR) mandates a well-built community-based surveillance system for assessing resistance patterns among commensals and pathogenic organisms. As there is no such surveillance system in Nepal, we attempted to describe the antimicrobial resistance pattern in E. coli isolated from the fecal samples of apparently healthy individuals in Dhulikhel municipality and also explored the local drivers of AMR. We used a mixed-method design with a cross-sectional quantitative component and a descriptive qualitative component, with focus group discussion and key informant interviews as the data collection method. Fecal samples were collected from 424 individuals randomly selected for the study. E. coli was isolated from 85.9% of human fecal samples, of which 14% were resistant to ≥3 class of antimicrobials (multidrug resistant). Of the 368 isolates, resistance to ampicillin (40.0%), tetracycline (20.7%) and cefotaxime (15.5%) were most prevalent. The major drivers of AMR were: lack of awareness of AMR, weak regulations on sales of antimicrobials, poor adherence to prescribed medications, and incomplete dosage due to financial constraints. These findings indicate the need for strict implementation of a national drug act to limit the over-the-counter sales of antimicrobials. Additionally, awareness campaigns with a multimedia mix are essential for educating people on AMR.

Molecular Detection of Some Efflux Pumps Genes in Escherichia Coli Isolated from Patients with Urinary Tract Infections in Baqubah City, Iraq

“…The results of the current study with regard to the tetracycline antibiotic, the percentage of Escherichia coli resistance to this antibiotic was (96%), as the results of this study were not consistent with the results reached by the researcher (18) as the resistance rate to the tetracycline antibiotic in Escherichia coli was (57%). Also, the results of my current study were inconsistent with the results reached by the researcher (26) as the percentage of resistance to this antibiotic was (20.7%). coli resistance to tetracyclines is due to the presence of the efflux pump of the master facilitator superfamily (MFS) type efflux pumps drive tetracycline out of the cell.…”

Drivers of inappropriate use of antimicrobials in South Asia: A systematic review of qualitative literature

“…After removing 11 duplicates and 1 preprint, 161 publications underwent abstract review, then 50 to full-text review. 46 publications were included in the final analysis [ 25 – 70 ], with publication dates ranging from 2010 to 2023. Table 3 includes a detailed description of the 46 publications that met criteria and were included in the final analysis.…”

“…Multiple studies reported that patients self-treat with antimicrobials due to multiple barriers, with socioeconomic status cited most frequently [ 27 , 28 , 30 , 45 , 48 , 53 , 70 ]. For example, patients living in rural villages may not have adequate funds to travel to formal health care facilities and obtain diagnostic testing and prescriptions [ 26 , 37 , 51 ].…”

Drivers of inappropriate use of antimicrobials in South Asia: A systematic review of qualitative literature

“…After removing 11 duplicates and 1 preprint, 161 publications underwent abstract review, then 50 to full-text review. 46 publications were included in the final analysis (25–70), with publication dates ranging from 2010 to 2023.…”

“…The study by Hayat et al (2019) indicated several barriers in ASP implementation in hospitals, which could be overcome if the government were to provide necessary support, including legislation and funding (50). Other studies noted that even in countries with existing government regulation and legislation, it is difficult to navigate, understand, and consistently enforce these policies in clinical settings (67,69,70). In a study of policymakers and clinicians in Bhutan and Nepal, Maki et al 2020 described policies related to prescription-only sales of antimicrobials, but a lack of enforcement in both the clinical and community settings (95).…”