Hari Prasad Kattel

Characterization of rotavirus causing acute diarrhoea in children in Kathmandu, Nepal, showing the dominance of serotype G12.

Diarrhoeal diseases are a major problem in developing countries. Though precise data on childhood mortality associated with diarrhoeal diseases in Nepal are not available, it has been estimated that approximately 25 % of child deaths are associated with diarrhoeal disease, particularly acute diarrhoea. The purpose of this study was to assess the incidence of rotavirus causing acute diarrhoea in children less than 5 years of age. A total of 525 children with acute diarrhoea in a childrens hospital of Kathmandu, Nepal, were enrolled between April and September 2011. The incidence of acute diarrhoea due to rotavirus was 25.9 % (136/525) as determined by ELISA. The percentage of rotavirus-infected males was higher (64.5 %) than females (35.5 %). The frequency of rotavirus cases was higher in children less than 2 years of age, among which the majority of cases (80.2 %) were in children between 6 and 24 months old (P<0.01). Genotypic characterization by RT-PCR revealed that the serotype G12 represented 55.9 % of cases in this study associated with P-types of either P[6], P[4] or P[8]. Further to this, a total of eight G/P combinations were identified, G12P[6] being the most common strain type of rotavirus in Nepal, with a prevalence rate of 46.4 %. The aim of this study was to find out the major genotypes of rotavirus causing acute diarrhoea in children.

Epidemiology of device-associated infections in an intensive care unit of a teaching hospital in Nepal: A prospective surveillance study from a developing country

HighlightsProspective epidemiological surveillance of device‐associated infections in an ICU of a major teaching hospital in Nepal.Higher incidences of DAIs‐VAP, CLABSI and CAUTI than that of developed countries.Major pathogens in DA‐HAIs were multidrug resistant Acinetobacter and Klebsiella spp.DA‐HAIs found associated with longer duration stay and higher crude mortality. Background: Device‐associated health care‐acquired infections (DA‐HAIs) in intensive care unit patients are a major cause of morbidity, mortality, and increased health care costs. Methods: A prospective, structured clinicomicrobiological surveillance was carried out for 3 common DA‐HAIs: ventilator‐associated pneumonia (VAP), central line‐associated bloodstream infection (CLABSI), and catheter‐associated urinary tract infection (CAUTI) present in the patients of an intensive care unit of a teaching hospital in Nepal. DA‐HAIs were identified using the Centers for Disease Control and Prevention definitions, and their rates were expressed as number of DA‐HAIs per 1,000 device‐days. Results: Overall incidence rate of DA‐HAIs was 27.3 per 1,000 patient‐days occurring in 37.1% of patients. The device utilization ratio for mechanical ventilation, central line catheter, and urinary catheter was 0.83, 0.63, and 0.78, respectively. The rates of VAP, CLABSI, and CAUTI were 21.40, 8.64, and 5.11 per 1,000 device‐days, respectively. Acinetobacter spp (32.7%), Klebsiella spp (23.6%), Burkholderia cepacia complex (12.7%), and Escherichia coli (10.9%) were the common bacterial pathogens. Most of the bacterial isolates associated with DA‐HAIs were found to be multidrug‐resistant. Conclusions: Incidence of DA‐HAIs in the study intensive care unit was high compared with that of developed countries. Formulation and implementation of standard infection control protocols, active surveillance of DA‐HAIs, and antimicrobial stewardship are urgently needed in our country.

Fact-finding Survey of Nosocomial Infection Control in Hospitals in Kathmandu, Nepal—A Basis for Improvement

The purpose of this study was to investigate the actual conditions of nosocomial infection control in Kathmandu City, Nepal as a basis for the possible contribution to its improvement. The survey was conducted at 17 hospitals and the methods included a questionnaire, site visits and interviews. Nine hospitals had manuals on nosocomial infection control, and seven had an infection control committee (ICC). The number of hospitals that met the required amount of personal protective equipment preparation was as follows: gowns (13), gloves (13), surgical masks (12). Six hospitals had carried out in-service training over the past one year, but seven hospitals responded that no staff had been trained. Eight hospitals were conducting surveillance based on the results of bacteriological testing. The major problems included inadequate management of ICC, insufficient training opportunities for hospital staff, and lack of essential equipment. Moreover, increasing bacterial resistance to antibiotics was recognized as a growing issue. In comparison with the results conducted in 2003 targeting five governmental hospitals, a steady improvement was observed, but further improvements are needed in terms of the provision of high quality medical care. Particularly, dissemination of appropriate manuals, enhancement of basic techniques, and strengthening of the infection control system should be given priority.

Enterohaemorrhagic Escherichia coli (E.coli O157): A Case Report from Nepal

E.coli O157 is one of the important causes of bloody diarrhea which can be self-limiting or may complicate into Haemolytic Ureaemic Syndrome (HUS). We are reporting a case of Enterohaemorrhagic Escherichia coli (E.coli O157) in a thirty year old male who presented to the surgical OPD of Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal with the complaint of bloody diarrhea and abdominal pain along with the history of consumption of food in local restaurant. Stool sample of the patient was processed to find out the cause of bloody diarrhea. Microscopic examination of the stool sample revealed plenty of red blood cells but no pus cells. Stool culture on MacConkey agar revealed lactose fermenting (pink) colonies whereas on sorbitol MacConkey agar, sorbitol fermenting (pink) and non-sorbitol fermenting (pale) colonies were isolated. Both the sorbitol fermenting and non-fermenting isolates were identified as Escherichia coli on the basis of biochemical tests. The non-sorbitol fermenting colonies which were identified as Escherichia coli were serotyped which were positive on polyvalent antisera 3 and monovalent antisera O157. Therefore, on the basis of biochemical reaction and serotyping, Escherichia coli O157 (Enterohaemorrhagic E. coli) was identified as the cause of the bloody diarrhea. The patient was managed symptomatically without any antibiotics and got improved in few days without any complication.