Shyam Kumar Mishra

Emerging threat of multidrug resistant bugs – Acinetobacter calcoaceticus baumannii complex and Methicillin resistant Staphylococcus aureus

BackgroundInfections caused by bacteria such as multidrug resistant (MDR) Acinetobacter spp. and methicillin-resistant Staphylococcus aureus (MRSA) constitute a worldwide pandemic. Without gathering information about these strains, we cannot reduce the morbidity and mortality due to infections caused by these notorious bugs.MethodsThis study was conducted to identify the status of MDR Acinetobacter spp. and MRSA in a tertiary care centre of Nepal. Sputum, endotracheal aspirate and bronchial washing specimens were collected and processed from patients suspected of lower respiratory tract infection following standard microbiological methods recommended by the American Society for Microbiology (ASM). Double disk synergy test method was employed for the detection of extended-spectrum beta-lactamase (ESBL) in Acinetobacter isolates. Methicillin resistance in S. aureus was confirmed by using cefoxitin and oxacillin disks.ResultsDifferent genomespecies of Acinetobacter were isolated; these consisted of Acinetobacter calcoaceticus baumannii complex and A. lwoffii. Around 95% of Acinetobacter isolates were MDR, while 12.9% were ESBL-producer. Of the total 33 isolates of S. aureus, 26 (78.8%) were MDR and 14 (42.4%) were methicillin resistant.ConclusionsA large number of MDR Acinetobacter spp. and MRSA has been noted in this study. The condition is worsened by the emergence of ESBL producing Acinetobacter spp. Hence, judicious use of antimicrobials is mandatory in clinical settings. Moreover, there should be vigilant surveillance of resistant clones in laboratories.

Dissemination of multidrug-resistant Klebsiella pneumoniae clinical isolates with various combinations of carbapenemases (NDM-1 and OXA-72) and 16S rRNA methylases (ArmA, RmtC and RmtF) in Nepal

2008 0812M7303 Typhimurium 193 blaCTX-M-55 M 50 Thailand CHL, CIP, FFN, GEN, SUL, STR, TET 0811R10895 Typhimurium RDNC blaCTX-M-1 M 1 Unknown SUL,TET 0809W37247 Stanley blaCMY-2-like F 37 No AMC, CHL, FFN, SUL, STR, TET 0809F35063 Stanley blaCMY-2-like F 6 Unknown AMC, CHL, FFN, GEN, SUL, STR, TET 0808S63221 Typhimurium NT blaCMY-2-like M 20 Thailand AMC, CHL, FFN, SUL, STR, TET 0807F21428 Stanley blaCMY-2-like F 22 Thailand AMC, CHL, FFN, GEN, SUL, STR, TET 0806H16365 Stanley blaCMY-2-like M 2 Unknown AMC, CHL, FFN, GEN, SUL, STR, TET 0806R9615 Typhimurium U292 blaCTX-M-3 M 12 No None 0805R9530 Typhimurium NT blaCTX-M-14 M 47 Greece AMC, CHL, GEN, SUL, STR, TMP 2009 0911W58164 Heidelberg blaCTX-M-14 M 40 Egypt GEN, SUL, STR 0910W56953 subsp. enterica (I) blaCMY-2-like M 55 Thailand AMC, CHL, CIP, FFN, GEN, NAL, SUL, STR, TET 0910F48822 Isangi blaCMY-2-like, blaOXA-10 M <1 South Africa AMC, CHL, CIP, FFN, GEN, NAL, SUL, STR, TET, TMP

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.

Identification of a Novel 6′-N-Aminoglycoside Acetyltransferase, AAC(6′)-Iak, from a Multidrug-Resistant Clinical Isolate of Stenotrophomonas maltophilia

ABSTRACT Stenotrophomonas maltophilia IOMTU250 has a novel 6′-N-aminoglycoside acetyltransferase-encoding gene, aac(6′)-Iak. The encoded protein, AAC(6′)-Iak, consists of 153 amino acids and has 86.3% identity to AAC(6′)-Iz. Escherichia coli transformed with a plasmid containing aac(6′)-Iak exhibited decreased susceptibility to arbekacin, dibekacin, neomycin, netilmicin, sisomicin, and tobramycin. Thin-layer chromatography showed that AAC(6′)-Iak acetylated amikacin, arbekacin, dibekacin, isepamicin, kanamycin, neomycin, netilmicin, sisomicin, and tobramycin but not apramycin, gentamicin, or lividomycin.

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.

P3.143 Serological prevalence of antibodies to human immunodeficiency virus among nepalese population

Introduction HIV is one of the major public health problems in recent time. Because of limited work opportunities in Nepal, seasonal labour migration especially disadvantaged groups to overseas become common. Nepalese government is promoting overseas employment opportunities’ for its citizens because of poor absorption of growing labour force in the country. This study was aimed to determine the serological prevalence of antibodies Human Immunodeficiency Virus (HIV) among the Nepalese population intended to depart overseas. Methods This study was conducted at Namaste Nepal Medical Centre and Polyclinic, Kathmandu, Nepal. Twenty Nine Thousand Four Hundred Forty One healthy populations were included for this study over a period from January 2013 to December 2014. The venous blood was collected aseptically and subjected to screening for anti HIV 1/2 (HIV Tri Dot, Jay Mitra, India) and confirmed by third generation HIV 1/2 ELISA (SD, Bio Lines, Korea) prior to overseas migration for labour employment. Data were analysed by using SPSS version 17.0 software. Results The serological prevalence of antibodies to HIV 1/2 were found to be 0.04% (11/29,441). Among the HIV infected population 0.03% (9/29,441) was male while only 0.01% (2/29,441) was female. Majority of the HIV infected people with HIV 1/2 was found to be 20–30 years old and belonging from disadvantaged groups like Dalit, Janajati and Kshetri. Conclusion The HIV seroprevalence showed decreasing trend, due to the cumulative effect of increasing awareness of HIV and better HIV testing and counselling (HTC) in Nepal. This study reflects that it would be alarming situation because young age population becomes more infected. Therefore, a continuous surveillance, advocacy and social mobilisation need to be considered for further improvements of transmission of HIV infection.

Clinicomycological Characterization of Superficial Mycoses from a Tertiary Care Hospital in Nepal.

Background. Superficial mycosis is a common fungal infection worldwide, mainly caused by dermatophytes. However, the prevalence of species varies geographically. In addition, fungal treatment is best guided according to species isolated. This study was carried out to determine the clinical as well as mycological profile of superficial mycoses in a tertiary care hospital, Nepal. Methods. This was a prospective case-control laboratory based study conducted over a period of six months from January to June 2014 at Tribhuvan University Teaching Hospital, Nepal. A total of 200 specimens were collected from the patients suspected of superficial mycoses. The specimens were macroscopically as well as microscopically examined. The growth was observed up to 4 weeks. Results. Out of total 200 specimens from the patients suspected of superficial mycoses, tinea corporis 50 (25%) was most common clinical types. KOH mount was positive in 89 (44.5%) and culture was positive in 111 (55.5%). Trichophyton mentagrophytes 44 (39.6%) was the most common isolate. Conclusions. The diagnostic yields of KOH mount and culture were found to be complementary to each other. Thus both the methods added with clinical findings are equally important to establish superficial mycosis.

The bad, the ugly and the demon: a tale of extensively drug-resistant, extended-spectrum-beta-lactamase- and metallo-beta-lactamase- producing superbugs associated with nosocomial pneumonia

Objective To determine the bacterial etiology of nosocomial pneumonia (NP) and to assess the current levels of antimicrobial resistance with special reference to the status of extended-spectrum-beta-lactamase (ESBL) and metallo-beta-lactamase (MBL)-producing bacterial strains in a university hospital of Nepal.