Objectives: To determine antimicrobial resistance patterns, and the number and proportion of multidrug-resistant (MDR-) and extensively drug-resistant (XDR-) cases among all patients with Acinetobacter isolates between September 2018 and September 2019.
Design: This was a hospital laboratory-based, cross-sectional study.
Results: Acinetobacter spp. (n = 364) were more common in respiratory (n = 172, 47.3%) and invasive samples such as blood, body fluids (n = 95, 26.1%). Sensitivity to AWaRe (Access, Watch and Reserve) Group antibiotics (tigecycline, polymyxin B, colistin) remained high. MDR (resistance to at least three classes of antimicrobial agents) (n = 110, 30.2%) and XDR (MDR plus carbapenem) (n = 87, 23.9%) isolates were most common in the Watch Group of antibiotics and found in respectively 99 (31.0%) and 78 (24.5%) patients (n = 319). Infected patients were more likely to be aged >40 years (n = 196, 61.4%) or inpatients (n = 191, 59.9%); 76 (23.8%) patients had an unfavourable outcome, including death (n = 59, 18.5%).
Conclusion: A significant proportion of MDR and XDR isolates was found; nearly one patient in five died. Robust hospital infection prevention and control measures (particularly for respiratory and invasive procedures) and routine surveillance are needed to reduce infections and decrease the mortality rate. Tigecycline, polymyxin B and colistin should be cautiously used only in MDR and XDR cases.
{"title":"High antibiotic resistance and mortality with <i>Acinetobacter</i> species in a tertiary hospital, Nepal.","authors":"M Mahto, M Chaudhary, A Shah, K L Show, F L Moses, A G Stewart","doi":"10.5588/pha.21.0036","DOIUrl":"https://doi.org/10.5588/pha.21.0036","url":null,"abstract":"<p><strong>Setting: </strong>Nepal Mediciti Hospital, Bhainsepati, Lalitpur, Nepal.</p><p><strong>Objectives: </strong>To determine antimicrobial resistance patterns, and the number and proportion of multidrug-resistant (MDR-) and extensively drug-resistant (XDR-) cases among all patients with <i>Acinetobacter</i> isolates between September 2018 and September 2019.</p><p><strong>Design: </strong>This was a hospital laboratory-based, cross-sectional study.</p><p><strong>Results: </strong><i>Acinetobacter</i> spp. (<i>n</i> = 364) were more common in respiratory (<i>n</i> = 172, 47.3%) and invasive samples such as blood, body fluids (<i>n</i> = 95, 26.1%). Sensitivity to AWaRe (Access, Watch and Reserve) Group antibiotics (tigecycline, polymyxin B, colistin) remained high. MDR (resistance to at least three classes of antimicrobial agents) (<i>n</i> = 110, 30.2%) and XDR (MDR plus carbapenem) (<i>n</i> = 87, 23.9%) isolates were most common in the Watch Group of antibiotics and found in respectively 99 (31.0%) and 78 (24.5%) patients (<i>n</i> = 319). Infected patients were more likely to be aged >40 years (<i>n</i> = 196, 61.4%) or inpatients (<i>n</i> = 191, 59.9%); 76 (23.8%) patients had an unfavourable outcome, including death (<i>n</i> = 59, 18.5%).</p><p><strong>Conclusion: </strong>A significant proportion of MDR and XDR isolates was found; nearly one patient in five died. Robust hospital infection prevention and control measures (particularly for respiratory and invasive procedures) and routine surveillance are needed to reduce infections and decrease the mortality rate. Tigecycline, polymyxin B and colistin should be cautiously used only in MDR and XDR cases.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"11 Suppl 1","pages":"13-17"},"PeriodicalIF":1.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575387/pdf/i2220-8372-11-s1-13.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39732093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R Ghimire, H A Gupte, S Shrestha, P Thekkur, S Kharel, H P Kattel, P S Shrestha, N Poudel, S Shakya, S Parajuli, A Mudvari, J Edwards
Setting: Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Objectives: 1) To report the number and proportion of Pseudomonas, Acinetobacter, Burkholderia, Stenotrophomonas (PABS) species among intensive care unit (ICU) patients with sputum culture; and 2) to assess antimicrobial resistance patterns, demographic and clinical characteristics associated with resistance to at least one antibiotic and ICU discharge outcomes among those patients with PABS species admitted to hospital between 14 April 2018 and 13 April 2019.
Design: This was a hospital-based, cross-sectional study using secondary data.
Results: Of 166 who underwent sputum culture, 104 (63%) had bacterial growth, of which, 67 (64%) showed PABS species. Of the positive cultures, Pseudomonas, Acinetobacter, Burkholderia and Stenotrophomonas were present in respectively 32 (30.7%), 31 (29.8%), 1 (1%) and 3 (2.8%). Pseudomonas showed a high level of resistance to levofloxacin (61%), cefepime (50%) and amikacin (50%). Acinetobacter was largely resistant to cefepime (95%), imipenem (92%) and levofloxacin (86%). Of the 67 with PABS infection, 32 (48%) died.
Conclusion: The study showed a high prevalence of Pseudomonas and Acinetobacter and the emergence of Stenotrophomonas in sputum culture samples of ICU patients. This highlights the need for monitoring PABS and associated resistance patterns to reduce mortality in ICU patients.
{"title":"High drug resistance among Gram-negative bacteria in sputum samples from an intensive care unit in Nepal.","authors":"R Ghimire, H A Gupte, S Shrestha, P Thekkur, S Kharel, H P Kattel, P S Shrestha, N Poudel, S Shakya, S Parajuli, A Mudvari, J Edwards","doi":"10.5588/pha.21.0034","DOIUrl":"https://doi.org/10.5588/pha.21.0034","url":null,"abstract":"<p><strong>Setting: </strong>Tribhuvan University Teaching Hospital, Kathmandu, Nepal.</p><p><strong>Objectives: </strong>1) To report the number and proportion of <i>Pseudomonas, Acinetobacter, Burkholderia</i>, <i>Stenotrophomonas</i> (PABS) species among intensive care unit (ICU) patients with sputum culture; and 2) to assess antimicrobial resistance patterns, demographic and clinical characteristics associated with resistance to at least one antibiotic and ICU discharge outcomes among those patients with PABS species admitted to hospital between 14 April 2018 and 13 April 2019.</p><p><strong>Design: </strong>This was a hospital-based, cross-sectional study using secondary data.</p><p><strong>Results: </strong>Of 166 who underwent sputum culture, 104 (63%) had bacterial growth, of which, 67 (64%) showed PABS species. Of the positive cultures, <i>Pseudomonas, Acinetobacter, Burkholderia</i> and <i>Stenotrophomonas</i> were present in respectively 32 (30.7%), 31 (29.8%), 1 (1%) and 3 (2.8%). <i>Pseudomonas</i> showed a high level of resistance to levofloxacin (61%), cefepime (50%) and amikacin (50%). <i>Acinetobacter</i> was largely resistant to cefepime (95%), imipenem (92%) and levofloxacin (86%). Of the 67 with PABS infection, 32 (48%) died.</p><p><strong>Conclusion: </strong>The study showed a high prevalence of <i>Pseudomonas</i> and <i>Acinetobacter</i> and the emergence of <i>Stenotrophomonas</i> in sputum culture samples of ICU patients. This highlights the need for monitoring PABS and associated resistance patterns to reduce mortality in ICU patients.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"11 Suppl 1","pages":"64-69"},"PeriodicalIF":1.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39623771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: To assess 1) compliance with National Antibiotic Treatment Guidelines (NATG), specifically, whether the administration of surgical antibiotic prophylaxis (SAP) (initial dosing and redosing) was in compliance with NATG for patients who were and were not eligible, and 2) development of surgical site infections (SSIs) among patients who underwent surgery in the Department of General Surgery (July-December 2019).
Design: This was a retrospective cohort analysis.
Results: The analysis included 846 patients, of which 717 (85%) patients were eligible for SAP and 129 (15%) were ineligible. Of those eligible, 708 (99%) received the initial dose; while 65 (50%) of the ineligible did not receive any dose. Of those who received the initial dose, 164 (23%) were eligible for redosing. Of these, only 23 (14%) received at least one redosing and 141 (86%) did not receive it. Overall compliance with NATG was achieved in 75% (632/846) of patients. SSIs occurred in 23 (3%) patients, 8 (35%) of whom did not have SAP administered according to NATG.
Conclusion: A relatively high overall compliance with NATG for SAP administration was reported. Recommendations were made to improve compliance among those who were ineligible for SAP and those who were eligible for redosing.
{"title":"Surgical antibiotic prophylaxis administration practices.","authors":"S Shrestha, K Hann, K W Y Kyaw, P Koju, M Khogali","doi":"10.5588/pha.21.0027","DOIUrl":"10.5588/pha.21.0027","url":null,"abstract":"<p><strong>Setting: </strong>A referral hospital in Kavre, Nepal.</p><p><strong>Objectives: </strong>To assess 1) compliance with National Antibiotic Treatment Guidelines (NATG), specifically, whether the administration of surgical antibiotic prophylaxis (SAP) (initial dosing and redosing) was in compliance with NATG for patients who were and were not eligible, and 2) development of surgical site infections (SSIs) among patients who underwent surgery in the Department of General Surgery (July-December 2019).</p><p><strong>Design: </strong>This was a retrospective cohort analysis.</p><p><strong>Results: </strong>The analysis included 846 patients, of which 717 (85%) patients were eligible for SAP and 129 (15%) were ineligible. Of those eligible, 708 (99%) received the initial dose; while 65 (50%) of the ineligible did not receive any dose. Of those who received the initial dose, 164 (23%) were eligible for redosing. Of these, only 23 (14%) received at least one redosing and 141 (86%) did not receive it. Overall compliance with NATG was achieved in 75% (632/846) of patients. SSIs occurred in 23 (3%) patients, 8 (35%) of whom did not have SAP administered according to NATG.</p><p><strong>Conclusion: </strong>A relatively high overall compliance with NATG for SAP administration was reported. Recommendations were made to improve compliance among those who were ineligible for SAP and those who were eligible for redosing.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"11 Suppl 1","pages":"18-23"},"PeriodicalIF":1.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39623764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S Koirala, N P Shah, P Pyakurel, M Khanal, S K Rajbhandari, T Pun, B Shrestha, B Maharjan, S Karki, S Koirala, K B Tamang, A Roggi, A M V Kumar, N Ortuño-Gutiérrez
Setting: Nine drug-resistant TB centres, some of them supported by Damien Foundation in Nepal where >80% of multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB) patients are treated.
Objective: To assess the uptake, effectiveness and safety of the 9-12-month shorter treatment regimen (STR) in MDR/RR-TB patients registered from January 2018 to December 2019.
Design: This was a cohort study involving secondary programme data.
Results: Of 631 patients, 301 (48.0%) started and continued STR. Key reasons for ineligibility to start/continue STR were baseline resistance or exposure to second-line drugs (62.0%), contact with extensively drug-resistant TB (XDR-TB) or pre-XDR-TB (7.0%) patients and unavailability of STR drugs (6.0%). Treatment success was 79.6%; unsuccessful outcomes were death (12.0%), lost to follow-up (5.3%), failure (2.7%) and not evaluated (0.7%). Unsuccessful outcomes were significantly associated with HIV positivity and patient age ⩾55 years, with adjusted relative risk of respectively 2.39 (95% CI 1.52-3.77) and 3.86 (95% CI 2.30-6.46). Post-treatment recurrence at 6 and 12 months was respectively 0.5% and 2.4%. Serious adverse events (SAEs) were seen in 15.3% patients - hepatotoxicity and ototoxicity were most common.
Conclusion: STR had a modest uptake, high treatment success and low post-treatment recurrence. For proper detection and management of SAEs, improving pharmacovigilance might be considered. Availability of rapid diagnostic test for second-line drugs is crucial for correct patient management.
环境:九个耐药结核病中心,其中一些得到了尼泊尔达米安基金会的支持,超过80%的耐多药/耐利福平结核病(MDR/RR-TB)患者在这些中心接受治疗:评估2018年1月至2019年12月登记的MDR/RR-TB患者对9-12个月短期治疗方案(STR)的接受情况、有效性和安全性:这是一项涉及二级计划数据的队列研究:在 631 名患者中,301 人(48.0%)开始并继续接受 STR 治疗。不符合开始/继续 STR 的主要原因是基线耐药或接触过二线药物(62.0%)、接触过广泛耐药结核病(XDR-TB)或前 XDR-TB 患者(7.0%)以及无法获得 STR 药物(6.0%)。治疗成功率为 79.6%;失败率为死亡(12.0%)、失去随访(5.3%)、失败(2.7%)和未评估(0.7%)。不成功的结果与 HIV 阳性和患者年龄 ⩾55 岁明显相关,调整后的相对风险分别为 2.39 (95% CI 1.52-3.77) 和 3.86 (95% CI 2.30-6.46)。治疗后6个月和12个月的复发率分别为0.5%和2.4%。15.3%的患者出现了严重不良事件(SAE)--肝毒性和耳毒性最为常见:结论:STR 的使用率不高,治疗成功率高,治疗后复发率低。为了正确检测和处理 SAE,可以考虑改进药物警戒。提供二线药物的快速诊断测试对于正确管理患者至关重要。
{"title":"High success and low recurrence with shorter treatment regimen for multidrug-resistant TB in Nepal.","authors":"S Koirala, N P Shah, P Pyakurel, M Khanal, S K Rajbhandari, T Pun, B Shrestha, B Maharjan, S Karki, S Koirala, K B Tamang, A Roggi, A M V Kumar, N Ortuño-Gutiérrez","doi":"10.5588/pha.21.0041","DOIUrl":"10.5588/pha.21.0041","url":null,"abstract":"<p><strong>Setting: </strong>Nine drug-resistant TB centres, some of them supported by Damien Foundation in Nepal where >80% of multidrug-resistant/rifampicin-resistant TB (MDR/RR-TB) patients are treated.</p><p><strong>Objective: </strong>To assess the uptake, effectiveness and safety of the 9-12-month shorter treatment regimen (STR) in MDR/RR-TB patients registered from January 2018 to December 2019.</p><p><strong>Design: </strong>This was a cohort study involving secondary programme data.</p><p><strong>Results: </strong>Of 631 patients, 301 (48.0%) started and continued STR. Key reasons for ineligibility to start/continue STR were baseline resistance or exposure to second-line drugs (62.0%), contact with extensively drug-resistant TB (XDR-TB) or pre-XDR-TB (7.0%) patients and unavailability of STR drugs (6.0%). Treatment success was 79.6%; unsuccessful outcomes were death (12.0%), lost to follow-up (5.3%), failure (2.7%) and not evaluated (0.7%). Unsuccessful outcomes were significantly associated with HIV positivity and patient age ⩾55 years, with adjusted relative risk of respectively 2.39 (95% CI 1.52-3.77) and 3.86 (95% CI 2.30-6.46). Post-treatment recurrence at 6 and 12 months was respectively 0.5% and 2.4%. Serious adverse events (SAEs) were seen in 15.3% patients - hepatotoxicity and ototoxicity were most common.</p><p><strong>Conclusion: </strong>STR had a modest uptake, high treatment success and low post-treatment recurrence. For proper detection and management of SAEs, improving pharmacovigilance might be considered. Availability of rapid diagnostic test for second-line drugs is crucial for correct patient management.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"11 Suppl 1","pages":"38-45"},"PeriodicalIF":1.3,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39623767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S K Yadav, S K Agrawal, S K Singh, A Giri, G K Singh, R Ghimire, A G Stewart, K L Show, F L Moses
Setting: Nobel Medical College and Teaching Hospital, Biratnagar, Nepal.
Objective: To determine the pattern of antimicrobial resistance and hospital exit outcomes in neonates with suspected sepsis in a tertiary neonatal intensive care unit (NICU).
Design: This hospital-based cohort study was conducted to follow patients from January to December 2019. All identified cases of suspected sepsis were enlisted from hospital records.
Results: Sepsis was suspected in 177 (88%) of the 200 cases admitted in the NICU; 52 (29%) were culture-positive. Pseudomonas was the predominant organism isolated (n = 40; 78%), followed by coagulase negative staphylococcus (n = 12, 23%). Nine (17%) of the 52 isolates were resistant to the Access and Watch group of antibiotics, including some resistance to Reserve group drugs such as imipenem and linezolid. Most treated cases (n = 170, 96%) improved, although 7 (4%) left against medical advice.
Conclusion: Most of the pathogens were resistant to WHO Access and Watch antibiotics and occasional resistance was observed to Reserve group drugs. Most sepsis was caused by Gram-negative bacilli. Improving turnaround times for antibiotic sensitivity testing using point-of-care testing, and a greater yield of culture-positive results are needed to enhance the management of neonatal sepsis.
{"title":"Antimicrobial resistance in neonates with suspected sepsis.","authors":"S K Yadav, S K Agrawal, S K Singh, A Giri, G K Singh, R Ghimire, A G Stewart, K L Show, F L Moses","doi":"10.5588/pha.21.0038","DOIUrl":"10.5588/pha.21.0038","url":null,"abstract":"<p><strong>Setting: </strong>Nobel Medical College and Teaching Hospital, Biratnagar, Nepal.</p><p><strong>Objective: </strong>To determine the pattern of antimicrobial resistance and hospital exit outcomes in neonates with suspected sepsis in a tertiary neonatal intensive care unit (NICU).</p><p><strong>Design: </strong>This hospital-based cohort study was conducted to follow patients from January to December 2019. All identified cases of suspected sepsis were enlisted from hospital records.</p><p><strong>Results: </strong>Sepsis was suspected in 177 (88%) of the 200 cases admitted in the NICU; 52 (29%) were culture-positive. <i>Pseudomonas</i> was the predominant organism isolated (<i>n</i> = 40; 78%), followed by coagulase negative <i>staphylococcus</i> (<i>n</i> = 12, 23%). Nine (17%) of the 52 isolates were resistant to the Access and Watch group of antibiotics, including some resistance to Reserve group drugs such as imipenem and linezolid. Most treated cases (<i>n</i> = 170, 96%) improved, although 7 (4%) left against medical advice.</p><p><strong>Conclusion: </strong>Most of the pathogens were resistant to WHO Access and Watch antibiotics and occasional resistance was observed to Reserve group drugs. Most sepsis was caused by Gram-negative bacilli. Improving turnaround times for antibiotic sensitivity testing using point-of-care testing, and a greater yield of culture-positive results are needed to enhance the management of neonatal sepsis.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"11 Suppl 1","pages":"6-12"},"PeriodicalIF":1.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39732092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P Koju, X Liu, R Zachariah, M Bhattachan, B Maharjan, S Madhup, H D Shewade, A Abrahamyan, P Shah, S Shrestha, H Li, R Shrestha
Setting: Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu, Nepal.
Objectives: 1) To report the incidence of health-care-associated infections (HAIs), 2) to compare demographic, clinical characteristics and hospital outcomes in those with and without HAIs; and 3) to verify bacterial types in HAI and community-acquired infections (CAIs) among inpatients with invasive devices and/or surgical procedures.
Design: This was a cohort study using secondary data (December 2017 to April 2018).
Results: Of 1,310 inpatients, 908 (69.3%) had surgical procedures, 125 (9.5%) had invasive devices and 277 (21.1%) both. Sixty-six developed HAIs (incidence = 5/100 patient admissions, 95% CI 3.9-6.3). Individuals with HAIs had a 5.5-fold higher risk of longer hospital stays (⩾7 days) and a 6.9-fold risk of being in intensive care compared to the surgical ward. Unfavourable hospital exit outcomes were higher in those with HAIs (4.5%) than in those without (0.9%, P = 0.02). The most common HAI bacteria (n = 70) were Escherichia coli (44.3%), Enterococcus spp. (22.9%) and Klebsiella spp. (11.4%). Of 98 CAIs with 41 isolates, E. coli (36.6%), Staphylococcus aureus (22.0%) and methicillin-resistant S. aureus (14.6%) were common.
Conclusion: We found relatively low incidence of HAIs, which reflects good infection prevention and control standards. This study serves as a baseline for future monitoring and action.
地点:尼泊尔加德满都加德满都大学医院 Dhulikhel 医院尼泊尔加德满都加德满都大学医院 Dhulikhel 医院:1)报告医疗相关感染(HAIs)的发生率;2)比较有HAIs和无HAIs患者的人口统计学、临床特征和住院结果;3)验证有侵入性设备和/或外科手术的住院患者中HAI和社区获得性感染(CAIs)的细菌类型:这是一项使用二手数据(2017 年 12 月至 2018 年 4 月)进行的队列研究:在1310名住院患者中,908人(69.3%)进行了外科手术,125人(9.5%)使用了侵入性设备,277人(21.1%)同时使用了侵入性设备和/或外科手术。其中 66 人发生了 HAI(发生率 = 5/100,95% CI 3.9-6.3)。与外科病房相比,发生 HAI 的患者住院时间延长(⩾7 天)的风险高出 5.5 倍,入住重症监护室的风险高出 6.9 倍。出现 HAI 的患者(4.5%)的出院不良后果高于未出现 HAI 的患者(0.9%,P = 0.02)。最常见的 HAI 细菌(n = 70)为大肠埃希菌(44.3%)、肠球菌属(22.9%)和克雷伯菌属(11.4%)。在 98 例 CAI 中的 41 个分离株中,大肠杆菌(36.6%)、金黄色葡萄球菌(22.0%)和耐甲氧西林金黄色葡萄球菌(14.6%)很常见:我们发现 HAIs 的发生率相对较低,这反映了良好的感染预防和控制标准。这项研究为今后的监测和行动提供了基线。
{"title":"Incidence of healthcare-associated infections with invasive devices and surgical procedures in Nepal.","authors":"P Koju, X Liu, R Zachariah, M Bhattachan, B Maharjan, S Madhup, H D Shewade, A Abrahamyan, P Shah, S Shrestha, H Li, R Shrestha","doi":"10.5588/pha.21.0039","DOIUrl":"10.5588/pha.21.0039","url":null,"abstract":"<p><strong>Setting: </strong>Dhulikhel Hospital, Kathmandu University Hospital, Kathmandu, Nepal.</p><p><strong>Objectives: </strong>1) To report the incidence of health-care-associated infections (HAIs), 2) to compare demographic, clinical characteristics and hospital outcomes in those with and without HAIs; and 3) to verify bacterial types in HAI and community-acquired infections (CAIs) among inpatients with invasive devices and/or surgical procedures.</p><p><strong>Design: </strong>This was a cohort study using secondary data (December 2017 to April 2018).</p><p><strong>Results: </strong>Of 1,310 inpatients, 908 (69.3%) had surgical procedures, 125 (9.5%) had invasive devices and 277 (21.1%) both. Sixty-six developed HAIs (incidence = 5/100 patient admissions, 95% CI 3.9-6.3). Individuals with HAIs had a 5.5-fold higher risk of longer hospital stays (⩾7 days) and a 6.9-fold risk of being in intensive care compared to the surgical ward. Unfavourable hospital exit outcomes were higher in those with HAIs (4.5%) than in those without (0.9%, <i>P</i> = 0.02). The most common HAI bacteria (<i>n</i> = 70) were <i>Escherichia coli</i> (44.3%), <i>Enterococcus</i> spp. (22.9%) and <i>Klebsiella</i> spp. (11.4%). Of 98 CAIs with 41 isolates, <i>E. coli</i> (36.6%), <i>Staphylococcus aureus</i> (22.0%) and methicillin-resistant <i>S. aureus</i> (14.6%) were common.</p><p><strong>Conclusion: </strong>We found relatively low incidence of HAIs, which reflects good infection prevention and control standards. This study serves as a baseline for future monitoring and action.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"11 Suppl 1","pages":"32-37"},"PeriodicalIF":1.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39623766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R R Karn, R Acharya, A K Rajbanshi, S K Singh, S K Thakur, S K Shah, A K Singh, R Shah, S Upadhya Kafle, M Bhattachan, A Abrahamyan, H D Shewade, R Zachariah
Setting: Biratnagar Eye Hospital, Biratnagar, Nepal, which offers ear surgery for chronic suppurative otitis media (CSOM).
Objective: In patients with CSOM awaiting surgery, to determine the 1) sociodemographic characteristics 2) bacterial isolates and their antibiotic resistance patterns and 3) characteristics of those refused surgery, including antibiotic resistance.
Design: A cohort study using hospital data, January 2018-January 2020.
Results: Of 117 patients with CSOM and awaiting surgery, 64% were in the 18-35 years age group, and 79% were cross-border from India. Of 118 bacterial isolates, 80% had Pseudomonas aeruginosa and 16% had Staphylococcus aureus. All isolates showed multidrug resistance to nine of the 12 antibiotics tested. The lowest antibiotic resistance in P. aeruginosa was for vancomycin (29%) and moxifloxacin (36%), and for S. aureus, this was vancomycin (9%) and amikacin (17%). Fourteen (12%) patients underwent surgery: myringoplasty (n = 7, 50%), cortical mastoidectomy with tympanostomy (n = 4, 29%) and modified radical mastoidectomy (n = 3, 21%). Those infected with P. aeruginosa and with resistance to over six antibiotics were significantly more likely to be refused for surgery.
Conclusion: Patients awaiting ear surgery were predominantly infected with multidrug-resistant P. aeruginosa and were consequently refused surgery. This study can help inform efforts for improving surgical uptake and introducing cross-border antimicrobial resistance surveillance.
{"title":"Antibiotic resistance in patients with chronic ear discharge awaiting surgery in Nepal.","authors":"R R Karn, R Acharya, A K Rajbanshi, S K Singh, S K Thakur, S K Shah, A K Singh, R Shah, S Upadhya Kafle, M Bhattachan, A Abrahamyan, H D Shewade, R Zachariah","doi":"10.5588/pha.21.0029","DOIUrl":"10.5588/pha.21.0029","url":null,"abstract":"<p><strong>Setting: </strong>Biratnagar Eye Hospital, Biratnagar, Nepal, which offers ear surgery for chronic suppurative otitis media (CSOM).</p><p><strong>Objective: </strong>In patients with CSOM awaiting surgery, to determine the 1) sociodemographic characteristics 2) bacterial isolates and their antibiotic resistance patterns and 3) characteristics of those refused surgery, including antibiotic resistance.</p><p><strong>Design: </strong>A cohort study using hospital data, January 2018-January 2020.</p><p><strong>Results: </strong>Of 117 patients with CSOM and awaiting surgery, 64% were in the 18-35 years age group, and 79% were cross-border from India. Of 118 bacterial isolates, 80% had <i>Pseudomonas aeruginosa</i> and 16% had <i>Staphylococcus aureus</i>. All isolates showed multidrug resistance to nine of the 12 antibiotics tested. The lowest antibiotic resistance in <i>P. aeruginosa</i> was for vancomycin (29%) and moxifloxacin (36%), and for <i>S. aureus</i>, this was vancomycin (9%) and amikacin (17%). Fourteen (12%) patients underwent surgery: myringoplasty (<i>n</i> = 7, 50%), cortical mastoidectomy with tympanostomy (<i>n</i> = 4, 29%) and modified radical mastoidectomy (<i>n</i> = 3, 21%). Those infected with <i>P. aeruginosa</i> and with resistance to over six antibiotics were significantly more likely to be refused for surgery.</p><p><strong>Conclusion: </strong>Patients awaiting ear surgery were predominantly infected with multidrug-resistant <i>P. aeruginosa</i> and were consequently refused surgery. This study can help inform efforts for improving surgical uptake and introducing cross-border antimicrobial resistance surveillance.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"11 Suppl 1","pages":"1-5"},"PeriodicalIF":1.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39732091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P Baral, K Hann, B Pokhrel, T Koirala, R Thapa, S M Bijukchhe, M Khogali
Setting: Patan Hospital, a tertiary care hospital in Lalitpur District, Nepal.
Objectives: To describe the annual parenteral antibiotic consumption in 1) defined daily dose (DDD) and DDD per 100 admissions; 2) calculate DDD per 100 admissions and proportions by pharmacological subgroup, chemical subgroup and AWaRe categories; and 3) describe patient expenditure on parenteral antibiotics as a proportion of the total patient expenditure on drugs and consumables between 2017 and 2019.
Design: This was a cross-sectional study.
Results: Total DDD of parenteral antibiotics increased by 23% from 39,639.7 in 2017 to 48,947.7 in 2019. DDD per 100 admissions increased by 10% from 172.1 in 2017 to 190.2 in 2019. Other beta-lactam antibacterials comprised the most frequently consumed pharmacological subgroup. The chemical substance most often consumed was ceftriaxone, with an increasing trend in the consumption of vancomycin and meropenem. Parenteral antibiotics in 'Watch' category were the most consumed over the study period, with a decreasing trend in 'Access' and increasing trend in 'Reserve' categories.
Conclusion: We aimed to understand the consumption of parenteral antibiotics at a tertiary care hospital and found that Watch antibiotics comprised the bulk of antibiotic consumption. Overconsumption of antibiotics from the 'Watch' and 'Reserve' categories can promote antimicrobial resistance; recommendations were therefore made for their rational use.
{"title":"Annual consumption of parenteral antibiotics in a tertiary hospital of Nepal, 2017-2019: a cross-sectional study.","authors":"P Baral, K Hann, B Pokhrel, T Koirala, R Thapa, S M Bijukchhe, M Khogali","doi":"10.5588/pha.21.0043","DOIUrl":"10.5588/pha.21.0043","url":null,"abstract":"<p><strong>Setting: </strong>Patan Hospital, a tertiary care hospital in Lalitpur District, Nepal.</p><p><strong>Objectives: </strong>To describe the annual parenteral antibiotic consumption in 1) defined daily dose (DDD) and DDD per 100 admissions; 2) calculate DDD per 100 admissions and proportions by pharmacological subgroup, chemical subgroup and AWaRe categories; and 3) describe patient expenditure on parenteral antibiotics as a proportion of the total patient expenditure on drugs and consumables between 2017 and 2019.</p><p><strong>Design: </strong>This was a cross-sectional study.</p><p><strong>Results: </strong>Total DDD of parenteral antibiotics increased by 23% from 39,639.7 in 2017 to 48,947.7 in 2019. DDD per 100 admissions increased by 10% from 172.1 in 2017 to 190.2 in 2019. Other beta-lactam antibacterials comprised the most frequently consumed pharmacological subgroup. The chemical substance most often consumed was ceftriaxone, with an increasing trend in the consumption of vancomycin and meropenem. Parenteral antibiotics in 'Watch' category were the most consumed over the study period, with a decreasing trend in 'Access' and increasing trend in 'Reserve' categories.</p><p><strong>Conclusion: </strong>We aimed to understand the consumption of parenteral antibiotics at a tertiary care hospital and found that Watch antibiotics comprised the bulk of antibiotic consumption. Overconsumption of antibiotics from the 'Watch' and 'Reserve' categories can promote antimicrobial resistance; recommendations were therefore made for their rational use.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"11 Suppl 1","pages":"52-57"},"PeriodicalIF":1.3,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39623769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To determine antimicrobial resistance patterns and prevalence of multi- (MDR, i.e., resistant to ⩾3 classes of antimicrobial agents) and extensively (XDR, i.e., resistant to ⩾3, susceptible to ⩽2 groups of antibiotics) drug-resistant strains of Pseudomonas aeruginosa.
Methods: This was a cross-sectional study conducted in Nepal Mediciti Hospital, Lalitpur, Nepal, using standard microbiological methods with Kirby Bauer disc diffusion to identify antimicrobial susceptibility.
Results: P. aeruginosa (n = 447) were most frequently isolated in respiratory (n = 203, 45.4%) and urinary samples (n = 120, 26.8%). AWaRe Access antibiotics showed 25-30% resistance, Watch antibiotics 30-55%. Susceptibility to AWaRe Reserve antibiotics remains high; however, 32.8% were resistant to aztreonam. Overall, 190 (42.5%) were MDR and 99 (22.1%) XDR (first Nepali report) based on mainly non-respiratory samples. The majority of infected patients were >40 years (n = 229, 63.2%) or inpatients (n = 181, 50.0%); 36 (15.2%) had an unfavourable outcome, including death (n = 25, 10.5%). Our larger study showed a failure of improvement over eight previous studies covering 10 years.
Conclusion: Antibiotic resistance in P. aeruginosa occurred to all 19 AWaRe group antibiotics tested. Vulnerable patients are at significant risk from such resistant strains, with a high death rate. Sustainable and acceptable antibiotic surveillance and control are urgently needed across Nepal, as antimicrobial resistance has deteriorated over the last decade.
{"title":"<i>Pseudomonas aeruginosa</i> in Nepali hospitals: poor outcomes amid 10 years of increasing antimicrobial resistance.","authors":"M Mahto, A Shah, K L Show, F L Moses, A G Stewart","doi":"10.5588/pha.21.0048","DOIUrl":"https://doi.org/10.5588/pha.21.0048","url":null,"abstract":"<p><strong>Objective: </strong>To determine antimicrobial resistance patterns and prevalence of multi- (MDR, i.e., resistant to ⩾3 classes of antimicrobial agents) and extensively (XDR, i.e., resistant to ⩾3, susceptible to ⩽2 groups of antibiotics) drug-resistant strains of <i>Pseudomonas aeruginosa</i>.</p><p><strong>Methods: </strong>This was a cross-sectional study conducted in Nepal Mediciti Hospital, Lalitpur, Nepal, using standard microbiological methods with Kirby Bauer disc diffusion to identify antimicrobial susceptibility.</p><p><strong>Results: </strong><i>P. aeruginosa</i> (<i>n</i> = 447) were most frequently isolated in respiratory (<i>n</i> = 203, 45.4%) and urinary samples (<i>n</i> = 120, 26.8%). AWaRe Access antibiotics showed 25-30% resistance, Watch antibiotics 30-55%. Susceptibility to AWaRe Reserve antibiotics remains high; however, 32.8% were resistant to aztreonam. Overall, 190 (42.5%) were MDR and 99 (22.1%) XDR (first Nepali report) based on mainly non-respiratory samples. The majority of infected patients were >40 years (<i>n</i> = 229, 63.2%) or inpatients (<i>n</i> = 181, 50.0%); 36 (15.2%) had an unfavourable outcome, including death (<i>n</i> = 25, 10.5%). Our larger study showed a failure of improvement over eight previous studies covering 10 years.</p><p><strong>Conclusion: </strong>Antibiotic resistance in <i>P. aeruginosa</i> occurred to all 19 AWaRe group antibiotics tested. Vulnerable patients are at significant risk from such resistant strains, with a high death rate. Sustainable and acceptable antibiotic surveillance and control are urgently needed across Nepal, as antimicrobial resistance has deteriorated over the last decade.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"11 Suppl 1","pages":"58-63"},"PeriodicalIF":1.4,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8575381/pdf/i2220-8372-11-s1-58.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39623770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N T Agathis, R Bhavaraju, V Shah, L Chen, C A Haley, N D Goswami, A Patrawalla
Background: Identifying and treating individuals with latent TB infection (LTBI) represents a critical and challenging component of national TB elimination. Medical consultations by the Centers for Disease Control and Prevention (CDC) funded TB Centers of Excellence (COEs) are an important resource for healthcare professionals (HCPs) caring for individuals with LTBI. This study aimed to identify the most common clinical concerns regarding LTBI care and to describe epidemiologic and clinical features of patients discussed in these consultations.
Methods: This mixed-methods study randomly sampled 125 consultation inquiries related to LTBI from the COEs' medical consultation database in 2018. Text from consultation records were reviewed and coded to identify reasons for the inquiries and common epidemiologic and clinical patient characteristics.
Results: The most common topics of inquiry for consultation included accurate LTBI diagnosis (36%), management of LTBI treatment-related issues (22%), and choice of appropriate LTBI treatment regimen (17%). Patients for whom consultations were requested commonly had another medical condition (34%), were non-U.S. born (31%), were children (25%), and had a history of travel to TB-endemic areas (18%).
Conclusion: Our findings emphasize the challenge of managing patients with either suspected or confirmed LTBI, highlighting the need for ongoing medical consultation support for nuanced clinical and epidemiologic scenarios.
{"title":"Challenges in LTBI care in the United States identified using a nationwide TB medical consultation database.","authors":"N T Agathis, R Bhavaraju, V Shah, L Chen, C A Haley, N D Goswami, A Patrawalla","doi":"10.5588/pha.21.0026","DOIUrl":"https://doi.org/10.5588/pha.21.0026","url":null,"abstract":"<p><strong>Background: </strong>Identifying and treating individuals with latent TB infection (LTBI) represents a critical and challenging component of national TB elimination. Medical consultations by the Centers for Disease Control and Prevention (CDC) funded TB Centers of Excellence (COEs) are an important resource for healthcare professionals (HCPs) caring for individuals with LTBI. This study aimed to identify the most common clinical concerns regarding LTBI care and to describe epidemiologic and clinical features of patients discussed in these consultations.</p><p><strong>Methods: </strong>This mixed-methods study randomly sampled 125 consultation inquiries related to LTBI from the COEs' medical consultation database in 2018. Text from consultation records were reviewed and coded to identify reasons for the inquiries and common epidemiologic and clinical patient characteristics.</p><p><strong>Results: </strong>The most common topics of inquiry for consultation included accurate LTBI diagnosis (36%), management of LTBI treatment-related issues (22%), and choice of appropriate LTBI treatment regimen (17%). Patients for whom consultations were requested commonly had another medical condition (34%), were non-U.S. born (31%), were children (25%), and had a history of travel to TB-endemic areas (18%).</p><p><strong>Conclusion: </strong>Our findings emphasize the challenge of managing patients with either suspected or confirmed LTBI, highlighting the need for ongoing medical consultation support for nuanced clinical and epidemiologic scenarios.</p>","PeriodicalId":46239,"journal":{"name":"Public Health Action","volume":"11 3","pages":"162-166"},"PeriodicalIF":1.4,"publicationDate":"2021-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8455022/pdf/i2220-8372-11-3-162.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39452645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}