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Alotaibi G. Prevalence, pandemic, preventions and policies to overcome antimicrobial resistance. Saudi J Biol Sci 2024; 31:104032. [PMID: 38854892 PMCID: PMC11157277 DOI: 10.1016/j.sjbs.2024.104032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 05/22/2024] [Accepted: 05/25/2024] [Indexed: 06/11/2024] Open
Abstract
Antimicrobial resistance (AMR) is a growing concern in Asia, and it is essential to understand the prevalence, pandemic, prevention, and policies to overcome it. According to the World Health Organization (WHO), AMR is one of the main causes of death; in 2019, it was linked to 4.95 million fatalities and caused about 1.27 million deaths. A core package of actions has been provided by WHO to help countries prioritize their needs when creating, carrying out, and overseeing national action plans on antimicrobial resistance. Using a people-cantered approach to AMR, the interventions address the needs and obstacles that individuals and patients encounter when trying to obtain healthcare. The people-cantered core package of AMR treatments seeks to improve public and policymakers; awareness and comprehension of AMR by changing the narrative of AMR to emphasize the needs of people and systemic impairments. Additionally, it backs a more comprehensive and programmatic national response to AMR, which emphasizes the value of fair and inexpensive access to high-quality healthcare services for the avoidance, identification, and management of drug-resistant diseases. The report signals increasing resistance to antibiotics in bacterial infections in humans and the need for better data. In conclusion, the prevalence of AMR in Asia is a significant public health concern, and it is crucial to implement policies and interventions to overcome it.
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Affiliation(s)
- Ghallab Alotaibi
- Department of Pharmacology, College of Pharmacy, Shaqra University, Riyadh 11961, Saudi Arabia
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Parajuli A, Mitchell J, King N, Arjyal A, Latham S, King R, Baral S. Drivers of antimicrobial resistance within the communities of Nepal from One Health perspective: a scoping review. Front Public Health 2024; 12:1384779. [PMID: 38706550 PMCID: PMC11066241 DOI: 10.3389/fpubh.2024.1384779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 04/01/2024] [Indexed: 05/07/2024] Open
Abstract
Background A major driver of antimicrobial resistance (AMR) is the inappropriate use of antimicrobials. At the community level, people are often engaged in behaviors that drive AMR within human, animal, and environmental (One Health) impacts. This scoping review consolidates research to determine (a) the community's knowledge, attitudes, and practices around AMR; (b) existing community-based interventions; and (c) barriers and enablers to addressing AMR in Nepal. Methods This scoping review follows the Joanna Briggs Institute scoping review methodology. Literature indexed in PubMed, Scopus, CINAHL, Global Index Medicus, HINARI-SUMMON, Embase (Ovid), Global Health (Ovid), CAB Abstracts (Ovid), Web of Science, and Google Scholar between January 2000 and January 2023 were reviewed for inclusion. Articles were included in the review if they considered the issues of AMR at the community level in Nepal; this excluded clinical and laboratory-based studies. A total of 47 studies met these criteria, were extracted, and analyzed to consolidate the key themes. Results A total of 31 (66%) articles exclusively included human health; five (11%) concentrated only on animal health; no studies solely focused on environmental aspects of AMR; and the remaining studies jointly presented human, animal, and environmental aspects. Findings revealed inadequate knowledge accompanied by inappropriate practice in both the human and animal health sectors. Four community interventions improved knowledge and practices on the appropriate use of antimicrobials among community people. However, various social and economic factors were found as barriers to the appropriate use of antimicrobials in the community. Conclusion Community engagement and One Health approaches could be key tools to improve awareness of AMR and promote behavioral change related to AM use in communities, as current studies have revealed inadequate knowledge alongside inappropriate practices shared in both human and animal health sectors. Systematic review registration DOI: 10.17605/OSF.IO/FV326.
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Affiliation(s)
| | - Jessica Mitchell
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
| | - Natalie King
- Academic Unit of Health Economics, University of Leeds, Leeds, United Kingdom
| | | | - Sophia Latham
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Rebecca King
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, United Kingdom
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Acharya R, Panthi S, Khatiwada P, Bhattarai B, Singh S, Bhattarai K, Aryal R, Neupane D, Thapa A, Karki K, Basnet LB, Khanal VK, Ghimire A. Antibiotics use among residents in Eastern Nepal: a community-based mixed method study. Ann Med Surg (Lond) 2024; 86:748-755. [PMID: 38333289 PMCID: PMC10849382 DOI: 10.1097/ms9.0000000000001611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/03/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction According to the WHO, more than two-thirds of all antibiotics are used in the community, of which about 30% are used inappropriately. The antimicrobial resistance (AMR) problem is a growing threat to Nepal because of indiscriminate and inappropriate use. However, exact data on the extent of inappropriate use of antibiotics in the community is scarce in Nepal. Objectives To know the extent of inappropriate use of antibiotics among the community and their knowledge and practice towards the usage of antibiotics. Methods A community-based cross-sectional study was conducted from 20 December 2017 to 20 March 2018 using a purposive sampling technique. A semi-structured questionnaire was used while conducting face-to-face interviews with 336 respondents to find out the knowledge and practice regarding antibiotic use. Investigators took different antibiotics (in all dosage forms) with them to show participants whether they knew and/or used the antibiotics in the last year. Results The mean age of respondents with standard deviation was 39.87±13.67 years ranging from 18 to 84 years. Around 35.42% of respondents were farmers and 34.52% were homemakers. 28.87% of respondents were illiterate, 32.44% had primary education and 33.33% had secondary education. Almost half of them (48.51%) think that antibiotics are safe and can be commonly used. So, 43.15% of them preferred taking antibiotics when they had a common cold. The majority of the participants (81.84%) did not have any idea about antibiotic resistance. 94.6% of the respondents used antibiotics inappropriately. Conclusion The results of the present study revealed that inappropriate use of antibiotics is high and associated with low earning wages in both males and females in the age group 18-39 years.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Anish Thapa
- Department of Medicine, Universal College of Medical Sciences, Bhairahawa, Lumbini Province
| | | | - Lila Bahadur Basnet
- School of Public Health and community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Province 1
| | - Vijay Kumar Khanal
- School of Public Health and community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Province 1
| | - Anup Ghimire
- School of Public Health and community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Sunsari, Province 1
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Marasini S, Sharma S, Joshi A, Kunwar S, Mahato RK, Shrestha A, Karmacharya B. Exploring knowledge, perceptions, and practices of antimicrobials, and their resistance among medicine dispensers and community members in Kavrepalanchok District of Nepal. PLoS One 2024; 19:e0297282. [PMID: 38241275 PMCID: PMC10798439 DOI: 10.1371/journal.pone.0297282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 01/02/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Inappropriate use of antimicrobials is a global public health issue, particularly in developing countries, including Nepal, where over-the-counter sales and self-medication of antimicrobials are common. OBJECTIVES To explore knowledge, perceptions, and practices of antimicrobials and their resistance among medicine dispensers and community members in Nepal. METHODS The study was conducted in three rural and five urban municipalities of the Kavrepalanchok district from May 2021 to August 2021. Data were collected using two qualitative approaches: In-Depth Interviews (IDIs) and Focus Group Discussions (FGDs). Data were analyzed using thematic analysis that combined deductive and inductive approaches to identify codes under pre-specified themes. RESULTS A total of 16 In-depth interviews with medicine dispensers and 3 focus group discussions with community members were conducted. Knowledge regarding antimicrobial resistance varied among dispensers. Those with a prior educational background in pharmacy often had good knowledge about the causes and consequences of antimicrobial resistance. Meanwhile, consumers were less aware of antimicrobial resistance. Community members perceived antimicrobials as effective medicines but not long-term solution for treating diseases. They reported that dispensing without a prescription was common and that both consumers and dispensers were responsible for the inappropriate use of antimicrobials. On the contrary, several dispensers said that self-medication was common among the consumers, especially among more educated groups. The medicine dispensers and consumers expressed concerns about the weak enforcement of policies regarding pharmacy drug use and dispensing practices. CONCLUSION Promoting and strengthening the appropriate use of antimicrobials among medicine dispensers and community members is crucial. Bold policies and collective implementation of regulations could help combat antimicrobial resistance.
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Affiliation(s)
- Sabina Marasini
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Sudim Sharma
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Anjali Joshi
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Surakshya Kunwar
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Roshan Kumar Mahato
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Archana Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
- Institute for Implementation Science and Health, Kathmandu, Nepal
| | - Biraj Karmacharya
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
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Pant L, Thapa S, Dahal B, Khadka R, Biradar MS. In Silico and In Vitro Studies of Antibacterial Activity of Cow Urine Distillate (CUD). EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2024; 2024:1904763. [PMID: 38225974 PMCID: PMC10789515 DOI: 10.1155/2024/1904763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/28/2023] [Accepted: 12/30/2023] [Indexed: 01/17/2024]
Abstract
Cow urine distillate (CUD) is a traditional Indian medicine used to treat various diseases, including bacterial infections. However, there is limited evidence to support its use as a medicine, and its safety and efficacy have not been thoroughly studied. In this study, we evaluated the antibacterial activity of CUD against five bacterial strains using in vitro and in silico approaches. In vitro experiments showed that CUD has significant antibacterial activity against all tested strains with a zone of inhibition (ZOI) ranging from 13 to 24 mm and minimum inhibitory concentration (MIC) values ranging from 12.5 to 50 µg/ml. The results indicated that the 15% concentration of CUD displayed the highest antibacterial activity against Staphylococcus aureus and Salmonella typhi. To further investigate the antibacterial mechanism of CUD, we performed in silico docking studies of the active compounds of CUD with bacterial proteins involved in protein synthesis. Our results showed that 2-hydroxycinnamic acid (ΔG = -6.9 kcal/mol) and ferulic acid (ΔG = -6.8 kcal/mol) exhibited the best docking scores with the targeted proteins (DNA gyrase, PDBID: 4KFG). The hydrogen bonding interaction with amino acids Val71 and Asp73 was found to be crucial for their antibacterial activity.
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Affiliation(s)
- LokRaj Pant
- Department of Pharmacy, Sunsari Technical College, Dharan, Nepal
| | - Shankar Thapa
- Department of Pharmacy, Universal College of Medical Sciences, Bhairahawa, Nepal
- Department of Pharmacy, Madan Bhandari Academy of Health Sciences, Hetauda, Nepal
| | - Bibek Dahal
- Department of Pharmacy, Sunsari Technical College, Dharan, Nepal
| | - Ravindra Khadka
- Department of Pharmacy, Sunsari Technical College, Dharan, Nepal
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Dhungel B, Thapa Shrestha U, Adhikari S, Adhikari N, Bhattarai A, Pokharel S, Karkey A, Limmathurotsakul D, Ghimire P, Rijal KR, Cheah PY, Pell C, Adhikari B. Use of antimicrobials during the COVID-19 pandemic: A qualitative study among stakeholders in Nepal. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002166. [PMID: 37963156 PMCID: PMC10645294 DOI: 10.1371/journal.pgph.0002166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/05/2023] [Indexed: 11/16/2023]
Abstract
The COVID-19 pandemic was a major public health threat and the pressure to find curative therapies was tremendous. Particularly in the early critical phase of the pandemic, a lot of empirical treatments, including antimicrobials, were recommended. Drawing on interviews with patients, clinicians and drug dispensers, this article explores the use of antimicrobials for the management of COVID-19 in Nepal. A total of 30 stakeholders (10 clinicians, 10 dispensers and 10 COVID-19 patients) were identified purposively and were approached for an interview. Clinicians and dispensers in three tertiary hospitals in Kathmandu assisted in the recruitment of COVID-19 patients who were undergoing follow-up at an out-patient department. Interviews were audio recorded, translated and transcribed into English, and were analyzed thematically. The respondents report that over-the-counter (OTC) use of antibiotics was widespread during the COVID-19 pandemic in Nepal. This was mostly rooted in patients' attempts to mitigate the potential severity of respiratory illnesses, and the fear of the stigmatization and social isolation linked to being identified as a COVID-19 patient. Patients who visited drug shops and physicians reportedly requested specific medicines including antibiotics. Clinicians reported uncertainty when treating COVID-19 cases that added pressure to prescribe antimicrobials. Respondents from all stakeholder groups recognized the dangers of excessive use of antimicrobials, with some referring to the development of resistance. The COVID-19 pandemic added pressure to prescribe, dispense and overuse antimicrobials, accentuating the pre-existing OTC use of antimicrobials. Infectious disease outbreaks and epidemics warrant special caution regarding the use of antimicrobials and specific policy response.
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Affiliation(s)
- Binod Dhungel
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | | | - Sanjib Adhikari
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Nabaraj Adhikari
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Alisha Bhattarai
- Manmohan Cardiothoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Sunil Pokharel
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Abhilasha Karkey
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Direk Limmathurotsakul
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medical Research Unit, Faculty of tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Phaik Yeong Cheah
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medical Research Unit, Faculty of tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Christopher Pell
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Bipin Adhikari
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medical Research Unit, Faculty of tropical Medicine, Mahidol University, Bangkok, Thailand
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Turankar TB, Gaidhane SA, Gaidhane AM, Sorte AG, Sawale SR. Comparison of health care professionals' and laypeople's knowledge, attitudes, and practices on the use of antimicrobial and antimicrobial resistance. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:313. [PMID: 38023079 PMCID: PMC10670862 DOI: 10.4103/jehp.jehp_39_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/27/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND The discovery of antimicrobials is a pioneering step in health sciences concerning preventive care and early management for infectious diseases. However, with advancements in health sciences, inappropriate knowledge, practices, and over-the-counter medications were often used by the general population in underdeveloped nations like India without thinking about its consequences which leads to the use of antimicrobials excessively or inadequately, which is also a factor for antimicrobial resistance. This quantitative study determines the awareness of healthcare professionals and laypersons about usage and resistance of antimicrobials. METHODS AND MATERIALS Research was carried out in rural tertiary teaching hospital of study participants were 106 nurses, 115 interns, 107 junior residents, and 97 laypersons using a "self-administered WHO questionnaire". SPSS version 27.0 software was used to analyze the data. The P value cut-off for significance was established at <.05. RESULTS Forty seven percent of nurses and 44% of interns consumed antimicrobials in the last month, more than interns and junior residents. Fourteen percent of interns and 13% of laypersons did not get any prescription for lastly taken antimicrobial. The majority of participants obtain prescribed antimicrobials from medical stores and pharmacies. Fifty five percent of laypersons and 59% of nurses stop taking antimicrobials when they feel better. Only 13% of nurses were aware of the proper indications of antimicrobials for the same illness. Only 22% of respondents know the term superbugs, significantly less than the other key terms related to the antimicrobials. Nurses and laypersons had some misconceptions related to the mechanism of development of antimicrobial resistance. CONCLUSIONS The analysis revealed that a significant lack of knowledge and various misconceptions were primarily seen in the nurses and laypersons. In contrast, medical graduates such as interns and junior residents lacked the right attitude and perspective regarding the use of antimicrobials and their resistance.
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Affiliation(s)
- Tileshkumar B. Turankar
- Medical Student, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research Centre (DU), Sawangi (M), Wardha, Maharashtra, India
| | - Shilpa A. Gaidhane
- Professor, Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research Centre (DU), Sawangi (M), Wardha, Maharashtra, India
| | - Abhay M. Gaidhane
- Professor, Department of Community Medicine, Dean Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research Centre (DU), Sawangi (M), Wardha, Maharashtra, India
| | - Akshayata G. Sorte
- Medical Student, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research Centre (DU), Sawangi (M), Wardha, Maharashtra, India
| | - Shantanu R. Sawale
- Medical Student, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research Centre (DU), Sawangi (M), Wardha, Maharashtra, India
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Chaudhary MK, Jadhav I, Banjara MR. Molecular detection of plasmid mediated bla TEM, bla CTX-M,and bla SHV genes in Extended Spectrum β-Lactamase (ESBL) Escherichia coli from clinical samples. Ann Clin Microbiol Antimicrob 2023; 22:33. [PMID: 37147617 PMCID: PMC10163748 DOI: 10.1186/s12941-023-00584-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/12/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND Extended spectrum β-lactamases (ESBLs) are a group of beta-lactamase enzymes that confer resistance to the oxyimino-cephalosporins and monobactams. The emergence of ESBL - producing genes possesses a serious threat for treating infections since it is associated with multi-drug resistance. This study was focused to identify the ESBLs producing genes from Escherichia coli isolates from clinical samples from a referral-level tertiary care hospital in Lalitpur. METHODS This was a cross-sectional study conducted from September 2018 to April 2020 at the Microbiology Laboratory of Nepal Mediciti Hospital. Clinical samples were processed, and culture isolates were identified and characterized following standard microbiological techniques. An antibiotic susceptibility test was performed by a modified Kirby-Bauer disc diffusion method as recommended by Clinical and Laboratory Standard Institute guidelines.Extended -spectrum beta-lactamases were phenotypically confirmed by the combined disc method. The ESBL-producing genes blaTEM, blaCTX-M and blaSHV were confirmed by PCR. RESULTS Of the 1449 total E. coli isolates, 22.29% (323/1449) isolates were multi-drug resistant (MDR). Among the total MDR E. coli isolates, 66.56% (215/323) were ESBL producers. The maximum number of ESBL E. coli was isolated from urine 90.23% (194) followed by sputum 5.58% (12), swab 2.32% (5), pus 0.93% (2), and blood 0.93% (2). The antibiotic susceptibility pattern of ESBL E. coli producers showed the highest sensitivity toward tigecycline (100%) followed by polymyxin b, colistin and meropenem. Out of 215 phenotypically confirmed ESBL E. coli, only 86.51% (186) isolates were found to be positive by PCR for either blaTEM or blaCTX-M genes. Among the ESBL genotypes, the most common were blaTEM 63.4% (118) followed by blaCTX-M 36.6% (68). CONCLUSION The emergence of MDR and ESBL - producing E. coli isolates with high antibiotic - resistant rates to commonly used antibiotics and increased predominance of major gene types blaTEM is a serious concern to the clinicians and microbiologists. Periodic monitoring of antibiotic susceptibility and associated genes would help guide the rationale use of antibiotics for treating the predominant pathogen E. coli in the hospitals and healthcare facilities of the communities.
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Affiliation(s)
- Mahesh Kumar Chaudhary
- School of Life and Basic Sciences, Jaipur National University, Jaipur, India.
- Department of Microbiology, Nepal Mediciti Hospital, Lalitpur, Nepal.
| | - Indrani Jadhav
- School of Life and Basic Sciences, Jaipur National University, Jaipur, India
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Nepal
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Ghimire K, Banjara MR, Marasini BP, Gyanwali P, Poudel S, Khatri E, Dhimal M. Antibiotics Prescription, Dispensing Practices and Antibiotic Resistance Pattern in Common Pathogens in Nepal: A Narrative Review. Microbiol Insights 2023; 16:11786361231167239. [PMID: 37066121 PMCID: PMC10102948 DOI: 10.1177/11786361231167239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 03/16/2023] [Indexed: 04/18/2023] Open
Abstract
Antimicrobial resistance (AMR) is increasing and it is a serious public health problem worldwide. Nepal is considered as one of the contributors for rising AMR due to the most prevalent irrational use of antibiotics. In this review, we have assessed the practices of antibiotic prescription and dispensing, and antibiotic resistance of commonly encountered bacteria in Nepal. There is exponential increase of therapeutic consumption of antibiotics either without clinician's prescription or irrational prescription. Almost half of the population in Nepal was found to purchase antibiotics easily from the nearby pharmacies without clinician's prescription. Irrational prescription is exceeded in remote areas which could be due to lack of access with health posts and hospitals. The third generation cephalosporins, which are considered as the last resort antibiotics were found to be relatively prescribed and dispensed higher as compared to other classes of antibiotics. Despite the existing limited functional surveillance system, antibiotic resistance among bacteria is increasing in Nepal because of irrational prescription, dispensing and consumption of antibiotics without prescription.
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Affiliation(s)
- Kalpana Ghimire
- Central Department of Microbiology,
Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Megha Raj Banjara
- Central Department of Microbiology,
Tribhuvan University, Kirtipur, Kathmandu, Nepal
- Megha Raj Banjara, Central Department of
Microbiology, Tribhuvan University, Kirtipur, Kathmandu 44618, Nepal.
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Berdida DJE, Grande RAN, Lopez V, Ramirez SH, Manting MME, Berdida MME, Bañas CB. A national online survey of Filipinos' knowledge, attitude, and awareness of antibiotic use and resistance: A cross-sectional study. Nurs Forum 2022; 57:1299-1313. [PMID: 36161465 DOI: 10.1111/nuf.12803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/23/2022] [Accepted: 09/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Antibiotic resistance is one of the 21st century's most challenging clinical and public health issues. However, this health issue remains underreported in the Philippines. AIM This study examined Filipinos' knowledge, attitude, and awareness regarding antibiotic use and resistance and the associated predictive variables of antibiotic resistance. METHODS A cross-sectional design and Strengthening the Reporting of Observational Studies in Epidemiology guidelines were used in this study. Convenience sampling of 3767 participants completed the Eurobarometer survey on antibiotic resistance from October 2021 to February 2022. χ2 and regression analysis were used to analyze the data. RESULTS Most participants were familiar with the popular types of available antibiotics. Males and healthcare workers had a higher percentage of correct responses on antibiotic resistance knowledge. Participants had moderate to high knowledge levels of antibiotic resistance. Age, educational attainment, profession, antibiotic use in the previous year, and household members taking antibiotics were significant predictors of the level of knowledge of antibiotic resistance. There was a significant difference in participants' sex, age, and educational attainment in their attitudes toward acquisition, hygienic practices, and the role of health professionals in antibiotic resistance. CONCLUSION Government agencies and policymakers should consider the identified predictors when establishing policies on antibiotic resistance. This will ensure that antibiotic use is safe and effective.
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Affiliation(s)
| | - Rizal Angelo N Grande
- Mental Health Nursing Department, College of Nursing, University of Ha'il, Ha'il City, Saudi Arabia
| | - Violeta Lopez
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Sheryl H Ramirez
- University Research Innovation and Extension, Universidad de Manila, Manila, Philippines
| | - Muhmin Michael E Manting
- Department of Biological Sciences, Mindanao State University-Iligan Institute of Technology, Iligan City, Lanao del Norte, Philippines
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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. Trop Med Infect Dis 2022; 7:tropicalmed7070133. [PMID: 35878145 PMCID: PMC9324341 DOI: 10.3390/tropicalmed7070133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 02/05/2023] Open
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.
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Aslam A, Zin CS, Jamshed S, Rahman NSA, Ahmed SI, Pallós P, Gajdács M. Self-Medication with Antibiotics: Prevalence, Practices and Related Factors among the Pakistani Public. Antibiotics (Basel) 2022; 11:antibiotics11060795. [PMID: 35740201 PMCID: PMC9219843 DOI: 10.3390/antibiotics11060795] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 11/17/2022] Open
Abstract
Self-medication with antibiotics (SMA) has become considerably common in developing countries, which is a critical factor for driving antibiotic resistance. Individuals involved in SMA generally do not have adequate knowledge regarding the appropriate use, indications and dosage of these drugs. The objective of the present study was to investigate population SMA practices, knowledge and sociodemographic factors associated with SMA in Islamabad, Pakistan. The study adopted a cross-sectional methodology and data collection was performed through an anonymous, structured and pilot-tested questionnaire, which was interview-administered. Inferential statistics and multivariate logistic regression were performed. Out of 480 participants, 55.6% (n = 267) were male with a mean age of 37.1 ± 10.1 years; the total prevalence of SMA was 32.5%. Ciprofloxacin (42.9%) was the most commonly used antibiotic to treat coughs or colds, a runny nose, flu or sore throat, diarrhea or fevers, which were relevant reasons for SMA. Findings from multivariate logistic regression showed that predictors of SMA were: male gender (95% CI: 0.383–1.005), age (95% CI: 0.317–0.953) and highest level of education (95% CI: 0.961–0.649). Despite reasonable access to healthcare facilities, people are still obtaining antibiotics without prescription, bypassing diagnostic and consultative healthcare services. Thus, the government must implement strict healthcare policies to restrict the sale of antibiotics without prescriptions, while at the same time, targeted public awareness campaigns about the proper use of antibiotics are also required.
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Affiliation(s)
- Adeel Aslam
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan 25200, Malaysia; (A.A.); (C.S.Z.); (N.S.A.R.)
| | - Che Suraya Zin
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan 25200, Malaysia; (A.A.); (C.S.Z.); (N.S.A.R.)
| | - Shazia Jamshed
- Department of Clinical Pharmacy and Practice, Faculty of Pharmacy, Universiti Sultan Zainal Abidin (UniSZA), Kuala Terengganu 20400, Malaysia;
| | - Norny Syafinaz Ab Rahman
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan 25200, Malaysia; (A.A.); (C.S.Z.); (N.S.A.R.)
| | - Syed Imran Ahmed
- School of Pharmacy, College of Science, University of Lincoln, Lincoln LN6 7TS, UK;
| | - Péter Pallós
- Department of Oral Biology and Experimental Dental Research, Faculty of Dentistry, University of Szeged, 6720 Szeged, Hungary;
| | - Márió Gajdács
- Department of Oral Biology and Experimental Dental Research, Faculty of Dentistry, University of Szeged, 6720 Szeged, Hungary;
- Correspondence:
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Bhandari S, Adhikari S, Karki D, Chand AB, Sapkota S, Dhungel B, Banjara MR, Joshi P, Lekhak B, Rijal KR. Antibiotic Resistance, Biofilm Formation and Detection of mexA/mexB Efflux-Pump Genes Among Clinical Isolates of Pseudomonas aeruginosa in a Tertiary Care Hospital, Nepal. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2021.810863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Efflux-pump system and biofilm formation are two important mechanisms Pseudomonas aeruginosa deploys to escape the effects of antibiotics. The current study was undertaken from September 2019 to March 2020 at a tertiary-care hospital in Kathmandu in order to ascertain the burden of P. aeruginosa in clinical specimens, examine their biofilm-forming ability and determine their antibiotic susceptibility pattern along with the possession of two efflux-pump genes-mexA and mexB. Altogether 2820 clinical specimens were collected aseptically from the patients attending the hospital and processed according to standard microbiological procedures. Identification of P. aeruginosa was done by Gram stain microscopy and an array of biochemical tests. All the P. aeruginosa isolates were subjected to in vitro antibiotic susceptibility testing and their biofilm-forming ability was also examined. Presence of mexA and mexB efflux-pump genes was analyzed by Polymerase Chain Reaction (PCR) using specific primers. Out of 603 culture positive isolates, 31 (5.14%) were found to be P. aeruginosa, of which 55% were multi-drug resistant (MDR). Out of 13 commonly used antibiotics tested by Kirby-Bauer disc diffusion method, greatest resistance was shown against piperacillin-tazobactam 15 (48.4%) and ceftazidime 15 (48.4%), and least against meropenem 6 (19.4%) and ofloxacin 5 (16.2%). Of all 17 MDR isolates subjected to biofilm detection, strong biofilm formation was exhibited by 11 (65%) and 14 (82%) isolates with microtiter plate method and tube method respectively. Out of 17 isolates tested, 12 (70.6%) isolates possessed mexA and mexB genes indicating the presence of active efflux-pump system. Higher number of the isolates recovered from sputum 7 (58.3%) and pus 5 (41.7%) possessed mexA/mexB genes while the genes were not detected at all in the isolates recovered from the urine (p<0.05). This study assessed no significant association between biofilm production and multi-drug resistance (p>0.05). Adoption of stern measures by the concerned authorities to curb the incidence of multi-drug resistant and biofilm-forming isolates is recommended to prevent their dissemination in the hospital settings.
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Geta K, Kibret M. Knowledge, Attitudes and Practices of Patients on Antibiotic Resistance and Use in Public Hospitals of Amhara Regional State, Northwestern Ethiopia: A Cross-Sectional Study. Infect Drug Resist 2022; 15:193-209. [PMID: 35115790 PMCID: PMC8799925 DOI: 10.2147/idr.s348765] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/13/2022] [Indexed: 12/14/2022] Open
Abstract
Background Although inappropriate antibiotic use could contribute to the spread of antimicrobial resistance, data on the knowledge, attitude and practice of antibiotic use and resistance among patients in north-western Ethiopia are scarce. This study assessed patients’ knowledge, attitudes and practices regarding antibiotic use and resistance in selected public hospitals of Amhara regional state, Ethiopia. Methods A cross-sectional study was conducted in selected public hospitals of Amhara regional state from November to December 2020 to assess the knowledge, attitude, and practice of patients on antibiotic resistance and use. Data were collected from 233 participants using a structured questionnaire and analyzed using SPSS version 23. Results According to the findings, 60.3% of the participants obtained their antibiotics without a prescription from private pharmacies, and the most commonly used antibiotic to treat human diseases was ampicillin (70.7%). Even though 69.8% of the patients heard about antibiotics and antibiotic resistance from several sources, 68.1–87.9% of them were unaware on the factors that contribute to the transmission of resistant bacteria to humans and the impact of antibiotic resistance on human and animal health. Using the mean score of 3.15 ± 0.08 as the cut-off, 37.5% of patients know about antimicrobial resistance and use. With a mean score of 27.6 ± 0.3, 45.3% of patients had positive attitudes toward prudent antibiotic use and resistance. About 44% of participants had a good practice, with a mean practice score of 4.95 ± 0.17. A higher level of education was associated with better knowledge, positive attitudes, and better practices regarding antibiotic use and resistance. Although 57.3% of respondents viewed poor handwashing practices in hospitals as a major factor contributing to increased antibiotic resistance, 59.9% of respondents viewed implementing hygiene, infection prevention, and control practices as a major strategy contributing to reducing antibiotic use and resistance. Conclusion According to the present study, there is a low level of awareness among patients about the proper antibiotics use and resistance. It is essential to raise awareness, develop, and implement interventions to reduce antimicrobial use and antibiotic resistance in the study area.
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Affiliation(s)
- Kindu Geta
- Department of Biology, Debre Tabor University, Debre Tabor, Ethiopia
- Department of Biology, Bahir Dar University, Bahir Dar, Ethiopia
- Correspondence: Kindu Geta, Email
| | - Mulugeta Kibret
- Department of Biology, Bahir Dar University, Bahir Dar, Ethiopia
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Gaire U, Thapa Shrestha U, Adhikari S, Adhikari N, Bastola A, Rijal KR, Ghimire P, Banjara MR. Antibiotic Susceptibility, Biofilm Production, and Detection of mecA Gene among Staphylococcus aureus Isolates from Different Clinical Specimens. Diseases 2021; 9:diseases9040080. [PMID: 34842640 PMCID: PMC8628674 DOI: 10.3390/diseases9040080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
The increasing incidence of methicillin-resistant and biofilm-forming S. aureus isolates in hospital settings is a gruesome concern today. The main objectives of this study were to determine the burden of S. aureus in clinical samples, assess their antibiotic susceptibility pattern and detect biofilm formation and mecA gene in them. A total of 1968 different clinical specimens were processed to isolate S. aureus following standard microbiological procedures. Antibiotic susceptibility test of the isolates was performed by Kirby–Bauer disc-diffusion method following CLSI guidelines. Biofilm was detected through tissue culture plate method. Methicillin-resistant S. aureus (MRSA) isolates were screened using cefoxitin (30 µg) discs and mecA gene was amplified by conventional polymerase chain reaction (PCR). Of 177 bacterial growth, the prevalence of S. aureus was 15.3% (n = 27). MRSA were 55.6% (15/27) and 44% (12/27) exhibited multidrug resistance (MDR). There was no significant association between methicillin resistance and MDR (p > 0.05). Both MRSA and MSSA were least sensitive to penicillin (100%, 75%) followed by erythromycin (86.6%, 66.6%). Most of the MRSA (93.4%) were susceptible to tetracycline. All S. aureus isolates were biofilm producers—19 (70%) were weak and only one (4%) was a strong biofilm producer. The strong biofilm-producing MSSA was resistant to most of the antibiotics except cefoxitin and clindamycin. None of the MSSA possessed mecA gene while 8 (53.3%) MRSA had it. More than half of S. aureus isolated were MRSA. High incidence of multidrug resistance along with capacity to form biofilm among clinical isolates of S.aureus is a matter of apprehension and prompt adoption of biosafety measures is suggested to curb their dissemination in the hospital environments.
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Affiliation(s)
- Upama Gaire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu 44600, Nepal; (U.G.); (U.T.S.); (S.A.); (N.A.); (P.G.)
| | - Upendra Thapa Shrestha
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu 44600, Nepal; (U.G.); (U.T.S.); (S.A.); (N.A.); (P.G.)
| | - Sanjib Adhikari
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu 44600, Nepal; (U.G.); (U.T.S.); (S.A.); (N.A.); (P.G.)
| | - Nabaraj Adhikari
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu 44600, Nepal; (U.G.); (U.T.S.); (S.A.); (N.A.); (P.G.)
| | - Anup Bastola
- Sukraraj Tropical and Infectious Diseases Hospital, Teku, Kathmandu 44600, Nepal;
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu 44600, Nepal; (U.G.); (U.T.S.); (S.A.); (N.A.); (P.G.)
- Correspondence: (K.R.R.); (M.R.B.)
| | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu 44600, Nepal; (U.G.); (U.T.S.); (S.A.); (N.A.); (P.G.)
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu 44600, Nepal; (U.G.); (U.T.S.); (S.A.); (N.A.); (P.G.)
- Correspondence: (K.R.R.); (M.R.B.)
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Gurung R, Adhikari S, Adhikari N, Sapkota S, Rana JC, Dhungel B, Thapa Shrestha U, Banjara MR, Ghimire P, Rijal KR. Efficacy of Urine Dipstick Test in Diagnosing Urinary Tract Infection and Detection of the blaCTX-M Gene among ESBL-Producing Escherichia coli. Diseases 2021; 9:diseases9030059. [PMID: 34562966 PMCID: PMC8482205 DOI: 10.3390/diseases9030059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 01/24/2023] Open
Abstract
A urine dipstick test used for prompt diagnosis of urinary tract infection (UTI) is a rapid and cost-effective method. The main objective of this study was to compare the efficacy of the urine dipstick test with culture methods in screening for UTIs along with the detection of the blaCTX-M gene in extended spectrum β-lactamase (ESBL)-producing Escherichia coli. A total of 217 mid-stream urine samples were collected from UTI-suspected patients attending Bharatpur Hospital, Chitwan, and tested by dipstick test strip (COMBI-10SL, Germany) prior to the culture. E. coli isolates were identified by standard microbiological procedures and subjected to antimicrobial susceptibility testing by Kirby Bauer disc diffusion method following CLSI guideline. Primary screening of ESBL-producing E. coli isolates was conducted using ceftriaxone, cefotaxime and ceftazidime discs and phenotypically confirmed by combined disk diffusion test. Plasmid DNA of ESBL-producing strains was extracted by phenol-chloroform method and subjected to PCR for detection of the blaCTX-M gene. Out of 217 urine samples, 48 (22.12%) showed significant bacteriuria. Among 46 (21.20%) Gram negative bacteria recovered, the predominant one was E. coli 37 (77.08%) of which 33 (89.19%) were multidrug resistant (MDR). E. coli isolates showed a higher degree of resistance towards cefazolin (62.16%) while 81.08% of the isolates were sensitive towards amikacin followed by nitrofurantoin (70.27%). Among 14 (37.84%) phenotypically confirmed ESBL isolates, only eight (21.62%) isolates carried the blaCTX-M gene. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of urine dipstick test were 43.75%, 77.51%, 35.59% and 82.91%, respectively. Besides, the use of dipstick test strip for screening UTI was associated with many false positive and negative results as compared to the gold standard culture method. Hence, dipstick nitrite test alone should not be used as sole method for screening UTIs.
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Affiliation(s)
- Rubina Gurung
- Central Department of Microbiology, Tribhuvan University, Kirtipur 44600, Kathmandu, Nepal; (R.G.); (S.A.); (N.A.); (B.D.); (U.T.S.); (M.R.B.); (P.G.)
| | - Sanjib Adhikari
- Central Department of Microbiology, Tribhuvan University, Kirtipur 44600, Kathmandu, Nepal; (R.G.); (S.A.); (N.A.); (B.D.); (U.T.S.); (M.R.B.); (P.G.)
| | - Nabaraj Adhikari
- Central Department of Microbiology, Tribhuvan University, Kirtipur 44600, Kathmandu, Nepal; (R.G.); (S.A.); (N.A.); (B.D.); (U.T.S.); (M.R.B.); (P.G.)
| | - Sanjeep Sapkota
- Department of Microbiology, Birendra Multiple Campus, Tribhuvan University, Bharatpur 44200, Chitwan, Nepal;
| | - Jid Chani Rana
- Department of Microbiology, Bharatpur Hospital, Bharatpur 44200, Chitwan, Nepal;
| | - Binod Dhungel
- Central Department of Microbiology, Tribhuvan University, Kirtipur 44600, Kathmandu, Nepal; (R.G.); (S.A.); (N.A.); (B.D.); (U.T.S.); (M.R.B.); (P.G.)
| | - Upendra Thapa Shrestha
- Central Department of Microbiology, Tribhuvan University, Kirtipur 44600, Kathmandu, Nepal; (R.G.); (S.A.); (N.A.); (B.D.); (U.T.S.); (M.R.B.); (P.G.)
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur 44600, Kathmandu, Nepal; (R.G.); (S.A.); (N.A.); (B.D.); (U.T.S.); (M.R.B.); (P.G.)
| | - Prakash Ghimire
- Central Department of Microbiology, Tribhuvan University, Kirtipur 44600, Kathmandu, Nepal; (R.G.); (S.A.); (N.A.); (B.D.); (U.T.S.); (M.R.B.); (P.G.)
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur 44600, Kathmandu, Nepal; (R.G.); (S.A.); (N.A.); (B.D.); (U.T.S.); (M.R.B.); (P.G.)
- Correspondence: or
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Biofilm Formation and Phenotypic Detection of ESBL, MBL, KPC and AmpC Enzymes and Their Coexistence in Klebsiella spp. Isolated at the National Reference Laboratory, Kathmandu, Nepal. MICROBIOLOGY RESEARCH 2021. [DOI: 10.3390/microbiolres12030049] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Klebsiella spp. are associated with several nosocomial and opportunistic infections. Increasing antimicrobial resistance of Klebsiella species is aggravated by a number of intrinsic and extrinsic factors. The main aim of this study is to determine antimicrobial resistance due to production of β-lactamase enzymes, extended spectrum beta-lactamase (ESBL), metallo-beta-lactamase (MBL) and AmpC and Klebsiella pneumoniae carbapenemase (KPC) and biofilm formation in Klebsiella isolates. A total of 2197 non-duplicate specimens of urine, sputum and pus were obtained from the National Public Health Laboratory (NPHL), Kathmandu, Nepal, between February and August 2019. Klebsiella species were isolated, identified and screened for antimicrobial susceptibility testing with the disk diffusion method. Phenotypic detection of ESBL, MBL, KPC and AmpC production was observed and biofilm production was detected by the microtiter plate method. Out of a total of 2197 clinical specimens, bacterial growth was detected in 8% (175/2197) of the specimens. Of the total isolates, 86.3% (151/175) were Gram-negative bacteria and 37.7% (57/151) were Klebsiella spp. Of the total Klebsiella spp., 56% (32/57) were multi drug resistant (MDR), 16% (9/57) were ESBL, 26% (15/57) were MBL, 4% (2/57) were KPC (class A carbapenemase), 16% (9/57) were AmpC producers and 95% (54/57) were biofilm producers. Gentamicin was the most effective antibiotic, followed by cotrimoxazole, as 68% (39/57) and 47% (27/57) of the Klebsiella isolates were susceptible towards these drugs, respectively. The study results show evidence of β-lactamase production, high prevalence of MDR and biofilm producing Klebsiella species. Integrating the test parameters for phenotypic confirmation of ESBL, MBL, AmpC β lactamase and KPC in routine diagnostic procedures can help in the early detection and management of these resistant strains.
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