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Browsing Publications by Author "Acharya, D"
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Publication Asymptomatic throat carriage rate and antimicrobial resistance pattern of Streptococcus pyogenes in Nepalese school children(Kathmandu University, 2009) Dumre, SP; Sapkota, K; Adhikari, N; Acharya, D; Karki, M; Bista, S; Basnyat, SR; Joshi, SKAbstract Background: Streptococcus pyogenes or Group A streptococcus (GAS) causes several suppurative and non suppurative infections. In addition to pharyngitis and skin infections, GAS are also the causative agent of post-streptococcal infection syndromes such as acute rheumatic fever (ARF) and post-streptococcal glumerulonephritis (PSG). GAS frequently colonises in the throat of an asymptomatic person. Pharyngeal carriage rates of GAS among healthy school children vary with geographical location and seasons. Objectives: We carried out this preliminary study to determine the throat carriage rate and antimicrobial resistance trend of Streptococcus pyogenes or Group A streptococcus (GAS) among the Nepalese school children. Materials and methods: Four schools situated at different locations of Kathmandu valley were included in the study. Throat swabs from 350 students of age group 5-15 years were collected, immediately transported to the laboratory and were processed for S. pyogenes following standard microbiological procedures. Antimicrobial susceptibility testing of the isolates was performed by Kirby Bauer disc diffusion method following CLSI guidelines. Results: S. pyogenes was isolated from 10.9% (38/350) of the screened children. The GAS colonisation rate was statistically insignificant (P>0.05) with sex and age sub-groups, although the rate was slightly higher among girls and age sub-group 9-12 years. No significant difference in carrier rate was observed among different schools (P>0.05). All isolates were susceptible to azithromycin. No resistance was detected for penicillin and its derivative antibiotic ampicillin. Highest resistance rate was observed for cotrimoxazole (71.0%) followed by chloramphenicol (7.8%), ciprofloxacin (5.2%) and erythromycin (5.2%). Conclusion: Antibiotic resistant GAS isolated from asymptomatic Nepalese school children is a public health concern. When screened and appropriately treated with antibiotics, carriers can be prevented from spreading of streptococcal infections in the school environment and the community. Preventing cross infections would ultimately reduce the incidence of life-threatening sequelae which are debilitating and difficult to treat. It is recommended to conduct regular screening and GAS surveillance in schools, and maintain rational use of antibiotics to minimise GAS carriage/infections and resistance. Key words: Streptococcus pyogenes, Antibiotics Resistance, Throat carriage, Children, Nepal.Publication Current Fluoroquinolone Susceptibility Criteria for Salmo- nella Needs Re-evaluation(Kathmandu University, 2012) Acharya, D; Malla, S; Bhatta, DR; Adhikari, N; Dumre, SPABSTRACT Background Disc diffusion technique is the routine susceptibility testing procedure for isolates of enteric fever, the most common clinical diagnosis among febrile patients in Nepal. Objective To evaluated the current fluoroquinolones (FQs) susceptibility criteria and nalidixic acid screening test in Salmonella enterica serovar Typhi and Paratyphi A. Methods S. Typhi and Paratyphi A strains isolated from 443 suspected enteric fever patients visiting National Public Health Laboratory (NPHL) during April through October 2008 were analyzed. All isolates were confirmed by standard microbiological procedures including serotyping. Antibiotic susceptibility testing was performed by using Kirby Bauer disc diffusion method and Clinical and Laboratory Standards Institute (CLSI) approved interpretive criteria. Agar dilution method was used to determine Minimum Inhibitory Concentration (MIC) of ciprofloxacin, ofloxacin and nalidixic acid. Result Out of 41 Salmonella isolates, 80.49% were nalidixic acid resistant, with S. Paratyphi A showing higher resistance rate (88.23%) compared to S. Typhi (75%). The difference in both MIC and zone diameter in nalidixic acid susceptible and nalidixic acid resistant isolates was found to be significant (P < 0.001) and decreased susceptibility to FQs was strongly correlated (sensitivity and specificity of 100%) with resistance to nalidixic acid. Regression analysis of MIC against zone diameter based on the current CLSI recommended guidelines suggests that accommodation of current susceptible and resistant MIC requires increase in the zone diameter of ciprofloxacin and ofloxacin. Conclusion Before using these drugs for management of enteric fever, appropriate identification of Salmonella isolates with reduced susceptibility to FQs is essential to limit the possible treatment failure and development of highly resistant strains. The current FQs susceptibility break point criteria for Salmonella need re-evaluation. KEY WORDS Enteric fever, Salmonella, Reduced FQ susceptibility, NepalPublication Throat carriage rate and antimicrobial resistance trend of Streptococcus pyogenes among the asymptomatic Nepalese school children(Kathmandu University, 2009) Dumre, SP; Sapkota, K; Adhikari, N; Acharya, D; Karki, M; Basnyat, SR; Joshi, SKAbstract Background: Streptococcus pyogenes or Group A streptococcus (GAS) causes several suppurative and non suppurative infections. Since the 1980s there has been re-emergence in the incidence of invasive S. pyogenes infections and rheumatic heart disease all over the world and hence throat carriage has assumed of great importance. Objectives: We carried out this preliminary study to determine the throat carriage rate and antimicrobial resistance trend of Streptococcus pyogenes or Group A streptococcus (GAS) among the Nepalese school children. Materials and methods: Four schools situated at different locations of Kathmandu valley were included in the study. Throat swabs from 350 students of age group 5-15 years were collected, immediately transported to the laboratory and were processed for S. pyogenes following standard microbiological procedures. Antimicrobial susceptibility testing of the isolates was performed by Kirby Bauer disc diffusion method following CLSI guidelines. Results: S. pyogenes was isolated from 10.9% (38/350) of the screened children. The GAS colonisation rate was statistically insignificant (P>0.05) with sex and age subgroups, although the rate was slightly higher among girls and age subgroup 9-12 years. No significant difference in carrier rate was observed among different schools (P>0.05). Highest resistance rate was observed for Cotrimoxazole (71.05%) followed by Chloramphenicol (7.8%), Ciprofloxacin (5.2%) and Erythromycin (5.2%). All isolates were susceptible to Azithromycin. No resistance was detected for penicillin and its derivative and Azithromycin. Conclusion: Antibiotic resistant GAS isolated from asymptomatic Nepalese children is a concern. When screened and appropriately treated with antibiotics, carriers can be prevented from spreading of streptococcal infections in the community. This would ultimately reduce the incidence of life-threatening sequelae which are debilitating and difficult to treat. It is recommended to conduct regular screening programs and GAS surveillance, and maintain rational use of antibiotics to keep GAS carriage/ infections and resistance in check. Key words: Streptococcus pyogenes, Antibiotics Resistance, Children, Throat carriage, Nepal