Browsing by Author "Ohara, H"

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    Co-existence of aminoglycosides and β-lactam-resistant Escherichia coli phenotypes in a Tertiary care center of Nepal
    (Institute of Medicine, 2015) Shrestha, B; Tada, T; Shrestha, S; Katte, HPl; Ohara, H; Kirikae, T; Rijal, BP; Sherchand, JB; Pokhrel, BM
    Abstract Introduction: Multidrug-resistant Escherichia coli isolates conferring simultaneous resistance to both aminoglycosides and β-lactam drugs have serious implications for clinicians worldwide. This study was designed to evaluate the co-existence of various β-lactamases in aminoglycoside- resistant Escherichia coli amongst hospitalized subjects in a tertiary care center of Kathmandu, Nepal, between December 2013 and December 2014. Methods: Standard microbiological techniques were used for isolation and identification of the isolates. The antimicrobial susceptibility of bacterial isolates was determined following Clinical and Laboratory Standard Institute recommended Kirby-Bauer Disc Diffusion method. The defining criterion in this study for an isolate to be MDR, resistance to at least one agent in three or more than three different structural classes was taken. Results: Among 302 MDR E. coli isolates, 174 (58.0 %) were resistance to gentamicin and 138 (46.0 %) were resistance to amikacin. Maximum aminoglycoside-resistant 9/11(82.0%) strains were isolated from body fluids followed by 7/10 (70.0%) from bile, 6/9 (67.0%) from blood and 2/3 (67.0%) from tissue. Out of 174 aminoglycosides-resistant E. coli isolates, the simultaneous occurrence of Extended-spectrum- b- lactamase (ESBL) and AmpC β–lactamaseswas noted in 13.0 % isolates and Metallo-β-lactamase (MBL) and AmpC β–lactamasesin 8.0 % isolates. None E. coli isolates were positive for all 3 types of β–lactamases in combinations. In amikacin- resistant isolates, ESBL+ AmpC observed in 12% and MBL+AmpC seen in 10% isolates. Conclusion: Our results show a high frequency of aminoglycoside- resistance phenotypes. Strict application for appropriate use of antimicrobials in medical settings should be essential to minimize the emergence of multidrug-resistance among E. coli in hospitalized patients. Keywords: Aminoglycoside-resistant E. coli, Amp C β–lactamases, Metallo-β-lactamase, MDR E.coli
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    Enteric Opportunistic Parasitic Infections Among HIV- Seropositive Patients in Kathmandu, Nepal
    (Kathmandu University, 2012) Sherchan, JB; Ohara, H; Sakurada, S; Basnet, A; Tandukar, S; Sherchand, JB; Bam, D S
    ABSTRACT Background Enteric opportunistic parasitic infections are the major source of diarrheal disease in developing countries mainly in Human Immunodeficiency virus (HIV) infected patients. Objective The study was to detect enteric parasites causing diarrhea and their association with immune status in HIV-seropositive patients. Methods The present study was conducted in Dirgh-Jeevan Health Care Research Center and Tribhuvan University Teaching Hospital, Public Health Research Laboratory, Kathmandu, Nepal between June 2010 and May 2011 involving 146 Human Immunodeficiency virus (HIV) positive patients. Serostatus from these patients were detected by Enzyme Linked Immunosorbent assay. CD4+ T cell counts were done by flow cytometry. Stool was examined for enteric parasites by microscopy with special staining methods. Results A total of 146 HIV sero-positive patients with and without diarrhea age between 20 to 45 years were included in the study. Of the 146 patients, the protozoan parasitic infection was found in 30.13% (44/146). Out of 146 patients, 78 had diarrhea in which parasitic infection was 39 (50%) and 7.35% (5/68) protozoal parasites positive cases did not have diarrhea. A significant difference (p<0.05) was observed in the level of infection of intestinal protozoan between the HIV seropositive with diarrhea and HIV-seropositive without diarrhea. Out of 43 patients whose CD4+ T cells were <200/μl, 29 (67.4%) had opportunistic parasitic infection whereas out of 103 patients whose CD4+ T cells were ≥200/μl, only 15 (14.56%) had opportunistic parasitic infection (P < 0.05). Conclusion Enteric opportunistic parasitic infections were detected in 30.1% among HIV- seropositive patients and low CD4+ T count indicated high enteric opportunistic infection. Early detection of enteric parasitic infections will help in the management and to improve the quality of life for HIV-infected individuals. KEYWORDS Diarrhea, HIV, Opportunistic parasites
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    Phenotypic characterization of multidrug-resistant Acinetobacter baumannii with special reference to metallo-β-lactamase production from the hospitalized patients in a tertiary care hospital in Nepal
    (Institute of Medicine, 2015) Shrestha, S; Tada, T; Shrestha, B; Ohara, H; Kirikae, T; Rijal, BP; Pokhrel, BM; Sherchand, JB
    Abstract Introduction: Acinetobacter baumanniiis an important cause of nosocomial infection and has been associated with a wide variety of illnesses in hospitalized patients, especially patients in the intensive care units. The emergence of carbapenem-resistant clones of A. baumannii has been the most serious problem worldwide. After the carbapenem resistant clones have emerged, leaving the hope of treatment of A. baumannii infection is by the last resort of antibiotics such as tigecycline, polymyxin-B and colistin. The purpose of this study is to determine the antibiotic resistance patterns of A. baumannil isolates, prevalence of multidrug resistance, extended spectrum beta lactamase production and metallo-beta lactamase production. Methods: This is a prospective study conducted at the department of Clinical Microbiology. Tribhuvan University Teaching Hospital, from December 2013 to September 2014. Ethical approval was taken from the Institutional Review Board of Institute of Medicine. Two hundred and forty six Acinetobacterisolates were identified by standard microbiological testing. Antimicrobial susceptibility testing was performed by Kirby Bauer method as per the CLSI guidelines. Multidrug resistance was determined. ESBL production was detected by combination disc method and confirmed by Clinical and Laboratory Standerd Institute confirmatory test. MBL production was detected by using imipenem and imipenem/EDTA disc. Result: All 122 Multidrug-resistant A. baumannii isolateswere resistant to majority of the drugs used. All the isolates were completely sensitive to polymyxin B, colistin and tigecycline only. Fifteen (12.29%) isolates of A. baumannii were extended spectrum beta-lactamase producers and 50 (40.98%) were metallo-beta-lactamase producers. Multidrug resistance was common in A. baumannii Conclusion: Multidrug resistance in A. baumannii is becoming more common ESBL and MBL production should be promptly detected and reported to control the spread of resistant phenotypes to other individuals. Keywords: Acinetobacter baumannii, ESBL, MBL, multidrug-resistance
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    Streptococcus pneumoniae among children with clinical meningitis in Nepal
    (Institute of Medicine, 2015) Sherchan, JB; Tandukar, S; Shrestha, L; Rai, GK; Sharma, A; Gami, FC; Rijal, B; Sherchand, JB; Ohara, H
    Abstract Introduction: Invasive bacterial disease is a significant cause of morbidity and mortality worldwide and it is a major cause of childhood deaths in Nepal. Streptococcus pneumoniae is responsible for invasive and non-invasive pneumococcal diseases worldwide, such as pneumonia, bacteremia and meningitis. The aim of the study was to isolate, identify and determine antimicrobial susceptibility pattern of Streptococcus pneumoniae along with use of rapid immunochromatographic test “Binax NOW”, to detect antigen for diagnosis of bacterial meningitis. Methods: The study was carried out from October 2013 to September 2015 in Children’s Hospital, Teaching Hospital-Department of Child Health and Public Health Research Laboratory, Institute of Medicine, Kathmandu, Nepal. Cerebrospinal fluid sample from 339 suspected cases of meningitis from children below 15 years of age were examined for identification by Gram staining, Culture and by Binax Now test. The identification of bacteria was done following standard method recommended by American Society for Microbiology. Antibiotic sensitivity testing was done by modified Kirby- Bauer disk diffusion method. Results: Of total 339 suspected cases, 24(7.08%) bacterial meningitis was detected by Gram staining and culture methods whereas BinaxNow method detected 28(8.26%). On the basis of age, the highest numbers of the positive cases were found in the age group between 0-23 months (9.30%) followed by age group 49-60 months (8.16%) Conclusions: In conclusion, a significant rate of bacterial meningitis was found in this study prompting concern for national wide surveillance. Keywords: Children, Meningitis, S. pneumoniae, Nepal
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    Ventilator Associated Pneumonia in Tertiary Care Hospital, Maharajgunj, Kathmandu, Nepal
    (Institute of Medicine, 2013) Shrestha, RK; Dahal, RK; Mishra, SK; Parajuli, K; Rijal, BP; Sherchand, JB; Kirikae, T; Ohara, H; Pokhrel, BM
    Abstract Introduction: Ventilator Associated Pneumonia (VAP) is the most common nosocomial infection among intensive care unit (ICU) patients and lack of much information in Nepal. So, the aim of this study was to determine prevalence and bacteriological profile of VAP with special reference to multi-drug resistant (MDR), Methicillin-resistant Staphylococcus aureus(MRSA), Metallo-β-Lactamase(MBL), Extended-Spectrum β-Lactamase(ESBL)-producing bacterial strains. Methods: A total 150 tracheal specimens were studied during June 2011 to May 2012 at Department of Microbiology, TUTH as described by American Society for Microbiology (ASM). Combination disk method was done for the detection of ESBL and MBL producing isolates. Results: Prevalence of VAP was found to be 34%. Acinetobactereal coaccticusbaumannii complex (44%) was the commonest isolate, followed by Klebsiellapneumoniae (22%), Pseudomonas aeruginosa (16%) and Staphylococcus aureus (12%). Among MDR Gram negative bacteria (GNB), 39% were MBL and 33% were ESBL-producers. All GNB (61) were sensitive to Polymyxin B and Colistinsulphate, whereas, 48% were found resistant to Carbapenems. Prevalence of MRSA was 75%, which were all sensitive to Vancomycin. Conclusion: High prevalence of VAP, MDR along with MRSA or ESBL or MBL producing strains was found in the study. Thus, suitable control measures must be adopted to cope up this alarming situation with genetic characterization. Keywords: VAP, ICU, MDR, MRSA, ESBL, MBL

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