Browsing by Author "Sharma, Sangita"
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Publication Bacteriological Profile of Surgical Site Infection Following Gastrointestinal Surgery and Their Antibiogram(Nepal Health Research Council, 2023) Shrestha, Neha; Sharma, Sangita; Ghimire, Bikal; Prasad, Pravin; Das, Debashis; Sherchand, Jeevan BahadurAbstract Background: Surgical site infection is one of the common complication following abdominal surgery. It causes great morbidity and mortality, further increasing prevalence of multidrug resistant bacteria have made its management very challenging. The current study aims to identify causative agent responsible for surgical site infection and their antibiotic resistance patterns. Methods: This study was conducted among patients developing surgical site infection following gastrointestinal surgery in Tribhuvan university teaching hospital over a period of one year. The samples were collected and processed according to standard methods. The bacterial pathogens with their antimicrobial susceptibility were determined and resistant pattern like methicillin resistant Staphylococcus aureus and extended spectrum beta lactamase were further detected. Results: A total of 832 patients had under gone gastrointestinal surgery during the study period. Among them, 162 cases (19.5%) developed surgical site infection and 125 cases showed growth in culture. A total of 160 aerobic bacteria were isolated; Escherichia coli (29.9%) was the commonest organism with 40.8% being extended spectrum beta lactamase producer and 47.4% of Staphylococcus aureus were methicillin resistant. About 75.9% (85/112) of gram negative bacteria and 60.4% (29/48) gram positive bacteria were multi drug resistant. Conclusions: The burden of multi drug resistant bacteria causing surgical site infection is high which needs to be addressed timely. Good surveillance of bacterial antibiogram and rational antimicrobial use is necessary to reduce emergence and spread of resistant bacteria. Keywords: Extended Spectrum beta lactamase; gastrointestinal surgery; methicillin resistant staphylococcus aureus; multi drug resistance; surgical site infectionPublication Epidemiological Characteristics of Hepatitis C Patients Attending a Tertiary Care Hospital(Nepal Health Research Council, 2024) Kattel, Hari Prasad; Sharma, Sangita; Alfsnes, Kristian; Pathak, Rahul; Rijal, Komal Raj; Ghimire, Prakash; Andreassen, Ashild K; Banjara, Megha RajBackground: Hepatitis C infection is a major public health concern in Nepal. Epidemiological information on hepatitis C virus along with the status of co-infection with hepatitis B virus and human immunodeficiency virus is essential to controlling the hepatitis C burden. The objective of this study was to determine the sero-prevalence of hepatitis C virus infections, proportions of co-infections with human immunodeficiency virus and hepatitis B virus, and identify the demographic characters, and routes of transmission. Methods: A cross-sectional study was conducted from December 2019 to February 2024 at Tribhuvan University Teaching Hospital. The serological tests were performed by enzyme-linked immunosorbent assays from 25133 patients’ serum in four years. Results: The sero-prevalence of hepatitis C virus -infected patients was 0.8% (211/25133). Among them, 6.6% (14/211) were co-infected with human immunodeficiency virus and 1.4% (3/211) with hepatitis B virus. Among 211 hepatitis C virus patients, 174 (82.5%) were male, 156 (73.9%) were young aged 15–47 years with various professions, 167 (79.1%) were literate, and almost one-third of the patients (33.2%, 70/211) were regular alcoholics. Needle sharing among intravenous drug users (45.5%, 96/211) and sexual intercourse (28%, 59/211) were the most common modes of transmission. Conclusions: Although the prevalence of hepatitis C infections is less than 1%, it is more common among young male intravenous drug users. Awareness of the spread of hepatitis C infections among this population needs to be emphasized to control hepatitis C in Nepal. Keywords: characters; co-infection; hepatitis C, sero-prevalence.Publication Metallo-β-lactamase-producing Pseudomonas aeruginosa Isolates from Two Tertiary Care Centres in a District of Nepal: A Descriptive Cross-sectional Study(Nepal Medical Association, 2024) Shrestha, Pushpa Man; Kattel, Hari Prasad; Sharma, Sangita; Bista, Pratibha; Basnet, Bhupendra Kumar; Ghimire, Prakash; Rijal, Komal RajAbstract Introduction: Pseudomonas aeruginosa isolates producing metallo-β-lactamase have caused nosocomial outbreaks, severe infections, and ineffective carbapenem therapy worldwide since 1991. Due to their prevalence, hospital infection control techniques are difficult. This study aimed to find out the prevalence of metallo-β-lactamase among P. aeruginosa isolates from two tertiary care hospitals in Kathmandu. Methods: A descriptive cross-sectional study was conducted at the Department of Microbiology and Department of Pathology of two tertiary care centres in Kathmandu from 7 December 2021 to 6 April 2023, after receiving ethical approval from the Ethical Review Board. Isolated strains were identified and tested for antibiotic susceptibility by modified Kirby-Bauer Methods. Metallo-β-lactamase presence was confirmed using an imipenem-imipenem/ ethylenediaminetetraacetic acid disc. A convenience sampling method was used. The point estimate was calculated at 95% Confidence Interval. Results: Among 255, Pseudomanas aeruginosa isolates, the distribution of metallo-β-lactamase-producing Pseudomanas aeruginosa was 103 (40.39%) (34.32-46.69 at 95% Confidence Interval). Multidrug resistance categories included multidrug resistance 74 (71.80%), extensively drug resistance 32 (31.10%), P. aeruginosa difficult-to-treat 16 (15.53%) and carbapenem-resistant P. aeruginosa was determined to be 82 (79.60%). Conclusions: The study found a high prevalence of metallo-β-lactamase-producing Pseudomanas aeruginosa isolates, requiring early identification, infection control measures, and an all-inclusive antimicrobial therapy protocol to reduce their spread in medical settings.Publication Multidrug-Resistance and Biofilm Formation among Acinetobacter baumannii Isolated from Clinical Specimens(Nepal Health Research Council, 2024) Yadav, Poonam; Mishra, Shyam Kumar; Shrestha, Sreska; Sah, Ranjit; Rai, Junu Richhinbung; Kattel, Hari Prasad; Sharma, Sangita; Willcox, MarkBackground: Acinetobacter baumannii has emerged as a problematic pathogen due to its ability to become resistant to antibiotics and form biofilms. The aim of this study was to explore antibiotic resistance and biofilm formation, and examine any correlation between these in Acinetobacter baumannii isolates. Methods: This was a cross-sectional study conducted at the 750-bed Tribhuvan University Teaching Hospital in Nepal. Identification and antibiotic sensitivity of Acinetobacter baumannii isolates were performed following American Society for Microbiology guidelines. Different ?-lactamases were detected by standard phenotypic tests. The microtiter plate method was used to screen strains of their ability to form biofilms. Results: Out of total 18,343 clinical samples processed, 4,249 (23.1%) showed bacterial growth. A. baumannii comprised of 4.7% of the total bacterial growth. Multidrug-resistant (MDR) was exhibited by 97.5% of Acinetobacter baumannii isolates. All multidrug-resistant Acinetobacter baumannii isolates were resistant to cephalosporins and carbapenems; however, they were sensitive to polymyxins. Only few isolates showed sensitivity to sulbactam-containing antibiotics (15.4-29.2%), fluoroquinolones (1.0-7.2%), aminoglycosides (2.6-5.6%), and cotrimoxazole (4.1%). Extended-spectrum-beta-lactamase (ESBL), metallo-beta-lactamase (MBL), Klebsiella pneumoniae carbapenemase (KPC) and AmpC production were found in 54.9%, 73.3%, 41.5% and 14.9% isolates, respectively. Among all tested isolates, 192 were able to produce biofilms, with 83.1% being classified as strong biofilm producers. Those strains that were resistant to gentamicin were more likely to produce biofilms (P<0.05). ESBL, MBL, KPC and AmpC were seen in 51.8%, 71.6%, 43.8% and 16.0% of strong biofilm producers respectively. Conclusions: Only polymyxins were effective against Acinetobacter baumannii. Carbapenemase producers were generally strong biofilm producers, and gentamicin resistant strains were more likely to produce biofilms. The findings of this study may help to understand antibiotic-resistance mechanisms and provide valuable information in the treatment of MDR Acinetobacter baumannii infections. Keywords: Acinetobacter baumannii, biofilm, carbapenemase; multidrug-resistant.Publication Prevalence and Antimicrobial Susceptibility of Multi-Drug Resistant Uropathogens in a Tertiary Hospital in Nepal: A One-Year Audit(Nepal Medical Association, 2025) Pradhan, Manish Man; Sharma, Sangita; Poudyal, Sujeet; Gnyawali, Diwas; Adhikari, Suman; Chapagain, Suman; Luitel, Bhojraj; Kattel, Hari Prasad; Chalise, Pawan RajAbstract Introduction: Antibiotic resistance, especially multidrug resistance, poses a global public health threat. It complicates the treatment of infections like urinary tract infections, leading to treatment failure, extended hospital stays, and increased healthcare costs. Empirical antibiotic therapy, guided by local resistance patterns, is crucial for patient outcomes and infection prevention. This study analyzes urine cultures from TU-Teaching Hospital from January to December 2024 to investigate the prevalence and antimicrobial susceptibility of multidrug-resistant uropathogens. Methods: This was a retrospective, observational hospital-based study conducted in a tertiary care center after obtaining the ethical approval from Institutional Review Committee (IRC), (Approval reference: 470 (6-11) E2). All samples tested fromJanuary 1, 2024, to December 31, 2024 the period included in the study. Data were collected from the Electronic health records of the Microbiology department and analyzed using Microsoft Excel 16.0.0 and SPSS 30.0.0 software to determine the urine culture positivity rate, the prevalence of multidrug-resistant uropathogens, and their antimicrobial susceptibility patterns with a specific focus on resistance to commonly prescribed antibiotics. Results: A total of 25,315 urine samples were collected for urine culture and sensitivity testing during the study period. Significant bacterial growth was seen in 4,557 (18%). Multidrug resistance was seen in 3,448 (75.66%). The most frequently isolated organisms were Escherichia coli 1724 (50%), Klebsiella 154 (17.7%). E. coli, Klebsiella, Enterococcus, Citrobacter, Pseudomonas, and Acinetobacter showed resistance to Ceftriaxone (74.61–92.20%), Amoxycillin+Clavulanate (67.58–97%), and Nitrofurantoin (52.29–89.55%) across selectively tested isolates. Conclusions: Urine samples demonstrated a high prevalence of multidrug resistance to routinely prescribed antibiotics, even among second-line parenterally administered antibiotics. Only costly third-line antibiotics exhibited low resistance.