Browsing by Author "Siwakoti, Shraddha"
Now showing 1 - 2 of 2
Results Per Page
Sort Options
Publication Bloodstream Infections in a Nepalese Tertiary Hospital-Aetiology, Drug Resistance and Clinical Outcome(Nepal Health Research Council, 2024) Siwakoti, Shraddha; Sah, Rinku; Chhetri, Roshan; Khanal, BasudhaBackground: Bloodstream infections (BSIs) are a leading cause of sepsis-related morbidity and mortality globally. We present the pathogenic agents of bloodstream infections, their antimicrobial susceptibilities, and associated outcomes, with a focus on drug-resistant cases. Methods: We included all adult patients admitted to B.P. Koirala Institute of Health Sciences with blood culture-positive sepsis from July 2019 to June 2020. Blood cultures and antimicrobial susceptibility tests followed standard methods. Demographic, clinical, and microbiological data, including clinical outcomes, were documented. Patients were categorized into non-multidrug resistant (non-MDR), multidrug resistant (MDR), and extensively drug resistant (XDR) groups for analysis of clinical outcomes. Results: Of 5372 adult patients with suspected bloodstream infections, 475 (9%) had culture-positive infections with 536 organisms cultured. The median age of the patients was 42 (25-60) years, and 47% of the patients were women. There were 146 (31%) non-MDR, 220 (46%) MDR and 109 (23%) XDR cases. Common pathogens were Staphylococcus aureus (27%), Acinetobacter spp (20%), and Klebsiella spp (15%). The overall in-hospital mortality rate was 8% (38/475). Mortality was highest among XDR patients (53%), compared to MDR (29%) and non-MDR patients (18%) (p < 0.001). Patients in XDR group had longer hospital stays compared to MDR-BSI and non-MDR BSI patients (p=<0.001). After adjusting for risk factors, the odds ratio for in-hospital mortality in XDR patients was 2.52 (CI 1.11–5.72, p = 0.02). Conclusions: Drug-resistant pathogens are prevalent in our setting, causing bloodstream infection. Extensively drug-resistant bacteria in the blood are independently and significantly linked to increased mortality. Keywords: Bloodstream infections; clinical outcome; drug resistance.Publication Clinical, Bacteriological Profile and Outcome of Neonatal Sepsis(Nepal Health Research Council, 2022) Siwakoti, Shraddha; Sah, Rinku; Singh, Rupa Rajbhandari; Khanal, BasudhaAbstract Background: Sepsis is a major cause of morbidity and mortality among neonates in Nepal. This study was conducted to determine the clinical-bacteriological profile, their antibiotic susceptibility patterns, and clinical outcome of culture-positive neonatal sepsis. Methods: This was a prospective study conducted at B.P Koirala Institute of Health Sciences from July 2018 to June 2019. Neonates with clinically diagnosed sepsis having blood culture positive were included in the study. Blood samples culture and antimicrobial susceptibility testing were performed with the standard microbiological method. Demographic, clinical information, and clinical outcomes were documented. Results: The incidence of culture-positive sepsis was 10.3% (183/1773) of neonatal admissions. Poor feeding 85(46%) and fever 68(37%) were the common clinical features at presentation. The incidence of early-onset sepsis and late-onset sepsis were found to be 116 (63%) and 67(37%) respectively. Staphylococcus aureus was the common pathogen in both early-onset 61(49%) and late-onset 34(41%) sepsis. The incidence of multidrug-resistant cases was 41% (75/183) with 20% (15/75) extensively drug-resistant gram-negative bacilli, 36% (20/75) multidrug-resistant gram-negative bacilli, and 44% (33/75) Methicillin-resistant Staphylococcus aureus cases. In-hospital mortality rate was 12 (7%) with a higher frequency in multidrug-resistant sepsis 92% (11/12) than non- multidrug-resistant 8% (1/12). The median hospital days were longer in multidrug-resistant cases than non- multidrug-resistant [11(9-13) verses 3(2-5)]. Conclusions: The incidence of multidrug-resistant pathogens causing neonatal sepsis is high at our hospital and are associated with more in-hospital mortality and longer hospital stay. Implementation of effective preventive strategies to combat the emergence of antimicrobial resistance is immediately needed. Keywords: Bacteriological profile; incidence; MDR; neonatal sepsis; outcome