Journal Issue: No 2, Issue 18, APRIL-JUNE, 2007
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1812-2027
1812-2027
1812-2027
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Articles
Neonatal sepsis bacterial isolates and antibiotic susceptibility patterns at a NICU in a tertiary care hospital in western Nepal: A retrospective analysis
(Kathmandu University, 2007) Shaw, CK; Shaw, P; Thapalial, A
Background: Neonatal sepsis is one of the commonest causes of neonatal mortality in the developing world. The
neonatal intensive care units (NICUs) today face one common problem of tackling sepsis and neonatologists remain
constantly baffled by the changing patterns of microbial flora and their sensitivity patterns. With the neonatal
services coming of age in Nepal this retrospective analysis spread over a period of six years has become very
pertinent.
Materials and methods: We conducted a retrospective study over a period of six years to study the prevalence of
different organisms causing septicaemia in the community and at our hospital and the antibiotic susceptibility
pattern. In all 265 cases of suspected sepsis were screened using a panel consisting of CRP, ANC and I/T ratio and
subsequently confirmed by cultures. The cases were early onset (n=44), late onset (n=56) and nosocomial groups
(n=40). The data for the intramural (n=32) and extramural (n=68) cases was analysed separately.
Results: One hundred nineteen cultures out of the 131 positives were obtained from blood (44.92%) and the
remaining were isolated from urine (6.11 %) and CSF (4.58 %). The most common organism to be isolated was
staphylococcus aureus (42.75%) followed by klebsiella pneumoniae (18.32%)and escherechia coli (12.21%).
Staphylococcus was isolated from 36.84%, 45.16% and 31.81% of the cultures obtained from neonates in the in-
born, out-born and the nosocomial groups respectively while klebsiella pneumoniae [18.32 %] was seen in 21.05 %,
17.39 % and 36.36 % in each of the three groups. Pseudomonas aeruginosa [6.11 %] was isolated from 13.64 % of
the nosocomial cultures compared to 8.7 % of the out-borns while it was not seen in the in-borns. Other organisms
isolated were much less in number, included - pathogenic streptococci, acinetobacter and enterobacter species.
Coagulase negative staphylococci (CoNS) was seen in 4.39 % [n=4] and 9.09 % [n=4] of the same groups
respectively. The gram positive organisms displayed a high degree of resistance to most penicillins and
cephalosporins but glycopeptides and monobactams were effective in them. There was a high incidence of resistance
noted with most third generation cephalosporins and aminoglycosides amongst most gram negative organisms
where-in cefepime and imepenem were effective in most cases.
Conclusions: Staphylococcal sepsis is not only common in community acquired infections but also in nosocomial
sepsis. There is an emerging resistance to cephalosposrins probably attributable to extended spectrum
betalactamases. Further large-scale multicentre studies are required to generalise the data for the whole country.
Key words: neonatal sepsis, culture and susceptibility patterns.
Sub-trochanteric fractures of the femur: Results of ORIF at KMCTH
(Kathmandu University, 2007) KP, Rijal; RR, Manandhar; BK, Pandey
Sub-trochanteric fractures of the femur are not commonly encountered as compared to trochanteric or neck of femur
fractures. Relatively younger persons are injured more and a considerable violence is required for this fracture to
occur. These fractures, treated conservatively by methods like traction, splints or casts, are often associated with
complications like non-union, mal-union, shortening of the limb etc. Thus, we undertook this study of 10
consecutive cases of sub-trochanteric fractures of the femur treated by open reduction and internal fixation and bone
grafting in Kathmandu Medical College Teaching Hospital, Sinamangal, from the year Nov. 2000 to April 2006.
There were 4 females and 6 male patients. Their age on average was 46.8 years (range 15 to 86 years). Most of the
patients were in Type II or III in Seinsheimer classification; Type II A, B, and C, one, two and one respectively, and
in Type III A and B three patients each. Seven patients were treated with dynamic hip screw. Three patients with
type III were managed with centro-medullary interlocking nail with one cerclage suture. They were followed for a
period of minimum 6 months to 6 years (average 3.5 years). Union was achieved in all, on an average 4 months
postoperatively. Results were excellent and complications like nonunion, malunion or breakage of the implants,
were not encountered in any patient.
Comparative study between bupivacaine heavy vs pethidine intrathecally to study early haemodynamic changes and postoperative analgesia in patients undergoing caesarean section
(Kathmandu University, 2007) BR, Shrestha; SK, Maharjan; C, Thapa
Objective: To study early hemodynamic changes and duration of postoperative analgesia between two study groups
of intrathecal pethidine and bupivacaine heavy in patients undergoing caesarean section.
Methodology: Total number of 60 patients of ASA I and II, undergoing caesarean section were enrolled in the
study. All the patients were divided into two groups: Pethidine and Bupivacaine heavy. The dose of pethidine for
subarachnoid block was 1mg/kg and in Bupivacaine group 2.2ml of 0.5% bupivacaine heavy was given
intrathecally. Heart rate and blood pressure of all the patients were recorded before subarachnoid block. After giving
spinal anesthesia, the heart rate and blood pressure were monitored and recorded in different time intervals. The
duration of postoperative analgesia in all patients was recorded in postoperative ward. The APGAR Scores of the
babies were recorded in 1and 5 minutes after delivery. The data were statistically compared using independent
sample t-test.
Conclusion: The hemodynamic parameters (HR & BP) were compared in different time intervals. The difference in
heart rate and blood pressure at different time intervals in the two study groups were statistically insignificant as (p
> 0.05). The total duration of postoperative analgesia in patients receiving sole intrathecal pethidine was 8 hours and
30 minutes. Where as, in Bupivacaine group the duration was 2 hrs and 36 minutes. This has been found statistically
significant (p<0.05).