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A decade-long analysis of trends in antimicrobial resistance at a neurosurgical hospital in Kathmandu, Nepal

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Aug 27, 2024 version files 1.45 MB

Abstract

Background: Multidrug-resistant (MDR) bacteria cause infections with higher risks of morbidity, mortality, and financial burden, emphasizing the importance of understanding pathogen-specific resistance patterns for effective treatment and resistance management. Therefore, this retrospective cohort study examined the prevalence, causes, and trends of antimicrobial resistance in bacterial infections in a neurosurgical hospital in Nepal.

Method: We analyzed the demographics, bacteriological profiles, and antimicrobial susceptibility results of patients who visited a neurosurgical hospital in Kathmandu, Nepal, between January 2014 and January 2024, using SPSS, version 17.00.

Results: Among 4,758 patients, 465 (9.77%) had infections caused by 571 bacteria. Of them, 435 (93.55%) patients had urinary tract infections, 89 (19.14%) had bloodstream infections, and 31 (6.67%) had respiratory tract infections. Klebsiella pneumoniae (n=172, 30.12%) was the predominant bacteria. Resistance rates for Enterobacterales and GPC against tetracyclines were 83.33% and 45.83%, cephalosporins were 78.02% and 40.45%, quinolones were 72.25% and 50.00%, aminoglycosides were 65.14% and 43.53%, carbapenems were 62.96% and 30.00%, penicillins were 54.55% and 57.89%, and penicillin with beta-lactamase inhibitors (PwBLIs) were 40.54% and 42.31%, respectively. Non-fermenters showed 100% resistance to these antibiotics. MDR isolates (n=118, 20.67%) were 100.00% susceptible to piperacillin-tazobactam and 83.33% to polymyxin B. Over the years, resistance increased for cephalosporins (48.15-60.53%) but decreased for carbapenems (50.00-33.33%), penicillins (64.29-42.31%), PwBLIs (50.00-12.50%), aminoglycosides (60.00-49.12%), tetracyclines (100.00-16.67%), and polymyxins (76.22-16.67%).

Conclusion: One-tenth of hospital-visiting patients had bacterial infections, with three-fourths involving Enterobacterales and one-fifth involving MDR bacteria. In recent years, resistance to cephalosporins has increased, while resistance to other beta-lactams, aminoglycosides, and polymyxins has decreased.