Yadav Santosh Kumar, Bhujel Rajshree, Hamal Pradip, Mishra Shyam Kumar, Sharma Sangita, Sherchand Jeevan Bahadur
Department of Microbiology, Rajarshi Janak University, Janakpurdham, Nepal.
Department of Clinical Microbiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Infect Drug Resist. 2020 Mar 3;13:725-732. doi: 10.2147/IDR.S239514. eCollection 2020.
has emerged as a significant multidrug-resistant (MDR) nosocomial pathogen worldwide and is responsible for various healthcare-associated infections. The MDR strains have been reported increasingly during the last decades in hospitalized patients. They have developed resistance to most of the available antibiotics and are known to produce various acquired β-lactamases. The β-lactamase producing strains have a potential for rapid dissemination in hospital settings, as it is often plasmid-mediated. The Infectious Diseases Society of America (ISDA) stated as one of the "red alert" pathogens that greatly threatens the utility of our current antibacterial armamentarium. The study attempted to investigate the spectrum and antimicrobial resistance among MDR and their potential implications in hospitalized patients in a tertiary care hospital of Nepal.
This study was conducted at Tribhuvan University Teaching Hospital (TUTH), Nepal from January 2017 to December 2017. A total of 177 isolated from hospitalized patients were included in the study. The AST was performed by disc diffusion method. The MDR strains were identified by the criteria of Magiorakos et al, ESBL production by CLSI guidelines, and AmpC β-lactamase production by the AmpC disc test. MBL and KPC production were detected as per the method of Tsakris et al.
Out of 177 , 91.0% were MDR isolates. Among the MDR isolates, the majority were isolated from respiratory tract specimens and were isolated from ICU patients. Most of the MDR isolates were resistant to all first-line antibiotics and all were completely sensitive to only polymyxin B and colistin sulfate. MBL (67.7%) was the common β-lactamase production among MDR isolates.
can cause a vast variety of infections in hospitalized patients. The highly resistant MDR strains are common in tertiary care hospitals. This bacteria lead to high morbidity and mortality as we are left with the only option of treating them by potentially toxic antibiotics like colistin sulfate and polymyxin B. Detection of drug resistance and rational use of antibiotics play a crucial role in the fight against this MDR pathogen.
已成为全球一种重要的多重耐药（MDR）医院病原体，可导致各种医疗保健相关感染。在过去几十年中，住院患者中多重耐药菌株的报告日益增多。它们已对大多数可用抗生素产生耐药性，并且已知会产生各种获得性β-内酰胺酶。产生β-内酰胺酶的菌株在医院环境中有迅速传播的可能性，因为它通常是质粒介导的。美国传染病学会（ISDA）将其列为严重威胁我们当前抗菌药物库效用的“红色警报”病原体之一。该研究试图调查尼泊尔一家三级护理医院中多重耐药菌的抗菌谱和耐药性及其对住院患者的潜在影响。
本研究于2017年1月至2017年12月在尼泊尔特里布万大学教学医院（TUTH）进行。共纳入177株从住院患者中分离出的菌株进行研究。采用纸片扩散法进行药敏试验。根据马焦拉科斯等人的标准鉴定多重耐药菌株，按照CLSI指南检测超广谱β-内酰胺酶（ESBL）的产生，通过AmpC纸片试验检测AmpCβ-内酰胺酶的产生。按照察克里斯等人的方法检测金属β-内酰胺酶（MBL）和肺炎克雷伯菌碳青霉烯酶（KPC）的产生。
在177株菌株中，91.0%为多重耐药分离株。在多重耐药分离株中，大多数分离自呼吸道标本，且多分离自重症监护病房（ICU）患者。大多数多重耐药分离株对所有一线抗生素耐药，且仅对多粘菌素B和硫酸粘菌素完全敏感。MBL（67.7%）是多重耐药分离株中常见的β-内酰胺酶类型。
可在住院患者中引起多种感染。高度耐药的多重耐药菌株在三级护理医院中很常见。由于我们只能选择使用硫酸粘菌素和多粘菌素B等潜在有毒抗生素来治疗它们，这种细菌导致了高发病率和高死亡率。耐药性检测和抗生素的合理使用在对抗这种多重耐药病原体的斗争中起着至关重要的作用。
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