Shrestha Raj Kumar, Shrestha Dhruba, Sah Ashok Kumar, Thapa Ashmita, Shrestha Nipun, Raya Ganendra Bhakta, Furushima Kenshi, Dhoubhadel Bhim Gopal, Parry Christopher M
Department of Research, Siddhi Memorial Hospital, Bhaktapur, Nepal.
School of Tropical Medicine and Global Health (TMGH), Nagasaki University, Nagasaki, Japan.
JAC Antimicrob Resist. 2024 Mar 12;6(2):dlae035. doi: 10.1093/jacamr/dlae035. eCollection 2024 Apr.
Data on antimicrobial resistance (AMR) among children in Nepal are limited. Here we have characterized the causes of bacterial bloodstream infections (BSIs), antimicrobial resistance patterns and the mechanisms of β-lactamase production in Enterobacterales among children attending outpatient and inpatient departments of a secondary care paediatric hospital in Nepal.
We retrospectively collected demographic and clinical data of culture-proven bacterial BSIs between January 2017 and December 2022 among children <18 years attending a 50-bedded paediatric hospital. Stored isolates were subcultured for antimicrobial susceptibility testing against commonly used antimicrobials. Enterobacterales displaying non-susceptibility to β-lactams were phenotypically and genotypically investigated for ESBLs, plasmid-mediated AmpC (pAmpC) β-lactamases and carbapenemases.
A total of 377 significant bacteria were isolated from 27 366 blood cultures. Among 91 neonates with a BSI, ( = 39, 42.4), ( = 15, 16.3%) and complex ( = 13, 14.1%) were most common. In the non-neonates, 275/285 (96.5%) infections were community-acquired including ( = 89, 32.4%), Typhi ( = 54, 19.6%) and ( = 32, 11.6%). Among the 98 , 29 (29.6%) were methicillin-resistant . and demonstrated non-susceptibility to extended-spectrum cephalosporins and carbapenems in both community and hospital-acquired cases. For and , (45/46), (7/10) and (5/6) were common among their respective groups.
We determined significant levels of AMR among children attending a secondary care paediatric hospital with BSI in Nepal. Nationwide surveillance and implementation of antimicrobial stewardship policies are needed to combat the challenge imposed by AMR.
尼泊尔儿童抗菌药物耐药性（AMR）的数据有限。在此，我们对尼泊尔一家二级护理儿科医院门诊和住院部儿童的细菌性血流感染（BSI）病因、抗菌药物耐药模式以及肠杆菌科细菌β-内酰胺酶产生机制进行了特征描述。
我们回顾性收集了2017年1月至2022年12月期间，在一家拥有50张床位的儿科医院就诊的18岁以下儿童经培养证实的细菌性BSI的人口统计学和临床数据。对储存的分离株进行传代培养，以检测其对常用抗菌药物的敏感性。对表现出对β-内酰胺类不敏感的肠杆菌科细菌进行超广谱β-内酰胺酶（ESBLs）、质粒介导的AmpC（pAmpC）β-内酰胺酶和碳青霉烯酶的表型和基因型研究。
从27366份血培养物中总共分离出377株重要细菌。在91例患有BSI的新生儿中，（=39，42.4%）、（=15，16.3%）和复杂（=13，14.1%）最为常见。在非新生儿中，275/285（96.5%）例感染为社区获得性感染，包括（=89，32.4%）、伤寒（=54，19.6%）和（=32，11.6%）。在98株中，29株（29.6%）为耐甲氧西林。在社区获得性和医院获得性病例中，和对超广谱头孢菌素和碳青霉烯类均表现出不敏感。对于和，（45/46）、（7/10）和（5/6）在各自组中较为常见。
我们确定了尼泊尔一家二级护理儿科医院患有BSI的儿童中存在显著水平的AMR。需要在全国范围内进行监测并实施抗菌药物管理政策来应对AMR带来的挑战。
