Basnet Ajaya, Shrestha Apurba, Sharma Gopal Raman, Shrestha Shila, Khanal Laxmi Kant, Rai Junu Richhinbung, Maharjan Rajendra, Basnet Bijaya, Rai Shiba Kumar
Department of Microbiology, Nepal Armed Police Force Hospital, Kathmandu, Nepal.
Department of Internal Medicine, Nepal Armed Police Force Hospital, Kathmandu, Nepal.
Microbiol Immunol. 2025 Jan;69(1):10-24. doi: 10.1111/1348-0421.13185. Epub 2024 Nov 27.
Multidrug-resistant (MDR) bacteria cause infections with higher risks of morbidity, mortality, and financial burden. Understanding the antimicrobial resistance patterns of these pathogens is crucial for effective treatment and managing resistance. Therefore, this retrospective study examined the prevalence, causes, and trends in antimicrobial resistance in bacterial infections at a neurosurgical hospital in Nepal. We analyzed the demographics, bacteriological profiles, and antimicrobial susceptibility results in patients who visited Dirghayu Guru Hospital and Research Center, Kathmandu, Nepal, between January 2014 and January 2024, using SPSS, version 17.00. Among 4758 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. Proportions of drug-resistant Enterobacterales and gram-positive cocci among drug-resistant bacteria 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. Proportions of drug-resistant nonfermenters among drug-resistant bacteria showed 100.00% resistance to these antimicrobials. 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%). 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, whereas resistance to other beta-lactams, aminoglycosides, and polymyxins has decreased.
多重耐药（MDR）细菌引起的感染具有更高的发病、死亡风险以及经济负担。了解这些病原体的抗菌药物耐药模式对于有效治疗和控制耐药性至关重要。因此，这项回顾性研究调查了尼泊尔一家神经外科医院细菌感染中抗菌药物耐药性的流行情况、原因及趋势。我们使用SPSS 17.00软件分析了2014年1月至2024年1月期间在尼泊尔加德满都迪尔加尤古鲁医院及研究中心就诊患者的人口统计学特征、细菌学特征和抗菌药物敏感性结果。在4758名患者中，465名（9.77%）患者的感染由571株细菌引起。其中，435名（93.55%）患者患有尿路感染，89名（19.14%）患者患有血流感染，31名（6.67%）患者患有呼吸道感染。肺炎克雷伯菌（n = 172，30.12%）是主要细菌。耐药肠杆菌科细菌和革兰氏阳性球菌对四环素的耐药比例分别为83.33%和45.83%，对头孢菌素的耐药比例分别为78.02%和40.45%，对喹诺酮类的耐药比例分别为72.25%和50.00%，对氨基糖苷类的耐药比例分别为65.14%和43.53%，对碳青霉烯类的耐药比例分别为62.96%和30.00%，对青霉素的耐药比例分别为54.55%和57.89%，对青霉素与β-内酰胺酶抑制剂（PwBLIs）的耐药比例分别为40.54%和42.31%。耐药非发酵菌在耐药细菌中对这些抗菌药物的耐药比例均为100.00%。多重耐药菌株（n = 118，20.67%）对哌拉西林-他唑巴坦的敏感性为100.00%，对多粘菌素B的敏感性为83.33%。多年来，头孢菌素的耐药性增加（从48.15%增至60.53%），但碳青霉烯类（从50.00%降至33.33%）、青霉素（从64.29%降至42.31%）、PwBLIs（从50.00%降至12.50%）、氨基糖苷类（从60.00%降至49.12%）、四环素（从100.00%降至16.67%）和多粘菌素（从76.22%降至16.67%）的耐药性降低。十分之一的就诊患者发生细菌感染，其中四分之三涉及肠杆菌科细菌，五分之一涉及多重耐药细菌。近年来，对头孢菌素的耐药性增加，而对其他β-内酰胺类、氨基糖苷类和多粘菌素的耐药性降低。
