Pseudomonas aeruginosa in Nepali hospitals: poor outcomes amid 10 years of increasing antimicrobial resistance.

IF 1.3 Q4 RESPIRATORY SYSTEM

Public Health Action Pub Date : 2021-11-01 DOI:10.5588/pha.21.0048

M Mahto, A Shah, K L Show, F L Moses, A G Stewart

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引用次数: 1

Abstract

Objective: To determine antimicrobial resistance patterns and prevalence of multi- (MDR, i.e., resistant to ⩾3 classes of antimicrobial agents) and extensively (XDR, i.e., resistant to ⩾3, susceptible to ⩽2 groups of antibiotics) drug-resistant strains of Pseudomonas aeruginosa.

Methods: This was a cross-sectional study conducted in Nepal Mediciti Hospital, Lalitpur, Nepal, using standard microbiological methods with Kirby Bauer disc diffusion to identify antimicrobial susceptibility.

Results: P. aeruginosa (n = 447) were most frequently isolated in respiratory (n = 203, 45.4%) and urinary samples (n = 120, 26.8%). AWaRe Access antibiotics showed 25-30% resistance, Watch antibiotics 30-55%. Susceptibility to AWaRe Reserve antibiotics remains high; however, 32.8% were resistant to aztreonam. Overall, 190 (42.5%) were MDR and 99 (22.1%) XDR (first Nepali report) based on mainly non-respiratory samples. The majority of infected patients were >40 years (n = 229, 63.2%) or inpatients (n = 181, 50.0%); 36 (15.2%) had an unfavourable outcome, including death (n = 25, 10.5%). Our larger study showed a failure of improvement over eight previous studies covering 10 years.

Conclusion: Antibiotic resistance in P. aeruginosa occurred to all 19 AWaRe group antibiotics tested. Vulnerable patients are at significant risk from such resistant strains, with a high death rate. Sustainable and acceptable antibiotic surveillance and control are urgently needed across Nepal, as antimicrobial resistance has deteriorated over the last decade.

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尼泊尔医院的铜绿假单胞菌:10年来抗菌素耐药性增加的不良结果

目的:确定铜绿假单胞菌耐药模式和多重(MDR，即对大于或小于3类抗菌剂耐药)和广泛(XDR，即对大于或小于2组抗生素敏感)耐药菌株的流行。方法:这是一项在尼泊尔拉利特普尔的尼泊尔梅迪奇蒂医院进行的横断面研究，使用标准微生物学方法与Kirby Bauer圆盘扩散来鉴定抗菌药物敏感性。结果:铜绿假单胞菌(P. aeruginosa)以呼吸道(n = 203, 45.4%)和尿液(n = 120, 26.8%)分离最多。AWaRe Access抗生素耐药25-30%，Watch抗生素耐药30-55%。对AWaRe储备抗生素的敏感性仍然很高;32.8%对氨曲南耐药。总体而言，190例(42.5%)为耐多药耐药，99例(22.1%)为广泛耐药(尼泊尔首次报告)，主要基于非呼吸道样本。大多数感染患者为>40岁(n = 229, 63.2%)或住院患者(n = 181, 50.0%);36例(15.2%)出现不良结局，包括死亡(n = 25, 10.5%)。我们更大的研究表明，在过去10年的8项研究中，这种改善是失败的。结论:铜绿假单胞菌对AWaRe组19种抗生素均有耐药性。易受感染的患者面临这种耐药菌株的重大风险，死亡率很高。尼泊尔各地迫切需要可持续和可接受的抗生素监测和控制，因为在过去十年中抗菌素耐药性已经恶化。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Public Health Action RESPIRATORY SYSTEM-

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期刊介绍： Launched on 1 May 2011, Public Health Action (PHA) is an official publication of the International Union Against Tuberculosis and Lung Disease (The Union). It is an open access, online journal available world-wide to physicians, health workers, researchers, professors, students and decision-makers, including public health centres, medical, university and pharmaceutical libraries, hospitals, clinics, foundations and institutions. PHA is a peer-reviewed scholarly journal that actively encourages, communicates and reports new knowledge, dialogue and controversy in health systems and services for people in vulnerable and resource-limited communities — all topics that reflect the mission of The Union, Health solutions for the poor.