Antibiotic resistance in patients with chronic ear discharge awaiting surgery in Nepal.

IF 1.3 Q4 RESPIRATORY SYSTEM

Public Health Action Pub Date : 2021-11-01 DOI:10.5588/pha.21.0029

R R Karn, R Acharya, A K Rajbanshi, S K Singh, S K Thakur, S K Shah, A K Singh, R Shah, S Upadhya Kafle, M Bhattachan, A Abrahamyan, H D Shewade, R Zachariah

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Abstract

Setting: Biratnagar Eye Hospital, Biratnagar, Nepal, which offers ear surgery for chronic suppurative otitis media (CSOM).

Objective: In patients with CSOM awaiting surgery, to determine the 1) sociodemographic characteristics 2) bacterial isolates and their antibiotic resistance patterns and 3) characteristics of those refused surgery, including antibiotic resistance.

Design: A cohort study using hospital data, January 2018-January 2020.

Results: Of 117 patients with CSOM and awaiting surgery, 64% were in the 18-35 years age group, and 79% were cross-border from India. Of 118 bacterial isolates, 80% had Pseudomonas aeruginosa and 16% had Staphylococcus aureus. All isolates showed multidrug resistance to nine of the 12 antibiotics tested. The lowest antibiotic resistance in P. aeruginosa was for vancomycin (29%) and moxifloxacin (36%), and for S. aureus, this was vancomycin (9%) and amikacin (17%). Fourteen (12%) patients underwent surgery: myringoplasty (n = 7, 50%), cortical mastoidectomy with tympanostomy (n = 4, 29%) and modified radical mastoidectomy (n = 3, 21%). Those infected with P. aeruginosa and with resistance to over six antibiotics were significantly more likely to be refused for surgery.

Conclusion: Patients awaiting ear surgery were predominantly infected with multidrug-resistant P. aeruginosa and were consequently refused surgery. This study can help inform efforts for improving surgical uptake and introducing cross-border antimicrobial resistance surveillance.

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尼泊尔等待手术的慢性耳部分泌物患者的抗生素耐药性。

地点：尼泊尔比拉特纳加比拉特纳格尔眼科医院，该医院为慢性化脓性中耳炎（CSOM）提供耳朵手术。目的：在等待手术的CSOM患者中，确定1）社会人口学特征2）细菌分离株及其抗生素耐药性模式，3）拒绝手术的患者的特征，包括抗生素耐药性。设计：一项使用医院数据的队列研究，2018年1月至2020年1月。结果：在117名等待手术的CSOM患者中，64%在18-35岁年龄组，79%来自印度。在118个细菌分离株中，80%为铜绿假单胞菌，16%为金黄色葡萄球菌。所有分离株对所测试的12种抗生素中的9种表现出多药耐药性。铜绿假单胞菌对万古霉素（29%）和莫西沙星（36%）的耐药性最低，对金黄色葡萄球菌的耐药性最低的是万古霉素（9%）和阿米卡星（17%）。14名（12%）患者接受了手术：鼓膜成形术（n=7,50%）、皮质乳突切除术伴鼓室造瘘术（n=4.29%）和改良乳突根治术（n=3.21%）。那些感染铜绿假单胞菌并对六种以上抗生素产生耐药性的患者更容易被拒绝接受手术。结论：等待耳部手术的患者主要感染耐多药铜绿假单胞菌，因此拒绝手术。这项研究有助于为提高手术接受率和引入跨境抗菌药物耐药性监测提供信息。

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.