Microorganisms Causing Severe Sepsis and Septic Shock in Patients Admitted to Alkhor Hospital Intensive Care Unit during 2010-2012.

Objective: To find out specifically the community acquired microorganisms that cause severe sepsis and septic shock in patients admitted to Alkhor hospital intensive care unit and it is susceptibility to antimicrobial agents. Methods: A Retrospective file review was performed on all adult patients who were admitted to intensive care unit with primary presenting diagnosis of severe sepsis or septic shock between 1st of January 2010 and 31st of December 2012. The primary outcome variable was inpatient mortality. Results: The top three organisms found were: Streptococcus pneumonia, Klebsiella pneumonie, and E. coli. 59% of patients did not have any organisms growing in the culture. Conclusions: This study concluded that 41% of blood cultures for patients with severe sepsis and septic shock had shown growth of micro-organism. The top three micro-organisms were Streptococcus pneumonia, Klebsiella pneumonie, and E. coli. Resistance to empiric antibiotic therapy was reported to be 35.7%. Patient age, antibiotic resistance and negative cultures were found to be the major risk factors for mortality in patients with severe sepsis and septic shock.

Isolation & antimicrobial susceptibility of Shigella from patients with acute gastroenteritis in Western Nepal.

BACKGROUND & OBJECTIVE: Shigellae play an important role as a causative organism of acute gastroenteritis, which is a global health problem with significant morbidity and mortality in especially in developing countries. This study was carried out to determine the isolation and pattern of antimicrobial resistance of Shigella in patients with acute gastroenteritis in western Nepal. METHODS: The study included all patients with acute gastroenteritis who visited a tertiary care hospital at Pokhara, Nepal during a 2-year period (2002-2004). The isolates was confirmed as Shigella by biochemical reaction and slide agglutination test using specific antisera. Antibiotic sensitivity test was determined by agar diffusion method and minimum inhibitory concentration (MIC) of the drugs was detected. RESULTS: Of the 770 stool samples, 83 (10.8%) yielded Shigella. Shigella flexneri caused 56 (67.4%) of the total cases of shigellosis followed by S. dysenteriae 12 (14.5%), S. sonnei 10 (12%) and S. boydii 5 (6%). Of the 83 isolates, 67 (80.7%) showed resistance to various drugs and 62 (74.7%) were resistant to two or more drugs. Resistance to cotrimoxazole was 80.7 per cent followed by tetracycline 74.7 per cent, ampicillin 53.0 per cent, nalidixic acid 31.3 per cent and ciprofloxacin 2.4 per cent. The MIC(50) and MIC(90) values of those drugs were also very high. All isolates were sensitive to cefotaxime and ceftriaxone. INTERPRETATION & CONCLUSION: The findings of our study suggested that Shigellae was an important etiological agent for acute gastroenteritis, with a high rate of drug resistance and requires constant monitoring in this region.

Emerging opportunistic protozoa and intestinal pathogenic protozoal infestation profile in children of western Nepal.

Intestinal parasitic infestation continues to be of public health importance in many tropical and subtropical countries for their high prevalence and effects on the morbidity in the population. This 5-year hospital-based retrospective analysis was aimed to find out the intestinal protozoal parasitic profile in 1790 pre-school and school-going children visiting the hospital with gastrointestinal illness. Giardia lamblia was the most prevalent pathogenic protozoan intestinal parasite (73.4%), followed by Entamoeba histolytica (24.4%). Interestingly, "newer" opportunistic pathogens like Cyclospora cayetanensis (1.0%) and Cryptosporidium sp. (1.0%) were detected from immunocompromised children below 2 years of age as a result of vertical transmission, which is alarming for a country like Nepal at the stage of 'concentrated epidemic' of HIV infection.

Salmonella bacteraemia in Pokhara: emergence of antibiotic resistance.

We undertook a retrospective hospital based study of 2,354 blood culture specimens from June 2000 to May 2003 in order to determine the isolation rates of Salmonella species and their antibiotic susceptibility patterns in western Nepal. Blood samples were cultured and identification of Salmonella species. and their antibiotic susceptibility testing were done as per standard protocol. Of the total 114 (4.8 %) yielded Salmonella species. Of them 76 (66.7%) Salmonella typhi and 38 (33.3%) S. paratyphi A. S. typhi was found to be the predominant species each year. Higher proportion of Salmonella bacteraemia was seen in adults, with a clearcut male to female preponderance (1.8:1). Monsoons enhanced the risk of acquiring enteric fever. There is also a rise in the number of multi-drug resistant strains in and around Pokhara Valley, with 40.7% S. typhi and 5.2% S. paratyphi A showing resistance to two or more antibiotics. These isolates were primarily resistant to the first line drugs namely Ampicillin, Chloramphenicol and Cotrimoxazole but susceptible to third generation Cephalosporins. Appearance of multi drug resistance poses considerable threat of increased morbidity and mortality in this region. This emphasizes the need for prudent use of antimicrobials.

Chromobacterium violaceum septicemia.

Chromobacterium violaceum is an extremely rare human pathogen. We report a rare case of septicemia with multiple abscesses and otitis media in a newborn caused by chromobacterium violaceum.