The Causes of Bacterial Bloodstream Infections and Antimicrobial Resistance Patterns in Children Attending a Secondary Care Hospital in Bhaktapur, Nepal, 2017-2022: a Retrospective Study

Overview

Journal JAC Antimicrob Resist

Publisher Oxford University Press

Specialty Infectious Diseases

Date 2024 Mar 13

PMID 38476771

Authors

Raj Kumar Shrestha

Dhruba Shrestha

Ashok Kumar Sah

Ashmita Thapa

Nipun Shrestha

Ganendra Bhakta Raya

Kenshi Furushima

Bhim Gopal Dhoubhadel

Christopher M Parry

Affiliations

Soon will be listed here.

Abstract

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

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