Epidemiology of multi drug resistant gram negative bacteria in Kathmandu, Nepal

Abstract

Purpose: Multi drug resistant (MDR) bacterial infections are considered to be hospital-acquired in high income countries. Little data are available regarding the epidemiology of MDR bacteria in low and middle-income countries. Our study looked at the epidemiology of gram negative bacterial infections in Kathmandu, Nepal. Methods & Materials: Kathmandu Model Hospital is a 125 bed tertiary care hospital, in Kathmandu, Nepal. All patients hospitalized with MDR bacterial infections over a 12 month period were retrospectively evaluated. MDR bacteria included those with extended spectrum beta lactamase (ESBL), carbapenem (CRE) or colistin resistance. Age matched controls of patients with clinical infection but negative cultures were selected during the same time period. Water surveillance was performed to identify a potential source of environmental exposure. 55 vials were filled from various drinking water sources in Kathmandu; including bottled water, home reservoirs, and community taps. Water samples were analyzed by centrifugation and conventional culture techniques. Results: No significant differences in patient characteristics were noted between the groups (Table 1). Among the cases, 73% had E. coli, 15% had Acinetobacter sp (ACBC), and 12% had K. pneumoniae. The majority of infections in both groups were community acquired. 5 water samples from 4 locations were found to have ACBC.Tabled 1CasesControlsAge years mean (range)54 (23-95)54 (18-89)Sex Male13 (32%)17 (43%) Female27 (68%)23 (57%)Admission Diagnosis Respiratory7 (18%)18 (45%) Genitourinary17 (43%)5 (13%) Skin and Soft Tissue4 (10%)0 (0%) Abdominal9 (22%)5 (13%) Unknown source3 (7%)12 (29%)Comorbidities Cardiac1211 Respiratory213 Renal52 Endocrine135 Other83Hospital Ward Medicine25 (64%)27 (68%) Surgery9 (23%)10 (25%) Gynecology5 (13%)3 (7%)Organism E. coli290 K. pneumoniae50 ACBC60 No growth040Community Acquired3936Hospital Acquired14 Open table in a new tab Conclusion: Gram negative bacterial resistance is a prevalent concern in low and middle-income countries. Our study demonstrated gram negative bacteria in the drinking water in various locations throughout Kathmandu. This is a possible source of community acquired MDR bacterial infection.