Multi-drug Resistant Bacterial Isolates Associated with Blood Stream Infection

Multidrug resistant (MDR) bacteria complicate therapeutic management and limit treatment options. With the increase of antibiotic resistance among bacterial isolates, monitoring of the of drug resistance pattern became critical for appropriate empiric selection of antibiotic therapy. Between June 2014 to January 2015, a prospective study was carried out in Manmohan Memorial Medical College and Teaching Hospital, Kathmandu with an objective to determine the status of Extended Spectrum Beta- Lactamase (ESBL) and Biofilm producing MDR bacterial isolates from blood samples. Identification of the isolates was done by standard microbiological techniques and antibiotic susceptibility testing was done by Kirby Bauer disc diffusion method following Clinical and Laboratory Standard Institute (CLSI) guidelines. ESBL screening of gram negative isolates was done using Ceftriaxone, Aztreonam, Cefotaxime, Ceftazidime and Cefpodoxime followed by confirmation using MASTDISCSTM Extended Spectrum Beta- Lactamase (ES?L) Detection Discs and Biofilm detection was done by Congo-Red and Tube- adherence Method. The culture positivity of 16% and 10 different species of bacteria were isolated. The most frequently occurring isolate was Escherichia coli followed by Staphylococcus aureus. In vitro antibiotic susceptibility test showed that Amikacin remains the principle antibiotic of choice based on its effectiveness on both gram positive and gram negative bacteria.Ninety five percent of isolates were MDR with 77.19% ESBL producers and 72.5% were biofilm producers. A statistically significant relationship was found between increasing spectrum of drug resistance and ESBL production and drug resistant in biofilm production (p<0.05)

Biofilm and MBL production among imipenem resistant Pseudomonas aeruginosa and Acinetobacter species

Pseudomonas aeruginosa and Acinetobacter species are the primary cause of nosocomial infections. The advent of Metallo-beta-lactamase (MBL) and biofilm-producing bacterial strains poses a serious threat to reserve drugs such as carbapenem. The objective of this study was to determine the rate of MBL and biofilm production among imipenem resistant P. aeruginosa (IRPA) and imipenem resistant Acinetobacter spp. (IRAS) isolates. A total of 79 P. aeruginosa and 117 Acinetobacter spp. were isolated from various clinical specimens of patients from July 2016 to January 2017 at Manipal Teaching Hospital, Pokhara. MBL in IRPA and IRAS isolates were detected by Combined disc test and E-test. Biofilm production in imipenem resistant isolates was carried out by Microtitre plate assay. Fifteen (19%) P. aeruginosa and 57 (48.7%) Acinetobacter spp. were imipenem resistant isolates. MBL producers were found among 53.3% of IRPA and 38.6% of IRAS, whereas 100% of IRPA and 82.5% of IRAS were biofilm producers. All the biofilm producer IRPA isolates were Extensively Drug-Resistant (XDR), and a larger proportion of XDR IRAS strains were of high biofilm-producing phenotype. However, the majority of imipenem resistant (80% of IRPA and 49.1% of IRAS) and MBL producing (63%) isolates were weak biofilm formers. The study demonstrated the high capability of IRPA and IRAS to form a biofilm, which was strongly related to higher drug resistance. Nonetheless, imipenem resistant and MBL producer isolates showed an analogous association with the degree of biofilm formation. These MBL cum biofilm producer isolates were better susceptible to polymyxin B and ampicillin-sulbactam. DOI: http://dx.doi.org/10.5281/zenodo.419547

Use of antimicrobials during the COVID-19 pandemic: a qualitative study among stakeholders in Nepal

The COVID-19 pandemic was a major public health threat and the pressure to find curative therapies was tremendous. Particularly in the early critical phase of the pandemic, a lot of empirical treatments, including antimicrobials, were recommended. Drawing on interviews with patients, clinicians and drug dispensers, this article explores the use of antimicrobials for the management of COVID-19 in Nepal. A total of 30 stakeholders (10 clinicians, 10 dispensers and 10 COVID-19 patients) were identified purposively and were approached for an interview. Clinicians and dispensers in three tertiary hospitals in Kathmandu assisted in the recruitment of COVID-19 patients who were undergoing follow-up at an out-patient department. Interviews were audio recorded, translated and transcribed into English, and were analyzed thematically. The respondents report that over-the-counter (OTC) use of antibiotics was widespread during the COVID-19 pandemic in Nepal. This was mostly rooted in patients' attempts to mitigate the potential severity of respiratory illnesses, and the fear of the stigmatization and social isolation linked to being identified as a COVID-19 patient. Patients who visited drug shops and physicians reportedly requested specific medicines including antibiotics. Clinicians reported uncertainty when treating COVID-19 cases that added pressure to prescribe antimicrobials. Respondents from all stakeholder groups recognized the dangers of excessive use of antimicrobials, with some referring to the development of resistance. The COVID-19 pandemic added pressure to prescribe, dispense and overuse antimicrobials, accentuating the pre-existing OTC use of antimicrobials. Infectious disease outbreaks and epidemics warrant special caution regarding the use of antimicrobials and specific policy response

Field assessment of the operating procedures of a semi-quantitative G6PD Biosensor to improve repeatability of routine testing

In remote communities, diagnosis of G6PD deficiency is challenging. We assessed the impact of modified test procedures and delayed testing for the point-of-care diagnostic STANDARD G6PD (SDBiosensor, RoK), and evaluated recommended cut-offs. We tested capillary blood from fingerpricks (Standard Method) and a microtainer (BD, USA; Method 1), venous blood from a vacutainer (BD, USA; Method 2), varied sample application methods (Methods 3), and used micropipettes rather than the test’s single-use pipette (Method 4). Repeatability was assessed by comparing median differences between paired measurements. All methods were tested 20 times under laboratory conditions on three volunteers. The Standard Method and the method with best repeatability were tested in Indonesia and Nepal. In Indonesia 60 participants were tested in duplicate by both methods, in Nepal 120 participants were tested in duplicate by either method. The adjusted male median (AMM) of the Biosensor Standard Method readings was defined as 100% activity. In Indonesia, the difference between paired readings of the Standard and modified methods was compared to assess the impact of delayed testing. In the pilot study repeatability didn’t differ significantly (p = 0.381); Method 3 showed lowest variability. One Nepalese participant had <30% activity, one Indonesian and 10 Nepalese participants had intermediate activity (≥30% to <70% activity). Repeatability didn’t differ significantly in Indonesia (Standard: 0.2U/gHb [IQR: 0.1–0.4]; Method 3: 0.3U/gHb [IQR: 0.1–0.5]; p = 0.425) or Nepal (Standard: 0.4U/gHb [IQR: 0.2–0.6]; Method 3: 0.3U/gHb [IQR: 0.1–0.6]; p = 0.330). Median G6PD measurements by Method 3 were 0.4U/gHb (IQR: -0.2 to 0.7, p = 0.005) higher after a 5-hour delay compared to the Standard Method. The definition of 100% activity by the Standard Method matched the manufacturer-recommended cut-off for 70% activity. We couldn’t improve repeatability. Delays of up to 5 hours didn’t result in a clinically relevant difference in measured G6PD activity. The manufacturer’s recommended cut-off for intermediate deficiency is conservative

Digital learning Initiatives, Challenges and Achievement in Higher Education in Nepal Amidst COVID-19

The COVID-19 pandemic has affected higher education institutions (HEIs) worldwide and reshaped the existing educational system. Due to travel constraints and physical separation, there has been a global shift toward distance learning, and Nepal is no exception. This research intends to assess the practicality of online education by evaluating learners' experiences amidst COVID-19. A cross-sectional study was directed among HEIs students in Nepal using self-structured questionnaires. Our study revealed that 64.6% of the respondents were unsatisfied with online classes. More than half of the respondents (53.4%) use cell phones for online studies. Online education was reported to be unappealing to 28.8% of respondents. Variables such as age group (p = 0.05), enjoying class (p &lt; 0.001), hours spent for an online class in a day (p = 0.05), and period for educational work using an electronic device (p = 0.1) were found significant with satisfaction level using both bivariate test and inferential test of univariate binary logistics regression. The challenges and opportunities encountered among students and faculties are highlighted along with the recommendations for fortifying communication in online-based teaching/learning

The durability of long-lasting insecticidal nets distributed to the households between 2009 and 2013 in Nepal

Background: Understanding and improving the durability of long-lasting insecticidal nets (LLINs) in the field are critical for planning future implementation strategies including behavioral change for care and maintenance. LLIN distribution at high coverage is considered to be one of the adjunctive transmission reduction strategies in Nepal’s Malaria Strategic Plan 2014–2025. The main objective of this study was to assess the durability through assessment of community usage, physical integrity, residual bio-efficacy, and chemical retention in LLINs: Interceptor®, Yorkool®, and PermaNet ®2.0 which were used in Nepal during 2009 through 2013. Methods: Assessments were conducted on random samples (n = 440) of LLINs from the eleven districts representing four ecological zones: Terai plain region (Kailali and Kanchanpur districts), outer Terai fluvial ecosystem (Surkhet, Dang, and Rupandhei districts), inner Terai forest ecosystem (Mahhothari, Dhanusa, and Illam districts), and Hills and river valley (Kavrepalanchock and Sindhupalchok districts). For each LLIN, fabric integrity in terms of proportionate hole index (pHI) and residual bio-efficacy were assessed. However, for chemical retention, a representative sample of 44 nets (15 Yorkool®, 10 Permanet®2.0, and 19 Interceptor®) was evaluated. Data were analyzed using descriptive statistics stratified by LLINs brand, districts, and duration of exposure. Results: On average, duration of use of LLINs was shortest for the Yorkool® samples, followed by PermaNet® 2.0 and Interceptor® with median ages of 8.9 (IQR = 0.4), 23.8 (IQR = 3.2), and 50.1 (IQR = 3.2) months, respectively. Over 80% of field distributed Yorkool® and PermaNet® 2.0 nets were in good condition (pHI< 25) compared to Interceptor® (66%). Bio-efficacy analysis showed that average mortality rates of Interceptor and Yorkool were below World Health Organization (WHO) optimal effectiveness of ≥ 80% compared to 2-year-old PermaNet 2.0 which attained 80%. Chemical retention analysis was consistent with bio-efficacy results. Conclusion: This study shows that distribution of LLINs is effective for malaria control; however, serviceable life of LLINs should be considered in terms of waning residual bio-efficacy that warrants replacement. As an adjunctive malaria control tool, National Malaria Control Program of Nepal can benefit by renewing the distribution of LLINs in an appropriate time frame in addition to utilizing durable and effective LLINs

Co-Circulation of Dengue Virus Serotypes 1, 2, and 3 during the 2022 Dengue Outbreak in Nepal: A Cross-Sectional Study

The largest dengue outbreak in the history of Nepal occurred in 2022, with a significant number of casualties. It affected all 77 districts, with the nation’s capital, Kathmandu (altitude 1300 m), being the hardest hit. However, the molecular epidemiology of this outbreak, including the dengue virus (DENV) serotype(s) responsible for this epidemic, remain unknown. Here, we report the epidemic trends, clinico-laboratory features, and virus serotypes and their viral load profiles that are associated with this outbreak in Nepal. Dengue-suspected febrile patients were investigated by routine laboratory, serological, and molecular tools, including a real-time quantitative polymerase chain reaction (qRT-PCR). Of the 538 dengue-suspected patients enrolled, 401 (74.5%) were diagnosed with dengue. Among these dengue cases, 129 (32.2%) patients who required hospital admission had significant associations with myalgia, rash, diarrhea, retro-orbital pain, bleeding, and abdominal pain. DENV-1, -2, and -3 were identified during the 2022 epidemic, with a predominance of DENV-1 (57.1%) and DENV-3 (32.1%), exhibiting a new serotype addition. We found that multiple serotypes circulated in 2022, with a higher frequency of hospitalizations, more severe dengue, and more deaths than in the past. Therefore, precise mapping of dengue and other related infections through integrated disease surveillance, evaluation of the dynamics of population-level immunity and virus evolution should be the urgent plans of action for evidence-based policy-making for dengue control and prevention in the country

Health inequalities in older Norwegians and the mediating role of social networks

This study aims to understand how social networks serve as an intervening pathway leading to socioeconomic health inequality among older adults in Norway. Longitudinal survey data and annual national register data from the second and the third waves of the Norwegian Life Course, Ageing, and Generation Study were used in this paper. The NorLAG second wave (NorLAG2) encompasses the nationwide gross sample of 9238 respondents aged between 40 and 80 during the interview. Similarly, Altogether, 6099 respondents aged between 50 and 95 during the interview participated in the third wave of NorLAG (NorLAG3). Hayes PROCESS was used to estimate the mediating effect of contact frequency and support potential of friends on the impact of socioeconomic position (SEP) at wave two on the health outcomes at wave three. The total indirect effect of income on physical health was observed as 0.04, meaning that those with a higher contact frequency with friends and higher support potential of friends, on average, report 0.04 units higher on the physical health score than those with lower contact frequency with friends and lower support potential of friends. The total indirect effect of the highest attained education level on physical health score is observed as 0.12, meaning that those with a higher contact frequency with friends and higher support potential of friends report on average 0.12 units higher on their physical health scores than those with lower contact frequency with friends and lower support potential of friends. The results showed a socioeconomic gradient in health among older adults in Norway, where the social network is a crucial pathway via which SEP influences peoples’ health. Evidence highlights that contact frequency with friends does not influence the relationship between SEP and health status among older Norwegian adults

Divergent Effects of Topography on Soil Properties and Above-Ground Biomass in Nepal’s Mid-Hill Forests

Various factors, including topography, climate, soil attributes, and vegetation composition, influence above-ground biomass productivity in forest ecosystems. Despite the success of community forestry in restoring degraded hill forests in Nepal, existing research offers limited insights into how topographic factors and plant species affect soil chemical properties and, in turn, influence above-ground biomass. This study investigates the interrelations between altitude, aspect, soil depth, and vegetation type on soil organic carbon (SOC), total nitrogen (TN), available phosphorus (P), available potassium (K), and soil pH. These soil metrics are further correlated with forestry indices, such as diameter at breast height (DBH), tree height (Ht), above-ground tree biomass (AGTB), basal area (BA), and above-ground total carbon (AGTC), in the mid-hill region of central Nepal. Our findings indicate that aspect had a significant influence on SOC (p p p p < 0.001) levels. Soils in the northwest (NW) aspect exhibited higher levels of SOC and TN but lower levels of P and pH than those in the southeast (SE) aspect. Altitude did not significantly affect soil properties. Variations in SOC, TN, K, and pH were observed across different soil depths. Key forestry metrics like DBH, Ht, AGTB, and AGTC were notably higher at elevated altitudes and under the NW aspect. We also found that vegetation composition adds a layer of complexity to the relationship between aspect, soil properties, and above-ground biomass. The higher altitudes in the SE aspect are more conducive to above-ground biomass productivity, while the NW aspect is favorable for higher levels of SOC and TN in the soil. These variations could be due to differences in carbon deposition rates, plant compositions, soil microbial activities, and microclimatic conditions between the aspects. These findings highlight the need for holistic forest management approaches that consider topographic factors, soil depth, and plant species, offering practical implications for the region’s sustainable forest management and restoration efforts

Divergent Effects of Topography on Soil Properties and Above-Ground Biomass in Nepal’s Mid-Hill Forests

Various factors, including topography, climate, soil attributes, and vegetation composition, influence above-ground biomass productivity in forest ecosystems. Despite the success of community forestry in restoring degraded hill forests in Nepal, existing research offers limited insights into how topographic factors and plant species affect soil chemical properties and, in turn, influence above-ground biomass. This study investigates the interrelations between altitude, aspect, soil depth, and vegetation type on soil organic carbon (SOC), total nitrogen (TN), available phosphorus (P), available potassium (K), and soil pH. These soil metrics are further correlated with forestry indices, such as diameter at breast height (DBH), tree height (Ht), above-ground tree biomass (AGTB), basal area (BA), and above-ground total carbon (AGTC), in the mid-hill region of central Nepal. Our findings indicate that aspect had a significant influence on SOC (p < 0.001), TN (p < 0.001), P (p < 0.05), and pH (p < 0.001) levels. Soils in the northwest (NW) aspect exhibited higher levels of SOC and TN but lower levels of P and pH than those in the southeast (SE) aspect. Altitude did not significantly affect soil properties. Variations in SOC, TN, K, and pH were observed across different soil depths. Key forestry metrics like DBH, Ht, AGTB, and AGTC were notably higher at elevated altitudes and under the NW aspect. We also found that vegetation composition adds a layer of complexity to the relationship between aspect, soil properties, and above-ground biomass. The higher altitudes in the SE aspect are more conducive to above-ground biomass productivity, while the NW aspect is favorable for higher levels of SOC and TN in the soil. These variations could be due to differences in carbon deposition rates, plant compositions, soil microbial activities, and microclimatic conditions between the aspects. These findings highlight the need for holistic forest management approaches that consider topographic factors, soil depth, and plant species, offering practical implications for the region’s sustainable forest management and restoration efforts