Study of microbial infection and associated antimicrobial resistance among patients admitted in intensive care unit of a tertiary care level hospital of Nepal

Background & objectives: In recent years, the rise in antibiotic resistance has posed challenges to the choice of empirical treatment for difficult cases. The objective of this study was to evaluate the prevalence of microbiological infections and the corresponding antibiotic resistance among patients admitted to the intensive care unit of a tertiary care hospital. Methods: The Microbiology laboratory received bacterial isolates from diverse clinical specimens originating from multiple Intensive Care Units (ICUs) for the purpose of culture and sensitivity testing. The identification of all species was conducted using both morphological and biochemical techniques, following established laboratory protocols. Additionally, the antibiotic susceptibility pattern was assessed by the utilization of disc diffusion methods. Results: The organisms were successfully isolated from 66.57% of the total 2920 samples collected. In 71.19% of the samples, a single organism was isolated, whereas in 28.8% of the samples, two or more organisms were found. Pseudomonas aeruginosa was the most often isolated bacterium, accounting for 38.17% of the total isolates. In the case of Pseudomonas aeruginosa, tobramycin has the most notable susceptibility rate at 94.2%, followed by meropenem at 93.93%, carbenicillin at 79.11%, and levofloxacin at 73.45%. The majority of commonly isolated pathogens have a high level of resistance to ampicillin, cephalexin, cefepime, and ciprofloxacin. Conclusions: The appropriate utilization of antibiotics in ICU plays a significant role in mitigating the development and spread of multi-drug resistance. Improved management of infections caused by resistant organisms in ICU necessitates the implementation of antibiotic policies and the establishment of robust surveillance systems

Undiagnosed case of klippel-trenaunnay syndrome presenting as extensive heterotrophic ossification and flexion deformity of right lower limb requiring amputation: A case report

Klippel-Trenaunnay Syndrome is a rare disease characterized by a clinical triad of capillary malformation, soft tissue and bony hypertrophy, and atypical varicosity. This syndrome ranges from asymptomatic disease to life-threatening bleeding, embolism, and deformities. Management includes early diagnosis, prevention, and treatment of complications. We present a case of a 43-year-old male presenting with pain, swelling and deformity of the right leg for 30 years. On examination, diffusely enlarged tender right limb with several dark patchy discolorations, multiple tortuous vessels were found. Right leg X-ray showed heterotrophic ossification and distortion of ankle joint. Due to chronic severe pain, recurrent infection, contracture and flexion deformity of right leg, the patient underwent above knee amputation. This case focuses on the variable presentation and multiple problems faced by patients with Klippel-Trenaununay Syndrome as they get diagnosed late and shows the importance of high index of suspicion for early diagnosis and prevention of complications