Bacteriological Profile of Wound Infection and Antibiotic Susceptibility Pattern of Various Isolates in a Tertiary Care Center

Introduction: Wound infection due to various pathogenic microorganisms and the development of resistance to antibiotics is one of the major problems in medical sector. This study aimed to identify the etiological agents of wound infection along with their antibiotic susceptibility. Methods: A total of 400 wound swab specimens were collected from the patients visiting a tertiary center in western Nepal over a period of six months. Thus, collected specimens were processed in Microbiology laboratory for isolation of causative agents. Antibiotic susceptibility test was performed for entire isolates by Kirby Baur disc diffusion method. Methicillin-Resistant Staphylococcus aureus was detected by cefoxitin disc diffusion test and Extended- Spectrum Beta-Lactamases producing Enterobacteriaeae by Phenotypic confirmatory disc diffusion test as recommended by Clinical and Laboratory Standards Institute. Results: Two hundred and fifty-nine (64.7%) of specimens were infected, giving rise to 269 different isolates. Among these, 166 (61.7%) were gram positive and 101 (37.6%) were gram negative bacteria. Staphylococcus aureus (n = 130, 48.3%) was the most predominant bacteria followed by Escherichia coli (n=44, 16.3%), and Klebsiella pneumoniae (n=23, 8.5%). Gentamicin followed by co-trimoxazole was the most effective among the tested antibiotics for Staphylococcus aureus. Gentamicin and ciprofloxacin were shown effective for isolated gram-negative bacteria. Conclusion: Fifty-eight (44.6%) of total Staphylococcus aureus were Methicillin-Resistant Staphylococcus aureus positive and 16 (20.7%) of total Enterobacteriaceae were Extended-Spectrum Beta-Lactamases producers. The increased prevalence of Methicillin-Resistant Staphylococcus aureus and Extended-Spectrum Beta-Lactamase suggest rational use of antibiotics on the basis of antibiotic sensitivity results

External Ophthalmomyiasis by Oestrus Ovis: Two Case Reports from Nepal

Introduction: Ophthalmomyiasis is an infestation of eye with larvae of dipteran flies most commonlyby Oestrus ovis (Sheep nasal botfly). External ophthalmomyiasis in humans is a rare condition seen inpeople residing in rural areas and also living close to livestock. Case Report: We report two cases ofexternal ophthalmomyiasis in 22 years old male and 38 years old female both having history of suddenonset of foreign body sensation and redness in left and right eyes respectively. Conclusion: This externalophthalmomyiasis presenting nonspecific symptoms similar to acute conjunctivitis is the first case reportedin Nepal to the best of our knowledge. This report may aware all ophthalmologists about larval conjunctivitispreventing misdiagnosis

Association of Preoperative mid-stream urine culture, Renal pelvic urine culture and Renal stone culture in the detection of Systemic inflammatory response syndrome/urosepsis post Percutaneous Nephrolithotomy

Introduction: Urosepsis post Percutaneous Nephrolithotomy (PCNL) is a dreaded complication with high mortality rate. Objective: To find the association of preoperative midstream urine culture (PMUC), renal pelvic urine culture (RPUC) and renal stone culture (RSC) in the post-operative development of Systemic Inflammatory Response Syndrome (SIRS) and urosepsis. Methods: It was a prospective cross-sectional observational study. The study included all symptomatic patients meeting the inclusion criteria who underwent Percutaneous Nephrolithotomy from 18th August, 2019 to 28th March, 2020. PMUC, RPUC and RSC were done and analyzed accordingly. Results: A total of 140 (73 males, 67 females) patients underwent PCNL. PMUC was positive in 15% (21/140) as compared to RPUC and RSC which were 7.9 % (11/140) and 4.3% (6/140) of total cases. None of the patients had simultaneous culture positivity in all the three types of specimens. Only two (1.42%) patients had simultaneous positivity in pelvic urine culture and stone culture. The organisms obtained in pelvic urine culture and stone culture were same i.e. Klebsiella and Escherichia coli respectively. Only two (1.42%) patients developed SIRS post PCNL, where in both the cases stone culture were positive but PMUC and RPUC were negative. Urosepsis was found in none of the patients. In the Fischer Exact test PMUC and RPUC were not statistically significant in the detection of SIRS post PCNL. Whereas only RSC showed statistical significance in the detection of SIRS. Conclusion: Stone culture has high prediction for SIRS and it might be considered for patients undergoing PCNL in order to prevent stone related infective complications

Inhibition and Reduction of Biofilm Production along with Their Antibiogram Pattern among Gram-Negative Clinical Isolates

Background. Bacterial biofilm is a significant virulence factor threatening patients, leading to chronic infections and economic burdens. Therefore, it is crucial to identify biofilm production, its inhibition, and reduction. In this study, we investigated biofilm production among Gram-negative isolates and assessed the inhibitory and reduction potential of ethylene diamine tetra acetic acid (EDTA) and dimethyl sulfoxide (DMSO) towards them. In addition, we studied the antimicrobial resistance pattern of the Gram-negative isolates. Methods. Bacterial isolation and identification was done using standard microbiological techniques, following the Clinical and Laboratory Standards Institute (CLSI) guideline, 28th edition. The Kirby–Bauer disk diffusion method was used to determine the antibiotic susceptibility pattern of the isolates, and β-lactamase production was tested via the combination disk method. Biofilm formation was detected through the tissue culture plate (TCP) method. Different concentrations of EDTA and DMSO were used to determine their inhibitory and reduction properties against the biofilm. Both inhibition and reduction by the various concentrations of EDTA and DMSO were analyzed using paired t-tests. Results. Among the 110 clinical isolates, 61.8% (68) were found to be multidrug resistant (MDR). 30% (33/110) of the isolates were extended-spectrum β-lactamase (ESBL) producers, 14.5% (16/110) were metallo-β-lactamase (MBL), and 8% (9/110) were Klebsiella pneumoniae carbapenemase (KPC) producers. Biofilm formation was detected in 35.4% of the isolates. Biofilm-producing organisms showed the highest resistance to antibiotics such as cephalosporins, chloramphenicol, gentamicin, and carbapenem. The inhibition and reduction of biofilm were significantly lower (p < 0.05) for 1 mM of EDTA and 2% of DMSO. Conclusion. Isolates forming biofilm had a higher resistance rate and β-lactamase production compared to biofilm nonproducers. EDTA and DMSO were found to be potential antibiofilm agents. Hence, EDTA and DMSO might be an effective antibiofilm agent to control biofilm-associated infections

Academic Stress among Adolescents of Rural Nepal: A Community-based Cross-Sectional Study

Background: Adolescents are in the transition phase between childhood and adulthood. Their mental health influences many aspects in their life as they go through many physical and emotional changes. Adolescent mental health is harmed by changes in emotional and physical state, as well as increased academic pressure. This study aimed to assess academic stress and its associated factors among adolescents in rural Nepal. Methods: A community-based cross-sectional survey was conducted among 424 adolescents residing in Karnali Province, Nepal. Academic stress was measured using Student Assessing Academic Stress. Multivariate logistic regression analysis was used to examine associated factors at the significance level of 0.05. Results: Of the total students, 19.8% had moderate academic stress and 2.4% of them had high academic stress. Female students had thrice higher odds of having academic stress as compared to male students (Adjusted Odds Ratio:3.47; 95% Confidence Interval:1.91to 6.31, p-value:<0.001). Grade 10 students had higher odds of having academic stress as compared to grade 9 (Adjusted Odds Ratio:2.02; 95% Confidence Interval:1.13 to 3.61, p-value:0.017). Students of literate mothers were more likely to experience academic stress than those with illiterate mothers (Adjusted Odds Ratio:0.53; 95% Confidence Interval:0.29 to 0.96, p-value:0.036). Students with unsatisfactory academic performance had thrice higher odds of having academic stress as compared to students with satisfactory academic performance (Adjusted Odds Ratio:3.12; 95% Confidence Interval:1.46 to 6.67, p-value:<0.003). Conclusions: The findings of the study showed that high school students have academic stress, which is related to many factors at home and school. Understanding academic stress and parents and teachers providing the best support to the students could help lessen the burden. Keywords: Academic stress; adolescents; Nepal; prevalenc