Cholera cases in Kathmandu - How to prevent yourself???

Preventive measures:

1. Environmental sanitation
2. Personal hygiene -regular hand washing
3. Avoid unknown sources of drinking water and street foods
4. Reasonable hygiene; use of disposable plates/glasses as much as possible for food serving, washing of food utensils with 0.5% hypochlorite water
5. Proper sewage disposal
6. Avoid raw vegetables
7. Use boiled or chlorinated water for drinking

The Story of Cholera

(Short and very informative)

Thank to Global Health Media for producing such a wonderful and informative short animation.

 

Multidrug-resistant bacteria with ESBL genes: A growing threat among people living with HIV/AIDS in Nepal

Multidrug-resistant bacteria with ESBL genes: A growing threat among people living with HIV/AIDS in Nepal

Riju Maharjan¹, Anup Bastola², Nabaraj Adhikari¹, Komal Raj Rijal¹, Megha Raj Banjara¹, Prakash Ghimire¹ Upendra Thapa Shrestha^1*

¹ Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal

² Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu, Nepal

 

*Corresponding author: Upendra Thapa Shrestha, Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal, Email: upendrats@gmail.com /  upendra.thapashrestha@cdmi.tu.edu.np

 

ABSTRACT

Background: Bacterial opportunistic infections are common in people living with HIV/AIDS (PLHA). Besides HIV-TB co-infection, lower respiratory tract infections (LRTIs) due to multidrug-resistant (MDR) bacteria cause significant morbidity and mortality among PLHA. This study identified bacterial co-infection of the lower respiratory tract and detected plasmid-mediated bla_TEM and bla_CTX-M genes among Extended-Spectrum b-Lactamase (ESBL) producing isolates from sputum samples in PLHA.

Methods: A total of 263 PLHA with LRTIs were enrolled in this study, out of which, 50 were smokers, 70 had previous pulmonary tuberculosis, and 21 had CD4 count <200 cells/µl. Sputum samples collected from PLHA were processed with standard microbiological methods to identify the possible bacterial pathogens. The identified bacterial isolates were assessed for antibiotic susceptibility pattern using modified Kirby Bauer disk diffusion method following Clinical Laboratory Standard Institute (CLSI) guidelines. In addition, plasmid DNA was extracted from MDR and ESBL producers for screening of ESBL genes; bla_CTX-M and bla_TEM by conventional PCR method using specific primers.

Results: Of 263 sputum samples, 67 (25.48%) showed bacterial growth. Among different bacterial pathogens, Klebsiella pneumoniae, (17; 25.37%) was the most predominant, followed by Haemophillus influenzae, (14; 20.90%)  and  Escherichia coli, (12; 17.91%). A higher infection rate (4/8; 50%) was observed among people aged 61 -70 years, whereas no infection was observed below 20 years. About 30.0% (15/50) of smokers, 32.86% (23/70) cases with previous pulmonary tuberculosis, and 52.38% (11/21) with CD4 count <200 cells/µl had bacterial LRTIs. Among 53 bacterial isolates excluding H. influenzae, 28 isolates were MDR and 23 were ESBL producers. All ESBL producers were sensitive to colistin and polymyxin B. Among ESBL producers, 47.83% (11/23) possessed bla_CTX-M, 8.6% (2/23) were positive for bla_TEM gene, and 43.48% (10/23) possessed both ESBL genes.

Conclusion: The increasing rate of MDR bacterial infections, mainly ESBL producers of LRTIs causes difficulty in disease management, leading to high morbidity and mortality of PLHA. Hence, it is crucial to know the antibiogram pattern of the isolates to recommend effective antimicrobial therapy to treat LRTIs in PLHA.

 

Keywords: PLHA, Lower respiratory tract infection, ESBL, bla_CTX-M, bla_TEM

Citation: Maharjan et al. Multidrug-resistant bacteria with ESBL genes: A growing threat among people living with HIV/AIDS in Nepal. BMC Infectious Diseases (2022) 22:526

https://doi.org/10.1186/s12879-022-07503-2

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