Use of antimicrobials and antimicrobial resistance in Nepal: a nationwide survey

Komal Raj Rijal^1,6*, Megha Raj Banjara^1,6, Binod Dhungel¹, Samarpan Kafle¹, Kedar Gautam¹, Bindu Ghimire¹, Prabina Ghimire², Samriddh Dhungel², Nabaraj Adhikari¹, Upendra Thapa Shrestha¹, Dev Ram Sunuwar³, Bipin Adhikari^4,5 & Prakash Ghimire^1*

¹Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal. ²Nepal Medical College, Jorpati, Kathmandu, Nepal.

³Department of Public Health, Asian College for Advance Studies, Purbanchal University, Lalitpur, Nepal.

⁴Mahidol‑Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.

⁵Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.

 

⁶These authors contributed equally: Komal Raj Rijal and Megha Raj Banjara.

 

*email: komal.rijal@cdmi.tu.edu.np; prakash.ghimire@cdmi.tu.edu.np

 

 

Nepal suffers from high burden of antimicrobial resistance (AMR) due to inappropriate use of antibiotics. The main objective of this study was to explore knowledge, attitude and practices of antibiotics uses among patients, healthcare workers, laboratories, drug sellers and farmers in eight districts of Nepal. A cross-sectional survey was conducted between April and July 2017. A total of 516 individuals participated in a face-to-face interview that included clinicians, private drug dispensers, patients, laboratories, public health centers/hospitals and, livestock and poultry farmers. Out of 516 respondents, 62.8% (324/516) were patients, 16.9% (87/516) were clinicians, 6.4% (33/516) were private drug dispensers. A significant proportion of patients (42.9%; 139/324) thought that fever could be treated with antibiotics. Majority (79%; 256/324) of the patients purchased antibiotics over the counter. The knowledge of antibiotics used among patients increased proportionately with the level of education: literate only [AOR = 1.4 (95% Cl = 0.6–4.4)], versus secondary education (8–10 grade) [AOR = 1.8 (95% Cl = 1.0–3.4)]. Adult patients were more aware of antibiotic resistance. Use of antibiotics over the counter was found high in this study. Knowledge, attitude and practice related to antibiotic among respondents showed significant gaps and need an urgent effort to mitigate such practice.

 

Citation: Scientific Reports (2021);11:11554 DOI: https://doi.org/10.1038/s41598-021-90812-4

www.nature.com/scientificreports

Full-text: Download

COVID-19 General Information from WHO

For More Information: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public?gclid=Cj0KCQjws-OEBhCkARIsAPhOkIYLtKnFJq5dzl7E4EMmrqP_3vsx-V3LydSMA61IgrwWtWa5GUzTImsaAgYpEALw_wcB

Antimicrobial Susceptibility Pattern of Salmonella spp. Isolated from Enteric Fever Patients in Nepal

Anu Maharjan¹, Binod Dhungel¹, Anup Bastola², Upendra Thapa Shrestha¹, Nabaraj Adhikari¹, Megha Raj Banjara¹, Binod Lekhak¹, Prakash Ghimire¹ and Komal Raj Rijal¹*

 

¹Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu 44618, Nepal;

²Sukraraj Tropical and Infectious Disease Hospital, Teku, Kathmandu 44600, Nepal

 

* Correspondence: rijalkomal@gmail.com

 

 ABSTRACT

Introduction: Enteric fever, a systemic infection caused by Salmonella enterica Typhi and S. enterica Paratyphi is one of the most common infections in developing countries such as Nepal. Aside from irrational practices of antibiotic use, mutations in chromosomal genes encoding DNA gyrase and Topoisomerase IV and by plasmid mediated quinolone resistant (PMQR) genes are suggested mechanisms for the development of resistance to nalidixic acid and reduced susceptibility to ciprofloxacin. Regardless of high endemicity of enteric fever in Nepal, there is paucity of studies on prevalence and drug-resistance of the pathogen. Therefore, this study aimed to assess the antibiotic susceptibility pattern of Salmonella isolates and determine the minimum inhibitory concentration of ciprofloxacin.

Methods: A total of 1298 blood samples were obtained from patients with suspected enteric fever, attending Sukraraj Tropical and Infectious Disease Hospital (STIDH) during March–August, 2019. Blood samples were inoculated immediately into BACTEC culture bottles and further processed for isolation and identification of Salmonella Typhi and S. Paratyphi. Axenic cultures of the isolates were further subjected to antimicrobial susceptibility testing (AST) by using the modified Kirby–Bauer disc diffusion method based on the guidelines by CLSI. The minimum inhibitory concentration (MIC) of ciprofloxacin was determined by agar-dilution method.

Results: Out of 1298 blood cultures, 40 (3.1%) were positive for Salmonella spp. among which 29 (72.5%) isolates were S. Typhi and 11 (27.5%) isolates were S. Paratyphi A. In AST, 12.5% (5/40), 15% (6/40) and 20% (8/40) of the Salmonella isolates were susceptible to nalidixic acid, ofloxacin and levofloxacin, respectively, whereas none of the isolates were susceptible to ciprofloxacin. The MIC value for ciprofloxacin ranged from 0.06-16 _g/mL in which, respectively, 5% (2/40) and 52.5% (21/40) of the isolates were susceptible and resistant to ciprofloxacin. None of the isolates showed multidrug résistance (MDR) in this study.

Conclusion: This study showed high prevalence of quinolone-resistant Salmonella spp., while there was marked re-emergence of susceptibilities to traditional first option drugs. Hence, conventional first-line-drugs and third-generation cephalosporins may find potential usage as the empirical drugs for enteric fever. Although our reporting was free of MDR strains, extensive surveillance, augmentation of diagnostic facilities and treatment protocol aided by AST report are recommended for addressing the escalating drug-resistance in the country.

 

Keywords: Enteric fever; Salmonella enterica Typhi; S. enterica Paratyphi A; blood culture; PMQR; MIC

 

Citation: Maharjan, A.; Dhungel, B.; Bastola, A.; Thapa Shrestha, U.; Adhikari, N.; Banjara, M.R.; Lekhak, B.; Ghimire, P.; Rijal, K.R. Antimicrobial Susceptibility Pattern of Salmonella spp. Isolated from Enteric Fever Patients in Nepal. Infect. Dis. Rep. 2021, 13, 388–400. https://doi.org/10.3390/idr13020037

PubMed Full text: Download