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

 

BMC Pediatrics

Burden of Human Metapneumovirus infections among children with acute respiratory tract infections attending a Tertiary Care Hospital, Kathmandu

Jyoti Lamichhane^{1 #}, Milan Upreti^{1 #}, Krishus Nepal¹, Bishnu Prasad Upadhyay², Urusha Maharjan², Ram Krishna Shrestha², Ram Hari Chapagain³, Megha Raj Banjara⁴, Upendra Thapa Shrestha^4*

 

¹GoldenGate International College, Battisputali, Kathmandu, Nepal

²Central Diagnostic Laboratory & Research Center, Kamalpokhari, Kathmandu, Nepal

³Kanti Children’s Hospital, Maharajgunj, Kathmandu, Nepal

⁴Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal

 

^# The authors have equal contributions to the study.

 

* Corresponding Author: Upendra Thapa Shrestha, Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal. Email: upendrats@gmail.com

 

 

ABSTRACT

 

Background Acute respiratory infections (ARIs) are one of the most common causes of mortality and morbidity worldwide.  Every year millions of children suffer from viral respiratory tract infections (RTIs) ranging from mild to severe illnesses. Human Metapneumovirus (HMPV) is among the most frequent viruses responsible for RTIs. However, HMPV infections and their severity among children have not been explored yet in Nepal. Purpose Therefore, the study was focused on HMPV infections and with other potential viral etiologies or co-infections using multiplex PCR among children attending Kanti Children’s Hospital and assess the clinical characteristics of the infections as well as find out the co-infections. A hospital based cross-sectional study was designed and a convenience sampling method was used to enroll children of less than 15 years with flu like sumptoms from both outpatients and inpatients departments over three month of the study period.

Results HMPV infection (13.3%) was the most predominant infection among the different viral infections in children with ARIs in Kanti Children’s Hospital. The HMPV was more prevalent in the age group less than three years (21.8%). Cough and fever were the most common clinical features present in all children infected with HMPV followed by rhinorrhea, sore throat, and wheezing.  HMPV-positive children were diagnosed with pneumonia (42.9%), bronchiolitis (28.5%), upper respiratory tract infections (14.3%), and asthma (14.3%). The prevalence of HMPV was high in late winter (14.3%) followed by early spring (13.5%).

Conclusions This study provides the baseline information on HMPV and associated co-infection with other respiratory viruses for the differential diagnosis based on molecular methods and also the comparison of clinical presentations among the different respiratory syndromes.

Keywords Respiratory tract infections, Human Metapneumovirus, Multiplex real-time RT-PCR, Pneumonia, Bronchiolitis

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Article Published in Microbiology Insights; SAGE

 

Genotypically confirmed Vancomycin-Resistant Staphylococcus aureus with vanB gene among clinical isolates in Kathmandu

Niranjan Nepal¹, Prakriti Mahara², Shishir Subedi³, Komal Raj Rijal¹, Prakash Ghimire¹, Megha Raj Banjara¹, Upendra Thapa Shrestha¹

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

²GoldenGate International College, Old Baneshwor, Kathmandu, Nepal

³Grande International Hospital, Dhapasi, Kathmandu, Nepal

 

CORRESPONDING AUTHORS: Upendra Thapa Shrestha, Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal, E-mail: upendrats@gmail.com; upendra.thapashrestha@cdmi.tu.edu.np/

Megha Raj Banjara, Central Department of Microbiology, TU Email: megha.banajara@cdmi.tu.edu.np;

 

ABSTRACT

Purpose: Methicillin-resistant Staphylococcus aureus, a common bacterial pathogen causes various infections. The acquisition of various antimicrobial-resistant genes in S. aureus has led to the transformation of this bacterium into a superbug. Vancomycin resistance among MRSA isolates is an emerging threat in empirical therapy of various infections. The study was hence aimed to find out the susceptibility status of S. aureus isolates towards vancomycin and detect mecA, vanA and vanB genes among the isolates.

Methods: A total of 1245 clinical samples from the participants attending a tertiary care hospital in Kathmandu were processed. S. aureus isolated from the samples subjected for antibiotic susceptibility pattern using the modified Kirby-Bauer disk diffusion method. Agar dilution method was used to determine the minimum inhibitory concentration of vancomycin. The antibiotic-resistant genes such as mecA, vanA, and vanB among S. aureus isolates were screened by a conventional polymerase chain reaction.

Results: Of 1245 samples, 80 S. aureus were identified. Out of which, 47.5% (38/80) were phenotypically confirmed MRSA isolates. mecA gene was detected in 84.2% (32/38) of MRSA isolates. 10.5% (4/38) were confirmed as vancomycin-intermediate S. aureus (VISA) by MIC determination. None of the isolates was positive for the vanA gene; however, two isolates were found to possess the vanB gene. The two isolates have vancomycin MIC breakpoints of 4-8 μg/mL.

Conclusion: There might be a spreading of vancomycin resistance among S. aureus, creating serious public health problems. Therefore, measures to limit vancomycin resistance should be considered in healthcare facilities as immediately as possible.

Key words: Staphylococcus aureus, Multidrug-resistant, MRSA, VISA, mecA, vanB

 

 

RECEIVED: January 23, 2023. ACCEPTED: May 26, 2023.

 

TYPE: Original Research

 

Microbiology Insights

Volume 16: 1–9

© The Author(s) 2023

Article reuse guidelines:

sagepub.com/journals-permissions

DOI: 10.1177/11786361231183675

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