Changing Antimicrobial Resistance Trends in Kathmandu, Nepal: A 23-Year Retrospective Analysis of Bacteraemia

Frontiers in Medicine

卷:5

Guy E. Thwaites¹  Buddha Basnyat²  Abhilasha Karkey²  Sabina Dongol³  Poojan Shrestha³  Samir Koirala³  Krishna G. Prajapati⁴  Paban K. Sharma⁴  Thomas C. Darton⁵  Stephen Baker⁶  Corinne N. Thompson⁷  Christine Boinett⁷  Raphaël M. Zellweger⁷ 

[1] Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom;

[2] Global Antibiotic Resistance Partnership, Centre for Disease Dynamics Economics and Policy, Washington, DC, United States;

[3] Oxford University Clinical Research Unit, Patan Academy of Health Sciences, Kathmandu, Nepal;

[4] Patan Academy of Health Sciences, Patan Hospital, Kathmandu, Nepal;

[5] Sheffield teaching hospitals NHS trust foundation and the University of Sheffield, Sheffield, United Kingdom;

[6] The Department of Medicine, University of Cambridge, Cambridge, United Kingdom;

[7] Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam;

关键词: bloodstream infections;    bacteraemia;    blood culture;    surveillance;    community acquired;    antimicrobial resistance;   

DOI  :  10.3389/fmed.2018.00262

来源: DOAJ

【 摘 要 】

A comprehensive longitudinal understanding of the changing epidemiology of the agents causing bacteraemia and their AMR profiles in key locations is crucial for assessing the progression and magnitude of the global AMR crisis. We performed a retrospective analysis of routine microbiological data from April 1992 to December 2014, studying the time trends of non-Salmonella associated bacteraemia at a single Kathmandu healthcare facility. The distribution of aetiological agents, their antimicrobial susceptibility profiles, and the hospital ward of isolation were assessed. Two hundred twenty-four thousand seven hundred forty-one blood cultures were performed over the study period, of which, 30,353 (13.5%) exhibited growth for non-contaminant bacteria. We observed a significant increasing trend in the proportion of MDR non-Salmonella Enterobacteriaceae (p < 0.001), other Gram-negative organisms (p = 0.006), and Gram-positive organisms (p = 0.006) over time. Additionally, there was an annual increasing trend in the proportion of MDR organisms in bacteria-positive blood cultures originating from patients attending the emergency ward (p = 0.006) and the outpatient department (p = 0.006). This unique dataset demonstrates that community acquired non-Salmonella bacteraemia has become an increasingly important cause of hospital admission in Kathmandu. An increasing burden of bacteraemia associated with MDR organisms in the community underscores the need for preventing the circulation of MDR bacteria within the local population.

【 授权许可】

Unknown