You are here:

Antibiotic resistance in patients with chronic ear discharge awaiting surgery in Nepal

Published on

Updated:

To ensure that scientific research of immediate concern is shared as rapidly as possible, we fast-track accepted articles from the IJTLD and PHA and publish them as edited preprints prior to publication in an issue.

All content in PHA is Open Access and free to read. PHA covers all areas of operational research including: infection control, nutrition, TB, HIV,  vaccines, smoking, COVID-19, microbial resistance or disease outbreaks. Find out more about PHA or sign-up to receive the Table of Contents

Read the PDF for the full text, including the Figures, Tables and References

R. R. Karna, R. Acharya, A. K. Rajbanshi, S. K. Singh, S. K. Thakur, S. K. Shah, A. K. Singh, R. Shah, S. Upadhya Kafle, M. Bhattachan, A. Abrahamyan, H. D. Shewade, R. Zachariah

SUMMARY

SETTINGBiratnagar Eye Hospital, Biratnagar, Nepal, which offers ear surgery for chronic suppurative otitis media (CSOM). 

OBJECTIVEIn patients with CSOM awaiting surgery, to determine the 1) sociodemographic characteristics 2) bacterial isolates and their antibiotic resistance patterns and 3) characteristics of those refused surgery, including antibiotic resistance.

DESIGNA cohort study using hospital data, January 2018–January 2020.

RESULTSOf 117 patients with CSOM and awaiting surgery, 64% were in the 18–35 years age group, and 79% were cross-border from India. Of 118 bacterial isolates, 80% had Pseudomonas aeruginosa and 16% had Staphylococcus aureus. All isolates showed  multidrug resistance to nine of the 12 antibiotics tested. The lowest antibiotic resistance in P. aeruginosa was for vancomycin (29%) and moxifloxacin (36%), and for S. aureus, this was vancomycin (9%) and amikacin (17%). Fourteen (12%) patients underwent surgery: myringoplasty (n = 7, 50%), cortical mastoidectomy with tympanostomy (n = 4, 29%) and modified radical mastoidectomy (n = 3, 21%). Those infected with P. aeruginosa and with resistance to over six antibiotics were significantly more likely to be refused for surgery.

CONCLUSIONPatients awaiting ear surgery were predominantly infected with multidrug-resistant P. aeruginosa and were consequently refused surgery. This study can help inform efforts for improving surgical uptake and introducing cross-border antimicrobial resistance surveillance.