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High drug resistance among Gram-negative bacteria in sputum samples from an intensive care unit in Nepal

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R. Ghimire, H. A. Gupte, S. Shrestha, P. Thekkur, S. Kharel, H. P. Kattel, P. S. Shrestha, N. Poudel, S. Shakya, S. Parajuli, A. Mudvari, J. Edwards


SETTING: Tribhuvan University Teaching Hospital, Kathmandu, Nepal.

OBJECTIVES: 1) To report the number and proportion of Pseudomonas, Acinetobacter, Burkholderia,Stenotrophomonas (PABS) species among intensive care unit (ICU) patients with sputum culture; and 2) to assess antimicrobial resistance patterns, demographic and clinical characteristics associated with resistance to at least one antibiotic and ICU discharge outcomes among those patients with PABS species admitted to hospital between 14 April 2018 and 13 April 2019. 

DESIGN: This was a hospital-based, cross-sectional study using secondary data.

RESULTS: Of 166 who underwent sputum culture, 104 (63%) had bacterial growth, of which, 67 (64%) showed PABS species. Of the positive cultures, Pseudomonas, Acinetobacter, Burkholderia and Stenotrophomonas were present in respectively 32 (30.7%), 31 (29.8%), 1 (1%) and 3 (2.8%). Pseudomonas showed a high level of resistance to levofloxacin (61%), cefepime (50%) and amikacin (50%). Acinetobacter was largely resistant to cefepime (95%), imipenem (92%) and levofloxacin (86%). Of the 67 with PABS infection, 32 (48%) died.

CONCLUSION: The study showed a high prevalence of Pseudomonas and Acinetobacter and the emergence of Stenotrophomonas in sputum culture samples of ICU patients. This highlights the need for monitoring PABS and associated resistance patterns to reduce mortality in ICU patients.