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High multidrug resistance in urinary tract infections in a tertiary hospital, Kathmandu, Nepal

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S. Shakya,1 J. Edwards,2 H. A. Gupte,3 S. Shrestha,4 B. M. Shakya,5 K. Parajuli,6 H. P. Kattel,6 P. S. Shrestha,5 R. Ghimire,7 P. Thekkur8,9


SETTINGTribhuvan University Teaching Tertiary Care Hospital, Kathmandu, Nepal, May-October 2019.

OBJECTIVE1) To describe the bacteriological profile, 2) to identify the antimicrobial resistance (AMR) pattern, and 3) to find the demographic characteristics associated with the presence of bacterial growth and multidrug resistance (MDR) in adult urine samples undergoing culture and drug susceptibility testing.

DESIGNThis was a hospital-based, cross-sectional study using routine laboratory records.

RESULTSAmong 11,776 urine samples, 16% (1,865/11,776) were culture-positive, predominantly caused by Escherichia coli (1,159/1,865; 62%). We found a high prevalence of resistance to at least one antibiotic (1,573/1,865; 84%) and MDR (1,000/1,865; 54%). Resistance to commonly used antibiotics for urinary tract infections (UTIs) such as ceftazidime, levofloxacin, cefepime and ampicillin was high. Patients aged ≥60 years (adjusted prevalence ratio [aPR] 1.6, 95% CI 1.4–1.7) were more likely to have culture positivity. Patients with age ≥45 years (45–59 years: aPR 1.5, 95% CI 1.3–1.7; ≥60 years: aPR 1.4, 95% CI 1.2–1.6), male sex (aPR 1.3, 95% CI 1.2–1.5) and from inpatient settings (aPR 1.4, 95% CI 1.2–1.7) had significantly higher prevalence of MDR.

CONCLUSIONUrine samples from a tertiary hospital showed high prevalence of E. coli and MDR to routinely used antibiotics, especially among inpatients. Regular surveillance and application of updated antibiograms are crucial to monitor the AMR situation in Nepal.