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Low yield but high levels of multidrug resistance in urinary tract infections in a tertiary hospital, Nepal

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R. Baral, L. B. Shrestha, N. Ortuño-Gutiérrez, P. Pyakurel, B. Rai, S. P. Rimal, S. Singh, S. K. Sharma, B. Khanal, K. Selvaraj, A. M. V. Kumar


SETTING: There are concerns about the occurrence of multidrug resistance (MDR) in patients with urine tract infections (UTI) in Nepal.

OBJECTIVE: To determine culture positivity, trends in MDR among Escherichia coli and Klebsiella pneumoniae infections and seasonal changes in culture-positive UTI specimens isolated from 2014 to 2018 at the B P Koirala Institute of Health Sciences, Dharan, Eastern Nepal. 

DESIGN: This was a cross-sectional study using secondary laboratory data.

RESULTS: Among 116,417 urine samples tested, 19,671 (16.9%) were culture-positive, with an increasing trend in the number of samples tested and culture positivity. E. coli was the most common bacteria (54.3%), followed by K. pneumoniae (8.8%). Among E. coli and K. pneumoniae isolates, MDR was found in respectively 42.5% and 36.0%. MDR was higher in males and people aged >55 years, but showed a decreasing trend over the years. The numbers of isolates increased over the years, with a peak always observed from July to August.

CONCLUSION: Low culture positivity is worrying and requires further work into improving diagnostic protocols. Decreasing trends in MDR are a welcome sign. Information on seasonal changes that peak in July–August can help laboratories better prepare for this time with adequate buffer stocks to ensure culture and antibiotic susceptibility testing.