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INTRODUCTION: Antimicrobial therapy is the main stone in treatment. Gram negative bacilli are common cause of sepsis, pneumonia and urinary tract infections in ICU patients. Their treatment becomes more challenging due to the evolution of multiple drug resistant strains. The findings of this study would be useful in the formation of effective diagnostic approaches and policy of antimicrobial therapy for the treatment of infections in a similar intensive care hospital setting. MATERIALS AND METHODS: A Laboratory based descriptive cross-sectional study was conducted at the department of clinical microbiology of the Chitwan Medical College Teaching Hospital based on the reports of 129 bacterial isolated of various clinical specimens from different ICUs of hospital between April 2018 to September 2018. RESULTS: Among the 129-gram bacilli isolated mono bacterial growth were 116(89.92%) while remaining 13(10.08%) had poly bacterial or mixed organisms isolated. The most frequently isolated organisms were Acinetobacter spp. 51(39.55%), Escherichia coli 25(19.37%), Klebsiella spp. 27(20.93%), Pseudomonas aeruginosa 17(13.95%) and Enterobacter spp. 8(6.2%). Antibiotic resistance was observed in many organisms with multidrug resistance 97(75.2%) among them. High level of resistance was observed to Cefotaxime (98.04%), Ceftriaxone (96.08%), Imipenem (80.39%), Ampicillin/sulbactam (72.55%) and Amikacin (70.59%). Ciprofloxacin (68.63%), Levofloxacin (27.45%) and Meropenem (28.21%) were found to be relatively effective against Acinetobacter spp. Isolated. CONCLUSIONS: Most of the frequently isolated organisms are multi drug resistant.

Introduction: Dengue is a mosquito-borne viral disease transmitted from person to person by Aedes mosquitoes which result in a wide spectrum of disease severity ranging from influenza-like illness (dengue fever; DF) to the life-threatening dengue hemorrhagic fever (DHF)/dengue shock syndrome (DSS). Terai regions of Nepal were focal epidemics of Dengue infections during the outbreak in 2010, 2013, and 2016. Dengue infections have been reported in the valleys of upland Hill regions at an altitude of 2500 m above sea level in Nepal. Methods: A cross-sectional study was carried out among febrile patients in Nepal Police Hospital (NPH), from 1st Baisakh 2076 to 30th Chaitra 2076. Blood samples were collected from dengue presumed cases and tested against dengue specific IgM antibody and/or NS1antigen. Clinical examination findings were recorded, hematological and biochemical parameters tests were done among the patients who fulfilled the inclusion criteria. Results: A total of 87 dengue cases were included in the study during the study period. Out of these, the majority were males ( 85.05%) from Kathmandu (38/87; 43.67%) seen in the month of Asoj (40/87; 45.98%). Fever was the major symptom (100%) followed by myalgia (52.87%), headache (45.97%), retro-orbital pain (12.64%), bleeding manifestations (9.19%). Common hematological abnormalities were thrombocytopenia and leucopenia in the critical phase. There was no case of dengue shock syndrome. Conclusion: This study highlights the utilization of most common clinical and easily available laboratory profiles of dengue viral infections in particular season and place that could alert physicians to diagnose early to reduce morbidity and mortality due to dengue hemorrhagic fever and dengue shock syndrome.

Background: Helicobacter pylori are gram-negative bacillus that colonizes the gastrointestinal mucosa. Dyspepsia is a clinical syndrome including manifestations related to the upper gastrointestinal tract, which may include acute, chronic, or recurrent pain or discomfort. Understanding the prevalence and the factors associated with H. pylori seropositivity in dyspeptic persons can provide a guide for health policies. Aim of the research was to study the prevalence and factors associated with H. pylori infection among dyspeptic patients in Chitwan, Nepal. Methods: A descriptive cross-sectional study was conducted in the Department of Microbiology at CMC-TH from July 2019 to June 2021. A non-probability consecutive sampling technique was employed to collect 510 Stool samples from the suspected patients for the detection of H. pylori stool antigen (HpSAg) following the procedures recommended by the manufacturer. A standard questionnaire on the potential risk factors was also designated and completed. Chi-square test was used to study the association of H. pylori colonization with symptoms, life-style findings and socio-economic status. p

Objectives: Staphylococcus aureus is often linked with human infection. Clindamycin is one of the key substitute antimicrobial agents in the treatment of S. aureus, especially in methicillin-resistant S. aureus (MRSA) infections. Inducible macrolide-lincosamide-streptogramin B (iMLS B) resistance is a crucial factor in antimicrobial susceptibility testing. The intention of the research was to identify S. aureus from distinct clinical specimens and investigate the prevalence of inducible clindamycin resistance among them and also study their association with MRSA. Methods: A descriptive cross-sectional study was accomplished in the Dept. of Microbiology CMC-TH, Nepal from January 2018 to December 2020 with 525 non-repeated S. aureus obtained from a different clinical specimen. Antibiotic susceptibility test was performed by Kirby–Bauer disc diffusion method. MRSA was detected using cefoxitin (30 μg) and results were interpreted as stated by CLSI. “D-Test” was done by applying erythromycin (15 μg) and clindamycin (2 μg) as per CLSI guidelines. Data were analyzed using SPSS IBM version 20. Results: Among 525 isolates, there were 315 (60.00%) MRSA. Results of D test analysis showed that 280 (53.33%) were MLSB sensitive while 245 (46.67%) were MLSB resistant; where 80 (15.24%) iMLSB with D zone, 100 (19.05%) constitutive MLSB (cMLSB) phenotype, and 65 (12.38%) MS phenotype. Of a total of 80 iMLSB, a significant proportion of 64 (80.00%) was MRSA (p

Introduction: Tuberculosis remains of public health concern, particularly in highly endemic regions.1 It accounts globally for 3 million deaths annually. Pulmonary tuberculosis is primarily diagnosed by identification of Mycobacterium tuberculosis using sputum smear microscopy.2 Clinicians often depend on alternative diagnostic algorithms based on patient symptoms and chest X-ray findings, which have low sensitivity which may lead to either over or under diagnosis of pulmonary tuberculosis. The GeneXpert assay has been shown to have an accuracy comparable to that of culture.3 The sensitivity of a single GeneXpert result in smear-negative, culture-positive cases is 72.5%; the sensitivity increases with repeated testing.4 Xpert has been found to be a cost-effective method for smear-negative TB diagnosis in comparison to traditional methods in resource-limited settings. The aim of the study was to find the prevalence of Genexpert Positive in Sputum negative cases. Methods: This descriptive cross sectional study was done in Bir Hospital, Mahabouddha, Kathmandu for 1 year after taking ethical clearance. Data was collected and entry was done with point estimate at 95%. Sample size was calculated using the standard formula. Convenience Sampling technique was used, data analysis was done with SPSS Microsoft Excel Sheet. Results: Prevalence of Genexpert Positive in Sputum negative cases was part to be 27.27%. Conclusions: Present study showed GeneXpert could be used as a diagnostic tool for the diagnosis of tuberculosis by correlating the clinicoradiological features to this infectious disease. With judicious case detection and implementing appropriate measures, TB incidence, prevalence and morbidity can be minimized to a greater extent. Keywords: acid fast bacilli; tuberculosis; X-ray.

BACKGROUND: Stroke related studies in Nepal are primarily hospital-based and mainly from the capital city. OBJECTIVES: We aimed to estimate the prevalence of stroke and stroke risk factors in the South-Western community of Nepal. METHODS: A cross-sectional study was conducted from May to August 2018 among 549 randomly selected Nepalese participants from diverse ethnicity, aged ≥15 years, in a region with the availability of neurological support facilities. Data were collected using a stroke questionnaire designed for the purpose. Stroke was identified by enumerators using the Balance-Eyes-Face-Arms-Speech-Time (BEFAST) scale, and a senior neurologist confirmed it. We assessed the presence of major risk factors associated with stroke. RESULTS: The crude and age-standardised prevalence of stroke were 2368 and 2967 per 100,000 respectively. Of all the surveyed participants, 61% (n=335) reported consumption of full-fat dairy products >3 days per week, 87.6% (n=481) reported a high intake of salt (>5 g/day), 83.6% (n=459) with a low intake of fruits and vegetables (

Background: Plants and plant-based medicaments are the basis of many of the modern pharmaceuticals we use today for our various ailments. The aim of the present study was to find out the bioactive chemical constituents such as flavonoids, alkaloids, tannins, saponins, carbohydrate and to find out the anti E. coli activity of the ethanolic extracts of traditionally used ten medicinal plants of Nepal at an altitude of 1500 ft from above the sea level.Methods: Ethanolic extracts of ten commonly used medicinal plants were analyzed phytochemically and evaluated for their significant antimicrobial activity against the clinical isolates of Escherichia coli. Mean zones of inhibition were calculated for each of the extracts.Results: The results revealed that though all the plants of the high altitude showed some degree of antimicrobial activity, the leaf extract of Syzygium cumini (5.7±0.3 cm), Chromolaena odorata (5.2±0.4 cm), Ocimum sanctum (4.7±0.6 cm) and Justicia adhatoda (3.2±0.3 cm) were most effective against the clinical isolates of E. coli, whereas the other six plant extracts were least effective against the clinical isolates of E. coli. Qualitative phytochemical analysis of the extracts revealed the presence of bioactive components. Seven of the plant extracts contain alkaloids, six of them contain glycosides, four of them contain flavonoids, three of them contain carbohydrate, oil and fats, two of them contain tannins, whereas only one of them contains saponins.Conclusion: The result of this study justified the folkloric usage of the studied plants and concluded that these plants extract have great potential in finding new clinically effective antimicrobial compounds.MED Phoenix Volume (1), Issue (1) July 2016, page: 3-9

Background: Urinary tract infection (UTI) is a serious health problem, affecting millions of people each year. Aim: The present study was undertaken to study the profile of uropathogenic bacterial flora in adult, their antibiotic resistant pattern, adherence factors of uropathogens and in vitro adherence capabilities of Uropathogens. Material and Methods: The samples were tested microbiologically by standard procedure. Antibiotic susceptibility of the isolated pathogens was tested for commonly used antibiotics by Kirby-Bauer technique according to CLSI guidelines. Adherence assay were done by hemagglutination test and Giemsa staining technique. Detection of hemolysin production was done on 5% washed sheep blood agar. Motility test was done by stabbing the isolates into SIM biochemical media. Results: Significant bacteriuria was present in 40% of samples. The most common pathogens isolated were Escherichia coli (52%), followed by Klebsiella pneumoniae (16%), Acinetobacter anitratus (11%), Proteus mirabilis (6%), Enterobacter species (5%), Citrobacter species (2%), Pseudomonas aeruginosa (2%), Morganella morganii (1%), Enterococcus species (3%) and Staphylococcus aureus (2%). The mean susceptibility of uropathogens was for amikacin (Ak-81%), nitrofurantoin (Nf-60%), cefotaxime (52%), ceftriaxone (Ci-47%), ciprofloxacin (Cf-45%), norfloxacin (Nx-33%), cotrimoxazole (Co-18%) and nalidixic acid (Na-17%). Mean adherence of pathogens to epithelial cells was 70 bacteria cell -1 . Of all, 52% isolates were hemagglutinating, 34% were alpha-hemolytic, 31% were beta-hemolytic and 68% were motile. Conclusion: Escherichia coli are the commonest cause of UTI. Adherence is one of the essential pre-requisites to establish UTI. Majority of UTI in men are mono-microbial. Most of uropathogens are susceptible to amikacin (81%) and nitrofurantoin (60%). Key words: UTI, uropathogens, adherence, antimicrobials.