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. 2021 Nov 1;11(Suppl 1):70-76.
doi: 10.5588/pha.21.0044.

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

R Baral  1 , L B Shrestha  1 , N Ortuño-Gutiérrez  2 , P Pyakure  1   3 , B Rai  1 , S P Rimal  1 , S Singh  1 , S K Sharma  1 , B Khanal  1 , K Selvaraj  4 , A M V Kumar  5   6   7
Affiliations

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

R Baral et al. Public Health Action. .

Abstract
in English, French

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.

Contexte: La résistance à plusieurs médicaments (MDR) chez les patients atteints d’infections urinaires (UTI) au Népal est un sujet de préoccupations.

Objectif: Déterminer le taux de positivité des cultures, les tendances de MDR parmi les infections à Escherichia coli et Klebsiella pneumoniae et les variations saisonnières dans les échantillons d’UTI positifs par culture de 2014 à 2018 au BP Koirala Institute of Health Sciences, Dharan, Népal oriental.

Méthode: Il s’agissait d’une étude transversale réalisée en utilisant des données de laboratoire secondaires.

Résultats: Parmi les 116 417 échantillons urinaires testés, 19 671 (16,9%) étaient positifs par culture, avec une tendance à la hausse du nombre d’échantillons testés et du taux de positivité par culture. E. coli était la bactérie la plus fréquente (54,3%), suivie de K. pneumoniae (8,8%). Une MDR a été observée chez respectivement 42,5% et 36,0% des isolats de E. coli et de K. pneumoniae. La MDR était plus élevée chez les hommes et les personnes âgées >55 ans, mais une tendance à la baisse a été observée au fil des ans. Le nombre d’isolats a augmenté au fil des ans, avec un pic toujours observé de juillet à août.

Conclusion: Le faible taux de positivité par culture est préoccupant et d’autres études sont nécessaires pour améliorer les protocoles diagnostiques. Les tendances à la baisse en matière de MDR sont un signe encourageant. Les informations relatives aux variations saisonnières avec un pic en juillet-août peuvent aider les laboratoires à mieux se préparer en prévision de cette période, en renouvelant les stocks de solutions tampons afin de pouvoir réaliser les cultures et les tests de sensibilité aux médicaments.

Keywords: UTI; antimicrobial resistance; seasonality; uropathogens.

PubMed Disclaimer

Conflict of interest statement

Conflict of interests: none declared.

Figures

FIGURE 1
FIGURE 1
Annual trend of urine numbers tested, number of samples cultured and culture positivity from 2014 to 2018. Figure 1 shows three indicators: number of urine samples tested (the total bar which includes both the green and red portions), number culture-positive (red portion) and proportion that is culture-positive (indicated by the percentages within the red portion).
FIGURE 2
FIGURE 2
Total number of A) urine samples by month, 2014–2018; and B) culture-positive urine samples by month, 2014–2018.
FIGURE 3
FIGURE 3
Number of culture-positive urine samples isolated at B P Koirala Institute of Health Sciences, Nepal, 2014–2018, by month (observed vs. fitted with SARIMA model). SARIMA = seasonal auto-regressive integrated moving average.
See this image and copyright information in PMC

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