Narayan Gyawali | Central Queensland University (original) (raw)

Papers by Narayan Gyawali

Research paper thumbnail of Bacteriological profile and antibiogram of neonatal septicemia

Indian journal of pediatrics, 2013

Objectives To determine the incidence of neonatal septicemia, identify the bacterial isolates and... more Objectives To determine the incidence of neonatal septicemia, identify the bacterial isolates and study their antimicrobial susceptibility pattern in neonates visiting out-patient door (OPD) and admitted to the pediatric ward and neonatal intensive care unit (NICU) of the College of Medical Sciences, Teaching Hospital, Chitwan, Nepal. Methods Blood culture of all neonates who were suspected for septicemia was performed. Isolate identification and antimicrobial susceptibility testing was done by standard microbiological method. Results Out of the total 7,868 blood culture samples submitted to the microbiology laboratory, 1,572 (19.97 %) samples were from suspected cases of neonatal septicemia. The blood culture was positive for neonatal sepsis in 238 (15.13 %) samples. The incidence of gram positive and gram negative organisms were 44.1 % and 55.9 % respectively. Staphylococcus aureus remained the predominant isolate followed by Klebsiella spp. Most of the gram positive isolates exhibited higher resistance to penicillin and cephalosporin. Susceptibility to commonly used aminoglycosides and quinolones was found. Similarly, more than two third isolates of gram negative Enterobacteriaceae showed resistance to ampicillin. Third generation cephalosporin and aminoglycosides were found to be more satisfactory among gram negative organisms as compared to gram positive. Conclusions The high incidence of neonatal septicemia in the present setting reflects high magnitude of problem in central part of Nepal. Organisms isolated in the study exhibited higher resistance towards commonly used antimicrobials. High resistances to recommended drugs awares health care workers to seek for alternative antimicrobial agents. The periodic survey of etiological agents and their antibiotic susceptibility patterns is indeed necessary for the timely alarm of such type of problems.

Research paper thumbnail of Effect of urogenital cleaning with paper soap on bacterial contamination rate while collecting midstream urine specimens

Journal of laboratory physicians, 2013

Context: Urinary tract infection (UTI) is one of the major health problems. Urine culture is cons... more Context: Urinary tract infection (UTI) is one of the major health problems. Urine culture is considered as a gold standard method for the diagnosis of UTI. But, improper sample collection can lead to contamination with normal urogenital flora. Use of any portable disinfectant that can reduce contamination rate would be the significant help in urine culture interpretation. Aims: To observe the effect of urogenital cleaning with paper soap on bacterial contamination rate while collecting specimens.

Research paper thumbnail of Prevalence of tuberculosis in household contacts of sputum smears positive cases and associated demographic risk factors

Nepal Medical College journal : NMCJ, 2012

Pulmonary tuberculosis (PTB) is transmitted by aerosolized droplets nuclei. Home is the vulnerabl... more Pulmonary tuberculosis (PTB) is transmitted by aerosolized droplets nuclei. Home is the vulnerable place for transmission of this disease to its contacts. Risk factors associated with this contact transmission may differ according to locality. This study aims to determine the prevalence of household contact (HC) PTB and examine the risk factors contributing to it. A cross-sectional study was conducted to determine the prevalence of HC TB among HCs aged >5 years in Dharan. During the study period (June 2009 -May 2010), 184 index cases with sputum smear positive for AFB and their 802 HCs were included. Three sputum specimens were collected from each HCs and examined microscopically for AFB detection. The prevalence of HC TB was found to be 1.6%. The result was statistically associated (P<0.05) with illiterate HCs (OR= 5.77, 95%CI=1.52-21.81), close proximity with ICs (OR=3.07, 95%CI= 1.02-9.25), primary relatives to ICs (OR= 4.85, and slum dweller (OR = 4.56, 95%CI = 1. 25-16.71). Similarly, AFB positivity was associated (P<0.05) with household crowding (OR = 7.46, 95%CI = 2.36-23.49), room size ≤10x10feet (OR=4.05, 95%CI =1.23-13.25), fi rewood user while cooking (OR=5.96,). The prevalence of HCs tuberculosis is found to be 1.6%. Poverty, illiteracy, overcrowding, close proximity, close relation with ICs, fi rewood while cooking, slum dweller, are major factors highlighted by this study as risk factors of contact TB. Our results recommend a much better contact tracing and treatment program.

Research paper thumbnail of High-level gentamicin resistance and vancomycin resistance in clinical isolates of enterococci in a tertiary care hospital in eastern Nepal

Nepal Medical College journal : NMCJ, 2012

High-level gentamicin resistance and vancomycin resistance in enterococci, a family of important ... more High-level gentamicin resistance and vancomycin resistance in enterococci, a family of important opportunistic pathogens, have emerged as a significant clinical problem over recent years. The present study was conducted to determine the high-level gentamicin and vancomycin resistance among the clinical isolates of enterococci. A total of 110 phenotypically identified enterococcal isolates were subjected to determination of high-level gentamicin resistance (by disk diffusion and agar dilution methods) and vancomycin resistance (by agar screening and agar dilution methods). About 36% of the isolates were found to have high-level gentamicin resistance, which indicates that gentamicin no longer remains an appropriate choice for inclusion in combination therapy with cell wall-active agents. Ten percent isolates exhibited resisance to vancomycin during screening. However, agar dilution confirmed that the isolates did not have resistance to vancomycin but had reduced susceptibility to it, which indicates their impending emergence of resistance to vancomycin.

Research paper thumbnail of Tobacco and alcohol: the relation to pulmonary tuberculosis in household contacts

Nepal Medical College journal : NMCJ, 2013

Tuberculosis is transmitted commonly by droplet nuclei and facilitated by weak immune system. Low... more Tuberculosis is transmitted commonly by droplet nuclei and facilitated by weak immune system. Lowered immunity may be associated with cigarette smoking, tobacco chewing and alcohol consumption. The corelationship between these all factors to TB should be explored. This study aims to detect the hidden household contacts (HC) cases early and to examine the relative contribution of tobacco and alcohol use to the risk of TB. A cross-sectional study was in Dharan among HCs. From index cases with sputum smear positive for AFB and their 802 HCs were included. Three sputum specimens were collected from each HCs and examined microscopically for AFB detection. AFB were detected in sputum of 13 (1.6%) HCs. The association between habits (alcohol user and smoking) and TB was found except with chewing tobacco user (P>0.05). The risk of contact TB was 4 and 8 times greater in smoker (OR= 3.94 95%CI= 1.26-12.26, P<0.05) and alcoholic (OR=8.23 95%CI= 2.71-24.98, P<0.05) HCs respectively. This study has revealed smoking and alcohols as the risk factors for tuberculosis. Effective campaign to discourage use of alcohol and tobacco, and awareness programme about the mode of transmission of TB are needed in community.

Research paper thumbnail of Intestinal parasitosis in school going children of Dharan municipality, Nepal

Tropical gastroenterology : official journal of the Digestive Diseases Foundation

This community-based investigation was carried out to estimate the prevalence of intestinal paras... more This community-based investigation was carried out to estimate the prevalence of intestinal parasitosis in primary school-going children of the Dharan municipality, Sunsari, Nepal from 2007 through 2008. A total of 182 stool samples were collected from 101 male and 81 female children of ages 4 to 10 years. A questionnaire including the factors predisposing to parasitosis, was filled up by the parents of each child. Parasitic examination was carried out by direct wet mount examination and concentration method using 10% formol-ether. The prevalence rate was found to be 22.5%. The result revealed preponderance of Giardia lamblia (11.5%) followed by Entamoeba histolytica/dispar (4.4%), Ascaris lumbricoides (3.3%), hookworm (1.6%) and Enterobius vermicularis (0.5%). Statistically significant difference in the prevalence with respect to age and gender was not seen. However, socioeconomic status, type of toilet used and the practice of hand washing had a strong correlation (p<0.05) with the prevalence of parasitic infection. Abdominal discomfort also had a strong statistical association (p<0.05) with the prevalence of parasitic infection. Proportionally higher infection rate was seen in participants not using filtered or boiled water. Lack of education of mothers and children, improper toilets and failure to practice proper hand washing were perceived from this study as contributors to the acquisition of intestinal parasitic infections. Figure 1: Preoperative CT scan showing the giant diverticulum and communication with sigmoid colon Figure 2: Specimen showing giant diverticulum arising from sigmoid colon

Research paper thumbnail of Adenosine deaminase in CSF and pleural fluid for diagnosis of tubercular meningitis and pulmonary tuberculosis

Nepal Medical College journal : NMCJ, 2012

Tuberculosis (TB) is one of the most common infectious diseases in developing countries including... more Tuberculosis (TB) is one of the most common infectious diseases in developing countries including Nepal. Delay in diagnosis and treatment of tuberculosis results in poor prognosis of the disease. The present study was conducted to estimate diagnostic cut off values of Adenosine Deaminase (ADA) in cerebrospinal fluid (CSF) and pleural fluid and to evaluate the sensitivity, specificity, positive and negative predictive values of ADA in pleural fluid and CSF from patients with tuberculous and non -tuberculous disease. A total of 98 body fluid (CSF: 24, pleural fluid: 74) specimens were received for the estimation of ADA. ADA activity was measured at 37ºC by spectrophotometric method of Guisti and Gallanti. Among the patients enrolled for the study, subjects for which CSF were received (n=24) included 8 tuberculous meningitis, and 16 non-tubercular meningitis. Pleural fluid samples (n=74) were received from 19 pulmonary TB with pleural effusion, 17 pulmonary TB without pleural effusion and 38 of non-tuberculous disease patients. CSF ADA activity were (11.16±2.03 IU/L) and (5.35±1.89 IU/L) (p <0.001) in tuberculous meningitis and non-tubercular meningitis groups and pleural fluid ADA activity were (103±22.18 IU/L) and (23.79±11.62 IU/L) (p<0.001) in pulmonary TB and non-TB groups respectively. ADA test in body fluids, which is simple, cost-effective and sensitive, specific for the tubercular disease is recommended to prevent delay in TB diagnosis.

Research paper thumbnail of In vitro activity of cefoperazone-sulbactam combination against gram negative bacilli

Nepal Medical College journal : NMCJ, 2012

Cefoperazone is a â-lactam antimicrobial and Sulbactam is an irreversible â-lactamase inhibitor. ... more Cefoperazone is a â-lactam antimicrobial and Sulbactam is an irreversible â-lactamase inhibitor. The objective of this study was to know the susceptibility pattern of gram negative bacilli (GNB) towards cefoperazonesulbactum. All GNB isolated from different clinical samples during the period of May, 2010 to Aug, 2010 were tested for susceptibility to cefoperazone-sulbactum, meropenem, ceftazidime, cefotaxime, ceftriaxone, chloromphenicol, cotrimoxazole, ampicillin, amikacin, nalidixic acid, ciprofloxacin, carbenicillin and piperacillin using standard Kirby-Bauer disc diffusion antimicrobial susceptibility testing method. The susceptibilities were recorded according to CLSI guidelines. A total of 406 GNB were isolated (urine: 66.7%, pus: 19.2%, and blood: 7.9%). Escherichia coli (54.4%) was most frequently isolated organisms followed by Acinetobacter species (17.7%), Klebsiella pneumoniae (9.1%) and Pseudomonas species (6.1%). Overall, 11.8% of isolates showed resistance to cefoperazone-sulbactam. Frequencies of isolates showing resistance to meropenem and amikacin were 14.7% and 26.25% respectively. Only 3.9% of Escherichia coli isolates showed resistance to cefoperazone-sulbactam. For other organisms, their lowest frequency ranging from 0-20%, exhibited resistance to meropenem. In Pseudomonas spp, in-vitro activity of amikacin was also better as only 11.1% isolates showed resistance to it. This study demonstrated the in-vitro synergistic effect of cefoperazonerazone-sulbactam and meropenem having good activity against GNB compared to the activity of other commonly tested antimicrobials. Cefoperazone-sulbactam can be recommended for the clinical practice against GNB exhibiting resistant to other antimicrobials as it is cheaper alternative to meropenem. Our results also focused on the continuous surveillance of the trends and features of resistance of common antimicrobials.

Research paper thumbnail of Bacteriological Profile and Antibiogram of Neonatal Septicemia

Objectives To determine the incidence of neonatal septicemia, identify the bacterial isolates and... more Objectives To determine the incidence of neonatal septicemia, identify the bacterial isolates and study their antimicrobial susceptibility pattern in neonates visiting out-patient door (OPD) and admitted to the pediatric ward and neonatal intensive care unit (NICU) of the College of Medical Sciences, Teaching Hospital, Chitwan, Nepal. Methods Blood culture of all neonates who were suspected for septicemia was performed. Isolate identification and antimicrobial susceptibility testing was done by standard microbiological method. Results Out of the total 7,868 blood culture samples submitted to the microbiology laboratory, 1,572 (19.97 %) samples were from suspected cases of neonatal septicemia. The blood culture was positive for neonatal sepsis in 238 (15.13 %) samples. The incidence of gram positive and gram negative organisms were 44.1 % and 55.9 % respectively. Staphylococcus aureus remained the predominant isolate followed by Klebsiella spp. Most of the gram positive isolates exhibited higher resistance to penicillin and cephalosporin. Susceptibility to commonly used aminoglycosides and quinolones was found. Similarly, more than two third isolates of gram negative Enterobacteriaceae showed resistance to ampicillin. Third generation cephalosporin and aminoglycosides were found to be more satisfactory among gram negative organisms as compared to gram positive.

Research paper thumbnail of Bacteriological profile and antibiogram of neonatal septicemia

Indian journal of pediatrics, 2013

Objectives To determine the incidence of neonatal septicemia, identify the bacterial isolates and... more Objectives To determine the incidence of neonatal septicemia, identify the bacterial isolates and study their antimicrobial susceptibility pattern in neonates visiting out-patient door (OPD) and admitted to the pediatric ward and neonatal intensive care unit (NICU) of the College of Medical Sciences, Teaching Hospital, Chitwan, Nepal. Methods Blood culture of all neonates who were suspected for septicemia was performed. Isolate identification and antimicrobial susceptibility testing was done by standard microbiological method. Results Out of the total 7,868 blood culture samples submitted to the microbiology laboratory, 1,572 (19.97 %) samples were from suspected cases of neonatal septicemia. The blood culture was positive for neonatal sepsis in 238 (15.13 %) samples. The incidence of gram positive and gram negative organisms were 44.1 % and 55.9 % respectively. Staphylococcus aureus remained the predominant isolate followed by Klebsiella spp. Most of the gram positive isolates exhibited higher resistance to penicillin and cephalosporin. Susceptibility to commonly used aminoglycosides and quinolones was found. Similarly, more than two third isolates of gram negative Enterobacteriaceae showed resistance to ampicillin. Third generation cephalosporin and aminoglycosides were found to be more satisfactory among gram negative organisms as compared to gram positive. Conclusions The high incidence of neonatal septicemia in the present setting reflects high magnitude of problem in central part of Nepal. Organisms isolated in the study exhibited higher resistance towards commonly used antimicrobials. High resistances to recommended drugs awares health care workers to seek for alternative antimicrobial agents. The periodic survey of etiological agents and their antibiotic susceptibility patterns is indeed necessary for the timely alarm of such type of problems.

Research paper thumbnail of Effect of urogenital cleaning with paper soap on bacterial contamination rate while collecting midstream urine specimens

Journal of laboratory physicians, 2013

Context: Urinary tract infection (UTI) is one of the major health problems. Urine culture is cons... more Context: Urinary tract infection (UTI) is one of the major health problems. Urine culture is considered as a gold standard method for the diagnosis of UTI. But, improper sample collection can lead to contamination with normal urogenital flora. Use of any portable disinfectant that can reduce contamination rate would be the significant help in urine culture interpretation. Aims: To observe the effect of urogenital cleaning with paper soap on bacterial contamination rate while collecting specimens.

Research paper thumbnail of Prevalence of tuberculosis in household contacts of sputum smears positive cases and associated demographic risk factors

Nepal Medical College journal : NMCJ, 2012

Pulmonary tuberculosis (PTB) is transmitted by aerosolized droplets nuclei. Home is the vulnerabl... more Pulmonary tuberculosis (PTB) is transmitted by aerosolized droplets nuclei. Home is the vulnerable place for transmission of this disease to its contacts. Risk factors associated with this contact transmission may differ according to locality. This study aims to determine the prevalence of household contact (HC) PTB and examine the risk factors contributing to it. A cross-sectional study was conducted to determine the prevalence of HC TB among HCs aged >5 years in Dharan. During the study period (June 2009 -May 2010), 184 index cases with sputum smear positive for AFB and their 802 HCs were included. Three sputum specimens were collected from each HCs and examined microscopically for AFB detection. The prevalence of HC TB was found to be 1.6%. The result was statistically associated (P<0.05) with illiterate HCs (OR= 5.77, 95%CI=1.52-21.81), close proximity with ICs (OR=3.07, 95%CI= 1.02-9.25), primary relatives to ICs (OR= 4.85, and slum dweller (OR = 4.56, 95%CI = 1. 25-16.71). Similarly, AFB positivity was associated (P<0.05) with household crowding (OR = 7.46, 95%CI = 2.36-23.49), room size ≤10x10feet (OR=4.05, 95%CI =1.23-13.25), fi rewood user while cooking (OR=5.96,). The prevalence of HCs tuberculosis is found to be 1.6%. Poverty, illiteracy, overcrowding, close proximity, close relation with ICs, fi rewood while cooking, slum dweller, are major factors highlighted by this study as risk factors of contact TB. Our results recommend a much better contact tracing and treatment program.

Research paper thumbnail of High-level gentamicin resistance and vancomycin resistance in clinical isolates of enterococci in a tertiary care hospital in eastern Nepal

Nepal Medical College journal : NMCJ, 2012

High-level gentamicin resistance and vancomycin resistance in enterococci, a family of important ... more High-level gentamicin resistance and vancomycin resistance in enterococci, a family of important opportunistic pathogens, have emerged as a significant clinical problem over recent years. The present study was conducted to determine the high-level gentamicin and vancomycin resistance among the clinical isolates of enterococci. A total of 110 phenotypically identified enterococcal isolates were subjected to determination of high-level gentamicin resistance (by disk diffusion and agar dilution methods) and vancomycin resistance (by agar screening and agar dilution methods). About 36% of the isolates were found to have high-level gentamicin resistance, which indicates that gentamicin no longer remains an appropriate choice for inclusion in combination therapy with cell wall-active agents. Ten percent isolates exhibited resisance to vancomycin during screening. However, agar dilution confirmed that the isolates did not have resistance to vancomycin but had reduced susceptibility to it, which indicates their impending emergence of resistance to vancomycin.

Research paper thumbnail of Tobacco and alcohol: the relation to pulmonary tuberculosis in household contacts

Nepal Medical College journal : NMCJ, 2013

Tuberculosis is transmitted commonly by droplet nuclei and facilitated by weak immune system. Low... more Tuberculosis is transmitted commonly by droplet nuclei and facilitated by weak immune system. Lowered immunity may be associated with cigarette smoking, tobacco chewing and alcohol consumption. The corelationship between these all factors to TB should be explored. This study aims to detect the hidden household contacts (HC) cases early and to examine the relative contribution of tobacco and alcohol use to the risk of TB. A cross-sectional study was in Dharan among HCs. From index cases with sputum smear positive for AFB and their 802 HCs were included. Three sputum specimens were collected from each HCs and examined microscopically for AFB detection. AFB were detected in sputum of 13 (1.6%) HCs. The association between habits (alcohol user and smoking) and TB was found except with chewing tobacco user (P>0.05). The risk of contact TB was 4 and 8 times greater in smoker (OR= 3.94 95%CI= 1.26-12.26, P<0.05) and alcoholic (OR=8.23 95%CI= 2.71-24.98, P<0.05) HCs respectively. This study has revealed smoking and alcohols as the risk factors for tuberculosis. Effective campaign to discourage use of alcohol and tobacco, and awareness programme about the mode of transmission of TB are needed in community.

Research paper thumbnail of Intestinal parasitosis in school going children of Dharan municipality, Nepal

Tropical gastroenterology : official journal of the Digestive Diseases Foundation

This community-based investigation was carried out to estimate the prevalence of intestinal paras... more This community-based investigation was carried out to estimate the prevalence of intestinal parasitosis in primary school-going children of the Dharan municipality, Sunsari, Nepal from 2007 through 2008. A total of 182 stool samples were collected from 101 male and 81 female children of ages 4 to 10 years. A questionnaire including the factors predisposing to parasitosis, was filled up by the parents of each child. Parasitic examination was carried out by direct wet mount examination and concentration method using 10% formol-ether. The prevalence rate was found to be 22.5%. The result revealed preponderance of Giardia lamblia (11.5%) followed by Entamoeba histolytica/dispar (4.4%), Ascaris lumbricoides (3.3%), hookworm (1.6%) and Enterobius vermicularis (0.5%). Statistically significant difference in the prevalence with respect to age and gender was not seen. However, socioeconomic status, type of toilet used and the practice of hand washing had a strong correlation (p<0.05) with the prevalence of parasitic infection. Abdominal discomfort also had a strong statistical association (p<0.05) with the prevalence of parasitic infection. Proportionally higher infection rate was seen in participants not using filtered or boiled water. Lack of education of mothers and children, improper toilets and failure to practice proper hand washing were perceived from this study as contributors to the acquisition of intestinal parasitic infections. Figure 1: Preoperative CT scan showing the giant diverticulum and communication with sigmoid colon Figure 2: Specimen showing giant diverticulum arising from sigmoid colon

Research paper thumbnail of Adenosine deaminase in CSF and pleural fluid for diagnosis of tubercular meningitis and pulmonary tuberculosis

Nepal Medical College journal : NMCJ, 2012

Tuberculosis (TB) is one of the most common infectious diseases in developing countries including... more Tuberculosis (TB) is one of the most common infectious diseases in developing countries including Nepal. Delay in diagnosis and treatment of tuberculosis results in poor prognosis of the disease. The present study was conducted to estimate diagnostic cut off values of Adenosine Deaminase (ADA) in cerebrospinal fluid (CSF) and pleural fluid and to evaluate the sensitivity, specificity, positive and negative predictive values of ADA in pleural fluid and CSF from patients with tuberculous and non -tuberculous disease. A total of 98 body fluid (CSF: 24, pleural fluid: 74) specimens were received for the estimation of ADA. ADA activity was measured at 37ºC by spectrophotometric method of Guisti and Gallanti. Among the patients enrolled for the study, subjects for which CSF were received (n=24) included 8 tuberculous meningitis, and 16 non-tubercular meningitis. Pleural fluid samples (n=74) were received from 19 pulmonary TB with pleural effusion, 17 pulmonary TB without pleural effusion and 38 of non-tuberculous disease patients. CSF ADA activity were (11.16±2.03 IU/L) and (5.35±1.89 IU/L) (p <0.001) in tuberculous meningitis and non-tubercular meningitis groups and pleural fluid ADA activity were (103±22.18 IU/L) and (23.79±11.62 IU/L) (p<0.001) in pulmonary TB and non-TB groups respectively. ADA test in body fluids, which is simple, cost-effective and sensitive, specific for the tubercular disease is recommended to prevent delay in TB diagnosis.

Research paper thumbnail of In vitro activity of cefoperazone-sulbactam combination against gram negative bacilli

Nepal Medical College journal : NMCJ, 2012

Cefoperazone is a â-lactam antimicrobial and Sulbactam is an irreversible â-lactamase inhibitor. ... more Cefoperazone is a â-lactam antimicrobial and Sulbactam is an irreversible â-lactamase inhibitor. The objective of this study was to know the susceptibility pattern of gram negative bacilli (GNB) towards cefoperazonesulbactum. All GNB isolated from different clinical samples during the period of May, 2010 to Aug, 2010 were tested for susceptibility to cefoperazone-sulbactum, meropenem, ceftazidime, cefotaxime, ceftriaxone, chloromphenicol, cotrimoxazole, ampicillin, amikacin, nalidixic acid, ciprofloxacin, carbenicillin and piperacillin using standard Kirby-Bauer disc diffusion antimicrobial susceptibility testing method. The susceptibilities were recorded according to CLSI guidelines. A total of 406 GNB were isolated (urine: 66.7%, pus: 19.2%, and blood: 7.9%). Escherichia coli (54.4%) was most frequently isolated organisms followed by Acinetobacter species (17.7%), Klebsiella pneumoniae (9.1%) and Pseudomonas species (6.1%). Overall, 11.8% of isolates showed resistance to cefoperazone-sulbactam. Frequencies of isolates showing resistance to meropenem and amikacin were 14.7% and 26.25% respectively. Only 3.9% of Escherichia coli isolates showed resistance to cefoperazone-sulbactam. For other organisms, their lowest frequency ranging from 0-20%, exhibited resistance to meropenem. In Pseudomonas spp, in-vitro activity of amikacin was also better as only 11.1% isolates showed resistance to it. This study demonstrated the in-vitro synergistic effect of cefoperazonerazone-sulbactam and meropenem having good activity against GNB compared to the activity of other commonly tested antimicrobials. Cefoperazone-sulbactam can be recommended for the clinical practice against GNB exhibiting resistant to other antimicrobials as it is cheaper alternative to meropenem. Our results also focused on the continuous surveillance of the trends and features of resistance of common antimicrobials.

Research paper thumbnail of Bacteriological Profile and Antibiogram of Neonatal Septicemia

Objectives To determine the incidence of neonatal septicemia, identify the bacterial isolates and... more Objectives To determine the incidence of neonatal septicemia, identify the bacterial isolates and study their antimicrobial susceptibility pattern in neonates visiting out-patient door (OPD) and admitted to the pediatric ward and neonatal intensive care unit (NICU) of the College of Medical Sciences, Teaching Hospital, Chitwan, Nepal. Methods Blood culture of all neonates who were suspected for septicemia was performed. Isolate identification and antimicrobial susceptibility testing was done by standard microbiological method. Results Out of the total 7,868 blood culture samples submitted to the microbiology laboratory, 1,572 (19.97 %) samples were from suspected cases of neonatal septicemia. The blood culture was positive for neonatal sepsis in 238 (15.13 %) samples. The incidence of gram positive and gram negative organisms were 44.1 % and 55.9 % respectively. Staphylococcus aureus remained the predominant isolate followed by Klebsiella spp. Most of the gram positive isolates exhibited higher resistance to penicillin and cephalosporin. Susceptibility to commonly used aminoglycosides and quinolones was found. Similarly, more than two third isolates of gram negative Enterobacteriaceae showed resistance to ampicillin. Third generation cephalosporin and aminoglycosides were found to be more satisfactory among gram negative organisms as compared to gram positive.