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Antibiotic resistance exhibited by Staphylococcus aureus is a growing global concern. This work was undertaken to determine the prevalence rate of inducible clindamycin resistant S. aureus in nasal sample and detect ermB gene in the isolates with inducible clindamycin resistance. Nasal swabs were collected from the school children and cultured on Mannitol Salt Agar (MSA) and Blood Agar (BA) for observation of colony morphology. Gram staining and biochemical test (catalase, oxidase, O-F and coagulase) were performed for further identification of the bacteria. The Kirby-Bauer disc diffusion method using a cefoxitin disc (30 μg) was used to detect methicillin resistant S. aureus (MRSA). All, the MRSA isolates were tested for ermB gene by PCR amplification. Among 64 S. aureus isolates, 17 (26 %) were MRSA. The prevalence of Inducible clindamycin resistant S. aureus (iMLSB) isolates was 23.4 % in the S. aureus isolates. All the isolates of MRSA were resistant to penicillin, while 88.2 % were sensitive to gentamicin. The prevalence of ermB gene was 3.1 % in the total S. aureus isolates and 11.7 % MRSA showed the presence of this gene. Routinely performing a D-test in laboratory will guide the clinicians on the rationale use of clindamycin and improving hygienic practices can reduce the spread of inducible clindamycin resistance.

Aim: Resistance to methicillin and Macrolide–Lincosamide and Streptogramins B and their association with erm genes in Staphylococcus aureus are unknown in Nepal. Materials & methods: Nonduplicate nasal swabs from 160 school children were collected from April to September 2018 and processed using standard microbiological procedures. Results: Out of 160 samples, 64 (40%) were S. aureus in which 17 (26.6%) were methicillin-resistance Staphylococcus aureus (MRSA). D-test identified 15 (23.4%) as inducible clindamycin-resistant, which were more prevalent in MRSA (76.4%) than methicillin-sensitive S. aureus (MSSA; 4.2%). 18.7% of isolates harbored the ermC gene followed by ermA (15.6%) and ermB (3.1%), and were more in MRSA than MSSA. Conclusion: To prevent treatment failure by inducible resistance, D-test must be performed on erythromycin-resistant and/or clindamycin-sensitive isolates., Lay abstract With the increased prevalence of methicillin-resistant S. aureus in hospital- and community-acquired infections, there has been an upsurge in resistance toward Macrolide–Lincosamide–Streptogramin type B antibiotics. This has rendered therapy difficult, thereby increasing morbidity, length of hospital-stay and cost of treatment. Therefore, the correct identification and reporting of S. aureus isolates and their susceptibility patterns, more specifically, toward methicillin, clindamycin and erythromycin is very crucial.

Aim: Resistance to methicillin and Macrolide–Lincosamide and Streptogramins B and their association with erm genes in Staphylococcus aureus are unknown in Nepal. Materials & methods: Nonduplicate nasal swabs from 160 school children were collected from April to September 2018 and processed using standard microbiological procedures. Results: Out of 160 samples, 64 (40%) were S. aureus in which 17 (26.6%) were methicillin-resistance Staphylococcus aureus (MRSA). D-test identified 15 (23.4%) as inducible clindamycin-resistant, which were more prevalent in MRSA (76.4%) than methicillin-sensitive S. aureus (MSSA; 4.2%). 18.7% of isolates harbored the ermC gene followed by ermA (15.6%) and ermB (3.1%), and were more in MRSA than MSSA. Conclusion: To prevent treatment failure by inducible resistance, D-test must be performed on erythromycin-resistant and/or clindamycin-sensitive isolates.

Objective: To determine the status of isolation blood stream serotypes of enteric fever pathogens and their antibiotic susceptibility patterns and to guide clinicians for appropriate therapy. Methods: Samples were examined by microbiological techniques to identify the causative agent and determine their antimicrobial susceptibility patterns by Kirby-Bauer disk diffusion methods and interpreted as per Clinical and Laboratory Standards Institute guidelines. Results: Among 403 blood samples, 76 (18.85%) showed growth for Salmonella isolates. Distribution of Salmonella typhi and Salmonella paratyphi A isolates were found to be 54% and 46% respectively. Among 76 Salmonella isolates, 28 (36.84%) were from male and remaining 48 (63.15%) were from female belonging to all age-groups. Multidrug-resistance was found to be 17% among the Salmonella isolates. Nalidixic acid resistance was 73.68% in Salmonella with higher proportion in Salmonella paratyphi A (85.7%) in comparison to Salmonella typhi (63.42%). Salmonella isolates demonstrated 100% susceptibility to azithromycin, ceftriazone, ciprofloxacin, ofloxacin and imipenem. Conclusions: The need of continual surveillance of resistance levels to guide clinicians for appropriate therapy based on the antibiotic susceptibility pattern for Salmonella isolates is sustained with discouragement in misuse of antibiotics prior to prescription as multidrugresistance-nalidixic acid resistant strains.

Background: Wound infection is a very common infection throughout the world and is causing a great fear in developing countries like Nepal. The present study was carried out in Kathmandu Model Hospital with an aim to find out the bacteriological episodes in pus samples in relation to age and sex, Antibiotic Susceptibility Testing (AST) and drug resistance pattern among the isolates. Methodology: A total of 157 pus samples included in the study were processed in the Microbiology laboratory of Kathmandu Model Hospital using standard microbiological techniques. Identification of organisms was done on the basis of microscopy, colony morphology, and biochemical tests. The antibiotic sensitivity testing of all isolates was performed by Kirby Bauer’s disc diffusion method on Muller Hinton agar and interpreted as per CLSI guidelines. Results: Analysis of 157 pus samples showed (93, 59.24%) culture positive cases with (63, 67.74%) Multi Drug Resistance (MDR) isolates. Age group (21-30) was found to be the most vulnerable age group. Staphylococcus aureus (29, 28.71%) was the predominant organism isolated among gram positive bacteria and Escherichia coli (26, 25.74%) among gram negative bacteria. Gentamycin was the most sensitive antibiotic among gram positive bacteria whereas Amikacin being the most sensitive Antibiotic among gram negative bacteria. Conclusion: Antibiograms of isolates can serve as a tool for physicians to start an empirical treatment and minimize the drug resistance problem.

Tuberculosis is a particular infectious disease caused by Mycobacterium tuberculosis .The disease primarily affects the lungs and cause pulmonary tuberculosis diagnosed with smear positive. The prospective case-control study was conducted in the Nepal Anti-Tuberculosis Association (NATA), GENETUP lab, Kalimati, Kathmandu from July 2010 to October 2010, on sputum samples from patient visiting at the GENETUP lab with suspected pulmonary tuberculosis cases without treatment and follow-up cases after DOTS and MDR treatment. A total of 299 sputum samples (170 from 78 suspected cases, 42 from 22 follow-up cases with DOTS treatment and 87 from Follow-up cases with MDR) were collected aseptically. The study clearly indicated that the case detection rate (efficacy) of fluorescent microscopy (AO stain) is remarkably higher than that of ZN (light microscopy) ,with aided advantages of less eye strain, easy visualization, less time consuming and even detection of low number of bacteria (paucibacillary cases) in comparison to ZN method. the correct diagnosis of pulmonary tuberculosis requires combination of AO (fluorescent microscopy), culture and biochemical analysis.

Introduction: Tuberculosis remains a worldwide public health problem despite the highly effective drugs and vaccines are available making tuberculosis a preventable and curable disease. The objective of this study was to compare the different laboratory diagnostic methods of tuberculosis and determine its prevalence. Methodology: Morning sputum samples were collected from suspected cases of pulmonary tuberculosis and preceded for Ziehl Neelsen staining, fluorescent staining (auramin-O) and mycobacterium culture in Lowenstein Jensen medium. Results: Total 78 suspected cases of pulmonary tuberculosis were included in this study among them 53 were male and 25 were female. Out of 78 cases, 46 cases were found to be culture positive. In culture positive cases (83%) were found to be M. tuberculosis and (17%) were found to be slow grower, fine colonies, AFB positive but niacin test negative (mycobacteria other than M. tuberculosis ). In the direct microscopic examination by Ziehl Neelsen stained smear 26 samples were found to be acid fast bacilli and one sample was culture negative but acid fast bacilli positive. In fluorescent stained smear 34 samples were found to be positive for acid fast bacilli and 5 samples were culture negative but acid fast bacilli positive. Culture was accepted as gold standard, the sensitivity of direct microscopic examination was found 56.5% for Ziehl Neelsen staining and 73.9% for fluorescent staining respectively. Conclusion : In culture positive cases M. tuberculosis and mycobacteria other than M. tuberculosis was found to be 83% and 17% respectively, it was found higher in male than female. Fluorescent microscopy is superior to Ziehl Neelsen microscopy but gives more false positive result than Z-N staining. Combining of Ziehl Neelsen and fluorescent staining is better than fluorescent staining alone. DOI: http://dx.doi.org/10.3126/saarctb.v11i2.12427 SAARC J TUBER LUNG DIS HIV/AIDS, 2014;XI(2), page: 1-6

Antiretroviral therapy has led to a profound improvement in the clinical care of HIV-infected patients. However, drug tolerability and the evolution of drug resistance have limited treatment options for many patients. Maturation inhibitors are a new class of antiretroviral agents for treatment of HIV-1. They act by interfering with the maturation of the virus by blocking the last step in Gag processing: the cleavage of the capsid-spacer peptide 1 (CA-SP1) intermediate to mature CA by the viral protease (PR). The first-in-class maturation inhibitor bevirimat (BVM) failed against a subset of HIV-1 isolates in clinical trials due to polymorphisms present in the CA-SP1 region of the Gag protein. Sequence analysis indicated that these polymorphisms are more common in non-clade B strains of HIV-1 such as HIV-1 clade C. Indeed, BVM was found to be ineffective against HIV-1 clade C molecular clones tested in this study. A number of BVM analogs were synthesized by chemical modifications at the C-28 position to improve its activity. The new BVM analogs displayed potent activity against HIV-1 clade B and C and also reduced infectivity of the virus. This study identifies novel and broadly active BVM analogs that may ultimately demonstrate efficacy in the clinic.