Vol. 4, No. 1, 2015 ISSN 2350-8566 University Grants Commission, Nepal Sanothimi, Bhaktapur, Nepal Website: http://www.ugcnepal.edu.np E-mail: [email protected] Published by Post Box: 10796, Kathmandu, Nepal Phone: (977-1) 6638548, 6638549, 6638550 University Grants Commission Fax: 977-1-6638552 Nepal Vol. 4 No. 1 2015 The Journal of University Grants Commission Published by University Grants Commission Nepal Advisors Parashar Prasad Koirala Bhola Nath Pokharel Hridaya Ratna Bajracharya Editorial Board Krishna Chandra Sharma Pramod Kumar Jha Dev Raj Adhikari Anirudra Thapa Managing Editor Devendra Rawal Asst. Managing Editor Narayan Bhandari Contents 1. Incidence of Multidrug Resistance Strains of Bacterial Uropathogens in Patients Visiting Venus International Hospital 1 S. Banjade, P.K. Shah and S. Karki 2. Cytotoxic and Antioxidant Activities of Extract of the Leaves of Annona reticulata 10 Khaga Raj Sharma, Surya Kant Kalauni and Suresh Awale 3. Factors Affecting Food Price Instabilities in Nepal 19 Thaneshwar Bhandari 4. Corrupt Adults and Castrated Adolescents: Questioning Aetonormativity in Robert Cormier’s Young Adult Novels 39 Hari R. Adhikari 5. Characterization of Kamerotar Clays of Madhyapur Thimi Municipality of Bhaktapur, Nepal 54 Nirjan Duwal, Madhusudan Dhakal, Narendara Mani Adhikari, Susan Joshi and Jagadeesh Bhattarai 6. Dietary Diversity and Nutritional Status of Women of Child Bearing Age in Sangla Village, Nepal 67 Manodhara Shakya 7. Risk Perception by Customers of Used Motorbike in Nepal 79 Keshava Raj Gnawali and Santosh Sharma 8. Prevalence and Factors Associated with Obesity Among Elderly Women 93 Nilu Thapa and Arya Rizal 9. Knowledge and Attitude on the Prevention of Swine Flu A (H1N1) among Nursing Students in Pokhara 104 Manmaya Rana 10. Nepal’s Military Relations with China and India: Dimensions and Perspectives 111 Ranjit Thapa 11. Status of the Implementation of Right to Information Act in Nepal 121 Yek Raj Pathak 12. Organizational Justice, Employee Trust and Commitment in Nepalese Financial Institutions 132 Prakash Shrestha 13. Perceived Leaders' Supportive Behavior and Subordinates' Creativity: Moderating Effect of Trust 148 Ganesh Bhattarai 14. Prevalence of Health Alteration Among Senior Citizens 168 Prabha Aryal and Neeta Tamrakar 15. Community Response to Climate Change and Food Security in Rupa Lake Basin Area, Kaski District of the Western Nepal 179 Sajani Shrestha 16. Nepalese Music Instruments and Mourning Rituals: From Permission to Proscription 194 Dhrubesh Chandra Regmi 17. Stress and Coping Mechanism Among Adolescents, Pokhara 200 Janaki Rai The Journal of University Grants Commission, Vol. 4, No. 1, 2015 INCIDENCE OF MULTIDRUG RESISTANCE STRAINS OF BACTERIAL UROPATHOGENS IN PATIENTS VISITING VENUS INTERNATIONAL HOSPITAL Sushil Banjade 1, Pradeep Kumar Shah 1 and Shovana Karki 2 1Department of Microbiology, St. Xavier’s College, Maitighar, Kathmandu 2Venus International Hospital, Baneshwor, Kathmandu Abstract: Urinary Tract Infection (UTI) is one of the most common infectious diseases that affect people of every age-group in every geographical location. The impact of disease is worst in developing countries due to unawareness of the UTIs caused by multidrug-resistant (MDR) pathogens. The aim of this cross- sectional study was to determine the bacterial uropathogens associated with Uninary Tract Infection and their antibiotic resistance pattern at Venus International Hospital, Baneshwor, Kathmandu. A total of 543 urine specimens were collected for urine culture during April to September 2012 in the microbiology laboratory of Venus International Hospital from the patients suspected of Urinary Tract Infection. Of them 129 (23.8%) were found to be culture positive. Urinary Tract Infection was more common in female (57.37%) than in male (42.63%). Association of significant bacteriuria and gender of patients was found to be statistically insignificant (P>0.05). Status of bacteriuria was found highest in age group 31-40 (17.82%) followed by age group 21-30 (17.05%). Altogether six different bacterial isolates were isolated, among which Gram-negative organism constituted 75.20% and Gram-positive constituted 24.80%. Escherichia coli (62.01%) was the predominant uropathogen followed by Staphylococcus aureus (24.80%), Klebsiella pneumoniae (6.97%), Pseudomonas aeruginosa (4.65%), Morganella morganii (0.77%) and Proteus mirabilis (0.77%). Gram-negative bacteria showed best susceptibility towards Nitrofurantoin (75.25%) whereas Nalidixic acid (58.76%) was found to be least effective. Gram-positive bacteria showed best susceptibility towards Vancomycin (100%) whereas Cotrimoxazole (37.5%) was found to be least effective. Out of 129 bacterial isolates 54 (41.86%) were found to be Multidrug Resistant (MDR). It was found that out of 80 isolates 36 (45%) isolates of Escherichia coli were multidrug resistant. Similarly, 9 out of 32 isolates (38.12%) Staphylococcus aureus, 5 out of 9 isolates (55.55%) Klebsiella pneumoniae, 3 out of 6 isolates (50%) Pseudomonas aeruginosa and 1 (100%) Proteus mirabilis out of 1 isolate were multidrug resistant. Keywords: Urinary tract infection, multidrug resistance, Uropathogens. Introduction Urinary tract infection (UTI) is defined as the colonization of microbes in any part of the urinary tract (Syeda et al ., 2010). Despite the advances in and the wide–spread availability of antimicrobials, UTIs continue to be the most common causes of infections in hospitalized patients, accounting for approximately 40% of the hospital 2 The Journal of University Grants Commission, Vol. 4, No. 1, 2015 acquired infections (Babypadmini & Appalaraju, 2004; Kamat et al ., 2009). Clinical experience has indicated the presence of numerous cases of antibiotic resistance to common antibiotics by uropathogens in both developed and developing countries (Gupta, 2002). Resistance to newer and more potent antimicrobials is no exception, making the therapeutic options very limited to certain antimicrobial agents like carbapenem, colistin and fosfomycin. The updated knowledge and situation of the prevailing bacterial uropathogens that are multidrug resistant (MDR) is of prime importance for the proper use of antimicrobial drugs and for the policy making to combat multidrug resistance in UTIs (Giamarellou, 2010). Wide spectrums of organisms are implicated in its aetiology, the most common being Escherichia coli (Babypadmini & Appalaraju, 2004; Kamat et al ., 2009; Pallavi et al ., 2010) and other Gram-negative bacteria, followed by Gram-positive organisms. The culture of the urine samples is essential for identifying the organisms and their antimicrobial susceptibilities. The antibiotic therapy aims at relieving the existing symptoms and in preventing the development of complications like renal scarring. The increased emergence of antimicrobial resistance in the uropathogens, probably due to the empirical administration of anti bacterial therapy, even before the availability of the urine culture results, is a matter of growing concern worldwide (Oladeinde et al ., 2011). These data might be informative to health professionals to make a positive contribution to current understanding of the situation in UTI caused by MDR bacterial pathogens. Materials and methods A cross-sectional study was conducted prospectively at Venus International Hospital from April to September 2012. A total of 543 urine samples were collected from patients of all age groups and both sexes, suspected of UTI visiting Venus Hospital, and samples were processed according to the standard laboratory methods. The urine samples were cultured onto MacConkey agar and Blood agar plates and then were aerobically incubated at 37 °C overnight. Colony count was performed to calculate the number of colony forming units (CFU) per ml of urine and the bacterial count was reported as: <104/ml organisms: not significant; 104 to 105/ml organisms: doubtful significance (suggest repeat specimen); >105/ml organisms: significant bacteriuria. The identification of bacterial isolates was done using standard microbiological techniques as described in Bergey’s Manual of Systemic Bacteriology which comprises of studying the colony characterstics, staining reactions and biochemical tests. Antibiotic susceptibility test of different isolates were performed by Kirby-Bauer disk Incidence of Multidrug Resistance Strains 3 diffusion method on Mueller Hinton agar (MHA). Those organisms which showed resistance to at least three or more antibiotics of different structural classes were considered MDR as described elsewhere (Sahm et al ., 2001; Simner et al ., 2011). Results Of 543 urine samples subjected for culture, male patients constituted 269 (49.5%) and female patients constituted 274 (50.5%). The highest number of patients 131 (24.1%) belonged to the age group 21-30 followed by the age group of 31-40 (20.8%), 41-50 (12.2%) and least from >80 (1.8%). Higher number of female patients 81 (29.5%) were found in the age group 21-30 and higher number of male patients 61 (22.67) were found in the age group 31-40 (Table 1). The chi-square test revealed significant (χ2=26.628, d.f.=8, P=0.001) difference between gender and age groups. Table 1. Age and gender-wise distribution of patients Age group Male Female Total P-value No % No % No % 0-10 12 2.20 30 5.52 42 7.73 11-20 17 3.13 24 4.41 41 7.55 21-30 50 9.20 81 14.91 131 24.12 31-40 61 11.23 52 9.57 113 20.81 41-50 37 6.81 29 5.34 66 12.15 P<0.05 51-60 33 6.07 23 4.23 56 10.31 61-70 23 4.23 17 3.13 40 7.36 71-80 29 5.34 15 2.76 44 8.10 >80 7 1.28 3 0.55 10 1.84 Total 269 49.5 274 50.5 543 100 Table 2 illustrates gender wise growth profile of sample. Of the total 543 urine samples subjected for culture, 129 (23.8%) were culture positive and 414 (76.2%) were culture negative. Among them the numbers of growth in male and in female were 55 and 74, respectively. The chi-square test revealed insignificant (χ2=3.226, d.f.=1, P=0.072) difference between gender and growth pattern. Table 2.