{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T00:09:01Z","timestamp":1782518941304,"version":"3.54.5"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"Supplement_5","license":[{"start":{"date-parts":[[2021,12,15]],"date-time":"2021-12-15T00:00:00Z","timestamp":1639526400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["OPP1180554"],"award-info":[{"award-number":["OPP1180554"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,12,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Bacterial diseases are the leading cause of mortality globally, and due to haphazard use of antibiotics, antimicrobial resistance has become an emerging threat.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>This cross-sectional observational study utilized a minimally invasive tissue sampling procedure to determine the cause of death among an adult population. Bacterial cultures (blood, cerebrospinal fluid, lung tissue) and antibiotic susceptibility were evaluated, and the results were compared between community and hospital deaths.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 100 deceased persons studied, 76 (76%) deaths occurred in the community and 24 (24%) in the hospital. At least 1 bacterial agent was cultured from 86 (86%) cases; of these, 74 (86%) had a bacterial disease attributed as the primary cause of death, with pneumonia (35, 47.3%), sepsis (33, 44.6%), and meningitis (3, 4.1%) most common. Of 154 bacterial isolates (76.6% from the community and 23.4% from the hospital) detected from 86 culture-positive cases, 26 (16.8%) were multidrug-resistant (MDR). Klebsiella species were the most common (13 of 26) MDR organisms. The odds of getting an MDR Klebsiella infection was 6-fold higher among hospital deaths compared with community deaths (95% confidence interval [CI], 1.37\u201326.40; P = .017) and almost 23-fold higher (CI, 2.45\u2013213.54; P = .006) among cases with prior antibiotic use compared to those without.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>High incidence of serious bacterial infections causing death of adults in the community, with most MDR organisms isolated from hospitalized cases, calls for robust surveillance mechanisms and infection prevention activities at the community level and evidence-driven antibiotic stewardship in healthcare settings.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciab773","type":"journal-article","created":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T19:38:21Z","timestamp":1631129901000},"page":"S415-S421","source":"Crossref","is-referenced-by-count":40,"title":["Burden of Serious Bacterial Infections and Multidrug-Resistant Organisms in an Adult Population of Nepal: A Comparative Analysis of Minimally Invasive Tissue Sampling Informed Mortality Surveillance of Community and Hospital Deaths"],"prefix":"10.1093","volume":"73","author":[{"given":"Suraj","family":"Bhattarai","sequence":"first","affiliation":[{"name":"DECODE-MAUN Research Project, GMCTHRC, Pokhara, Nepal"},{"name":"Department of Global Health, Global Institute for Interdisciplinary Studies, Kathmandu, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Binita Koirala","family":"Sharma","sequence":"additional","affiliation":[{"name":"DECODE-MAUN Research Project, GMCTHRC, Pokhara, Nepal"},{"name":"Department of Microbiology, GMCTHRC, Pokhara, Nepal"},{"name":"Department of Microbiology, Tribhuvan University Prithvi Narayan Campus, Pokhara, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuwadatta","family":"Subedi","sequence":"additional","affiliation":[{"name":"DECODE-MAUN Research Project, GMCTHRC, Pokhara, Nepal"},{"name":"Department of Forensic Medicine, GMCTHRC, Pokhara, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunita","family":"Ranabhat","sequence":"additional","affiliation":[{"name":"DECODE-MAUN Research Project, GMCTHRC, Pokhara, Nepal"},{"name":"Department of Pathology, GMCTHRC, Pokhara, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madan Prasad","family":"Baral","sequence":"additional","affiliation":[{"name":"DECODE-MAUN Research Project, GMCTHRC, Pokhara, Nepal"},{"name":"Department of Forensic Medicine, Pokhara Academy of Health Sciences, Western Regional Hospital, Pokhara, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,12,15]]},"reference":[{"key":"2021121514104845100_CIT0001","author":"World Health Organization.","year":"2020"},{"key":"2021121514104845100_CIT0002","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1016\/S0140-6736(20)31404-5","article-title":"Five insights from the Global Burden of Disease Study 2019","volume":"396","author":"Murray","year":"2020","journal-title":"Lancet"},{"key":"2021121514104845100_CIT0003","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1016\/S0140-6736(20)30977-6","article-title":"Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950\u20132019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019","volume":"396","year":"2020","journal-title":"Lancet"},{"key":"2021121514104845100_CIT0004","volume-title":"Tackling drug-resistant infections globally: final report and recommendations","author":"O\u2019Neill","year":"2016"},{"key":"2021121514104845100_CIT0005","doi-asserted-by":"crossref","first-page":"1178633720909798","DOI":"10.1177\/1178633720909798","article-title":"Extended-spectrum \u03b2-lactamase-producing Escherichia coli and Klebsiella species in pediatric patients visiting International Friendship Children\u2019s Hospital, Kathmandu, Nepal","volume":"13","author":"Kayastha","year":"2020","journal-title":"Infect Dis (Auckl)"},{"key":"2021121514104845100_CIT0006","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1086\/322688","article-title":"Bacterial meningitis in aging adults","volume":"33","author":"Choi","year":"2001","journal-title":"Clin Infect Dis"},{"key":"2021121514104845100_CIT0007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1086\/595011","article-title":"Bad bugs, no drugs: no ESKAPE! 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