{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T22:28:02Z","timestamp":1791412082129,"version":"4.3.3"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T00:00:00Z","timestamp":1710201600000},"content-version":"vor","delay-in-days":7,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Data on antimicrobial resistance (AMR) among children in Nepal are limited. Here we have characterized the causes of bacterial bloodstream infections (BSIs), antimicrobial resistance patterns and the mechanisms of \u03b2-lactamase production in Enterobacterales among children attending outpatient and inpatient departments of a secondary care paediatric hospital in Nepal.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We retrospectively collected demographic and clinical data of culture-proven bacterial BSIs between January 2017 and December 2022 among children &amp;lt;18 years attending a 50-bedded paediatric hospital. Stored isolates were subcultured for antimicrobial susceptibility testing against commonly used antimicrobials. Enterobacterales displaying non-susceptibility to \u03b2-lactams were phenotypically and genotypically investigated for ESBLs, plasmid-mediated AmpC (pAmpC) \u03b2-lactamases and carbapenemases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 377 significant bacteria were isolated from 27\u200a366 blood cultures. Among 91 neonates with a BSI, Klebsiella pneumoniae (n\u200a=\u200a39, 42.4%), Pseudomonas aeruginosa (n\u200a=\u200a15, 16.3%) and Acinetobacter baumannii complex (n\u200a=\u200a13, 14.1%) were most common. In the non-neonates, 275\/285 (96.5%) infections were community-acquired including Staphylococcus aureus (n\u200a=\u200a89, 32.4%), Salmonella Typhi (n\u200a=\u200a54, 19.6%) and Streptococcus pneumoniae (n\u200a=\u200a32, 11.6%). Among the 98 S. aureus, 29 (29.6%) were methicillin-resistant Staphylococcus aureus. K. pneumoniae and Escherichia coli demonstrated non-susceptibility to extended-spectrum cephalosporins and carbapenems in both community and hospital-acquired cases. For E. coli and K. pneumoniae, blaCTX-M (45\/46), blaEBC (7\/10) and blaOXA-48 (5\/6) were common among their respective groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We determined significant levels of AMR among children attending a secondary care paediatric hospital with BSI in Nepal. Nationwide surveillance and implementation of antimicrobial stewardship policies are needed to combat the challenge imposed by AMR.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jacamr\/dlae035","type":"journal-article","created":{"date-parts":[[2024,3,12]],"date-time":"2024-03-12T09:42:17Z","timestamp":1710236537000},"source":"Crossref","is-referenced-by-count":3,"title":["The causes of bacterial bloodstream infections and antimicrobial resistance patterns in children attending a secondary care hospital in Bhaktapur, Nepal, 2017\u20132022: a retrospective study"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7771-0110","authenticated-orcid":false,"given":"Raj Kumar","family":"Shrestha","sequence":"first","affiliation":[{"name":"Department of Research, Siddhi Memorial Hospital , Bhaktapur , Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhruba","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Department of Research, Siddhi Memorial Hospital , Bhaktapur , Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashok Kumar","family":"Sah","sequence":"additional","affiliation":[{"name":"Department of Research, Siddhi Memorial Hospital , Bhaktapur , Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashmita","family":"Thapa","sequence":"additional","affiliation":[{"name":"Department of Research, Siddhi Memorial Hospital , Bhaktapur , Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nipun","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Department of Research, Siddhi Memorial Hospital , Bhaktapur , Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ganendra Bhakta","family":"Raya","sequence":"additional","affiliation":[{"name":"Department of Research, Siddhi Memorial Hospital , Bhaktapur , Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenshi","family":"Furushima","sequence":"additional","affiliation":[{"name":"School of Tropical Medicine and Global Health (TMGH), Nagasaki University , Nagasaki , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhim Gopal","family":"Dhoubhadel","sequence":"additional","affiliation":[{"name":"School of Tropical Medicine and Global Health (TMGH), Nagasaki University , Nagasaki , Japan"},{"name":"Department of Respiratory Infections, Institute of Tropical Medicine, Nagasaki University , Nagasaki , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher M","family":"Parry","sequence":"additional","affiliation":[{"name":"School of Tropical Medicine and Global Health (TMGH), Nagasaki University , Nagasaki , Japan"},{"name":"Clinical Sciences and Education, Liverpool School of Tropical Medicine , Liverpool , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,3,12]]},"reference":[{"key":"2024042911452666100_dlae035-B1","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","author":"Murray","year":"2022","journal-title":"Lancet"},{"key":"2024042911452666100_dlae035-B2","volume-title":"Global Antimicrobial Resistance and use Surveillance System (GLASS) Report 2022","author":"WHO","year":"2022"},{"key":"2024042911452666100_dlae035-B3","doi-asserted-by":"crossref","first-page":"262","DOI":"10.3389\/fmed.2018.00262","article-title":"Changing antimicrobial resistance trends in Kathmandu, Nepal: a 23-year retrospective analysis of bacteraemia","volume":"5","author":"Zellweger","year":"2018","journal-title":"Front Med 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\u03b2-lactamase CITM and DHAM genes among Gram-negative clinical isolates","volume":"13","author":"Aryal","year":"2020","journal-title":"Infect Drug Resist"},{"key":"2024042911452666100_dlae035-B28","doi-asserted-by":"publisher","first-page":"e1004179","DOI":"10.1371\/journal.pmed.1004179","article-title":"Patterns of antibiotic use, pathogens, and prediction of mortality in hospitalized neonates and young infants with sepsis: a global Neonatal Sepsis Observational Cohort Study (NeoOBS)","volume":"20","author":"Russell","year":"2023","journal-title":"PLoS Med"}],"container-title":["JAC-Antimicrobial 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