{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T00:54:40Z","timestamp":1759366480409,"version":"build-2065373602"},"reference-count":48,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n<jats:p>Of all the recognized public health threats, antimicrobial resistance (AMR) is among the most serious. Antimicrobial resistance may have a higher prevalence in low- and middle-income countries, where antimicrobial misuse is compounded by inadequate infection control measures. In this study, we examined AMR trends in bacterial infections in a reference laboratory in Kathmandu, Nepal, from 2021 to 2024. We collected the clinical records of infected patients, including demographic details, pathogen profiles, and antibiograms, from the electronic laboratory information system and analyzed them using SPSS version 17.0 (IBM Corp., Armonk, NY). Among 3,720 patients, 703 (19.7%; median age: 40 years; 395 [54.0%] female) had infections primarily caused by bacteria (91.7%; 723\/731), followed by yeast (3.8%; 28\/731). Urinary tract infections (55.9%; 290\/703) were the most common. The predominant pathogen was <jats:italic>Escherichia coli<\/jats:italic> (41.3%; 290\/703). Resistance rates in Enterobacterales, nonfermenters, and Gram-positive cocci were 31.0%, 43.4%, and 13.5%, respectively, for aminoglycosides; 49.7%, 42.8%, and 40.2%, respectively, for fluoroquinolones; 64.9%, 59.0%, and 65.6%, respectively, for cephalosporins; 47.3%, 77.4%, and 27.2%, respectively, for trimethoprim\u2013sulfamethoxazole; and 83.0%, 100.0%, and 85.0%, respectively, for penicillins. Extensively drug-resistant (XDR; 19.1%; 134\/703) and multidrug-resistant (29.2%; 205\/703) bacteria exhibited &gt;90% resistance to ciprofloxacin, erythromycin, and beta-lactams. Over time (2022\u20132024), resistance increased for aminoglycosides (27.7\u201332.3%), fluoroquinolones (43.5\u201354.1%), and penicillin with beta-lactamase inhibitors (PwBLIs; 35.9\u201358.7%) but decreased for cephalosporins (67.5\u201362.8%), carbapenems (23.3\u201318.7%), penicillins (85.2\u201382.1%), trimethoprim\u2013sulfamethoxazole (59.6\u201342.2%), and nitrofurantoin (39.0\u20133.7%). A low rate of bacterial infections was detected among hospital visitors. Urinary tract infections were the most prevalent type of infection. Multidrug-resistant bacteria predominated over XDR bacteria. Resistance to beta-lactams declined over time; however, resistance to aminoglycosides, fluoroquinolones, and PwBLIs increased.<\/jats:p>","DOI":"10.4269\/ajtmh.25-0116","type":"journal-article","created":{"date-parts":[[2025,8,7]],"date-time":"2025-08-07T13:41:01Z","timestamp":1754574061000},"page":"749-757","source":"Crossref","is-referenced-by-count":0,"title":["A Retrospective Analysis of Bacterial Infections (2021\u20132024) in a Reference Laboratory in Kathmandu, Nepal"],"prefix":"10.4269","volume":"113","author":[{"given":"Sohani","family":"Bajracharya","sequence":"first","affiliation":[{"name":"Department of Microbiology and Molecular Biology, National Path Laboratory, Kathmandu, Nepal;"},{"name":"Department of Microbiology and Infectious Disease, Pokhara Academy of Health Sciences, Pokhara, Nepal;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajaya","family":"Basnet","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Nepal Armed Police Force Hospital, Kathmandu, Nepal;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ranjan Bhele","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Department of Microbiology and Molecular Biology, National Path Laboratory, Kathmandu, Nepal;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeevan","family":"Adhikari","sequence":"additional","affiliation":[{"name":"Department of Pathology, National Path Laboratory, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"BMC Infect Dis","first-page":"420","article-title":"Epidemiology of urinary tract infection and antimicrobial resistance in a pediatric hospital in Nepal","volume":"19","author":"Ganesh","year":"2019"},{"key":"b2","series-title":"J Med Surg Public Health","first-page":"100081","article-title":"Antimicrobial resistance: Impacts, challenges, and future prospects","volume":"2","author":"Ahmed","year":"2024"},{"key":"b3","series-title":"Lancet","first-page":"629","article-title":"Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis","volume":"399","author":"Murray","year":"2022"},{"key":"b4","series-title":"Lancet","first-page":"1172","article-title":"Global burden of antimicrobial resistance and forecasts to 2050","volume":"404","author":"Kariuki","year":"2024"},{"key":"b5","series-title":"Lancet","first-page":"168","article-title":"Access to effective antimicrobials: A worldwide challenge","volume":"387","author":"Laxminarayan","year":"2016"},{"key":"b6","series-title":"Trends Microbiol","first-page":"438","article-title":"Fluoroquinolone resistance: Mechanisms, impact on bacteria, and role in evolutionary success","volume":"22","author":"Redgrave","year":"2014"},{"key":"b7","series-title":"Iran J Med Sci","first-page":"515","article-title":"Prevalence of qnr and aac(6\u2032)-Ib-cr genes in clinical isolates of Klebsiella pneumoniae from Imam Hussein Hospital in Tehran","volume":"40","author":"Eftekhar","year":"2015"},{"key":"b8","series-title":"BMC Biol","first-page":"123","article-title":"Q&A: Antibiotic resistance: Where does it come from and what can we do about it?","volume":"8","author":"Wright","year":"2010"},{"key":"b9","series-title":"Microbiol Spectr","article-title":"Plasmid\u2010mediated quinolone resistance","volume":"2","author":"Jacoby","year":"2015"},{"key":"b10","series-title":"Nat Rev Microbiol","first-page":"42","article-title":"Molecular mechanisms of antibiotic resistance","volume":"13","author":"Blair","year":"2015"},{"key":"b11","series-title":"Biofilms in Plant and Soil Health","first-page":"195","author":"Padmavathi","year":"2017"},{"key":"b12","series-title":"Egypt J Basic Appl Sci","first-page":"64","article-title":"Bacterial biofilm dependent catheter associated urinary tract infections: Characterization, antibiotic resistance pattern and risk factors","volume":"8","author":"Ramadan","year":"2021"},{"key":"b13","series-title":"Australas Med J","first-page":"344","article-title":"Antibiotic resistance pattern of biofilm-forming uropathogens isolated from catheterised patients in Pondicherry, India","volume":"5","author":"Subramanian","year":"2012"},{"key":"b14","series-title":"Microbiol Immunol","first-page":"10","article-title":"A decade\u2010long analysis of trends in antimicrobial resistance in a neurosurgical hospital in Kathmandu, Nepal","volume":"69","author":"Basnet","year":"2025"},{"year":"2017","key":"b15","article-title":"Density of Physicians (Total Number per 1000 Population, Latest Available Year), Global Health Observatory (GHO) Data. Situation and Trends."},{"key":"b16","series-title":"EFSA J","first-page":"e06651","article-title":"Role played by the environment in the emergence and spread of antimicrobial resistance (AMR) through the food chain","volume":"19","author":"Koutsoumanis","year":"2021"},{"key":"b17","series-title":"J Nepal Health Res Counc","first-page":"102","article-title":"Antibiotic use, its resistance in Nepal and recommendations for action: A situation analysis","volume":"13","author":"Basnyat","year":"2015"},{"year":"2020","series-title":"Koneman\u2019s Color Atlas and Textbook of Diagnostic Microbiology","author":"Procop","key":"b18"},{"year":"2016","series-title":"CLSI Document M100S. Performance Standards for Antimicrobial Susceptibility Testing, 30th ed","key":"b19"},{"key":"b20","series-title":"Clin Microbiol Infect","first-page":"268","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"Magiorakos","year":"2012"},{"key":"b21","series-title":"Front Med (Lausanne)","first-page":"105","article-title":"Antimicrobial resistance in Nepal","volume":"6","author":"Acharya","year":"2019"},{"key":"b22","series-title":"J Karnali Acad Health Sci","first-page":"13","article-title":"Bacterial pathogens responsible for urinary tract infection among patients attending a tertiary hospital in eastern Nepal","volume":"5:","author":"Gupta","year":"2022"},{"key":"b23","series-title":"Am J Trop Med Hyg","first-page":"1237","article-title":"Antimicrobial resistance in bacterial species causing orthopaedic surgical site infections at a national trauma center, Kathmandu, Nepal","volume":"111","author":"Basnet","year":"2024"},{"key":"b24","series-title":"Kathmandu Univ Med J (KUMJ)","first-page":"295","article-title":"Microbiological analysis of the urine isolates in Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal. Kathmandu University","volume":"9","author":"Raza","year":"2011"},{"key":"b25","series-title":"J Nepal Health Res Counc","first-page":"664","article-title":"Antimicrobial susceptibility pattern in opportunistic pathogens isolated from immunocompromised patients","volume":"20","author":"Basnet","year":"2023"},{"key":"b26","series-title":"Clin Infect Dis","first-page":"S415","article-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","volume":"73","author":"Bhattarai","year":"2021"},{"year":"2019","key":"b27","article-title":"The AWaRe Classification of Antibiotics Database."},{"key":"b28","series-title":"Front Med (Lausanne)","first-page":"262","article-title":"Changing antimicrobial resistance trends in Kathmandu, Nepal: A 23-year retrospective analysis of bacteraemia","volume":"5","author":"Zellweger","year":"2018"},{"key":"b29","series-title":"J Oncol","first-page":"596504","article-title":"Clinical and microbiological profile of pathogens in febrile neutropenia in hematological malignancies: A single center prospective analysis","volume":"2015","author":"Taj","year":"2015"},{"key":"b30","series-title":"J Kathmandu Med Coll","first-page":"26","article-title":"Incidence of bacterial infections in chronic kidney disease patients admitted in nephrology unit of Kathmandu Medical College Teaching Hospital","volume":"7","author":"Adhikari","year":"2018"},{"key":"b31","series-title":"J Nepal Paedtr Soc","first-page":"1","article-title":"Assessment of bacterial profile and antimicrobial susceptibility pattern of bacterial isolates from blood culture in tertiary level paediatric hospital of Nepal","volume":"43","author":"Shrestha","year":"2023"},{"key":"b32","series-title":"Antimicrob Resist Infect Control","first-page":"67","article-title":"High burden of antimicrobial resistance among gram negative bacteria causing healthcare associated infections in a critical care unit of Nepal","volume":"6","author":"Parajuli","year":"2017"},{"key":"b33","series-title":"Glob J Med Res Microbiol Pathol","first-page":"24","article-title":"Bacteriological profile and antibiotic susceptibility pattern of blood culture isolates from patients visiting tertiary care hospital in Kathmandu, Nepal","volume":"16","author":"Simkhada","year":"2016"},{"key":"b34","series-title":"Trop Med Health","first-page":"23","article-title":"Prevalence of multidrug-resistant and extended-spectrum beta-lactamase producing Gram-negative isolates from clinical samples in a tertiary care hospital of Nepal","volume":"49","author":"Shilpakar","year":"2021"},{"key":"b35","series-title":"Antibiotics","first-page":"459","article-title":"Current trends in antimicrobial resistance patterns in bacterial pathogens among adult and pediatric patients in the intensive care unit in a tertiary care hospital in Kolkata, India","volume":"12","author":"Chakraborty","year":"2023"},{"key":"b36","series-title":"BMC Res Notes","first-page":"557","article-title":"Incidence of metallo-beta-lactamase producing clinical isolates of Escherichia coli and Klebsiella pneumoniae in central Nepal","volume":"7","author":"Bora","year":"2014"},{"key":"b37","series-title":"BMJ Open","first-page":"e067384","article-title":"Prevalence, antimicrobial susceptibility pattern and multidrug resistance of methicillin-resistant Staphylococcus aureus isolated from clinical samples at a tertiary care teaching hospital: An observational, cross-sectional study from the Himalayan country, Nepal","volume":"13","author":"Adhikari","year":"2023"},{"key":"b38","series-title":"J Assoc Physicians India","first-page":"32","article-title":"Surveillance of multidrug resistant organisms in tertiary care hospital in Delhi, India","volume":"58","author":"Wattal","year":"2010"},{"key":"b39","series-title":"J Biomed Sci","first-page":"11","article-title":"Prevalence of carbapenem resistant bacterial strains isolated from different clinical samples: Study from a tertiary care hospital in Kathmandu, Nepal","volume":"3","author":"Karn","year":"2017"},{"key":"b40","series-title":"Korean J Intern Med","first-page":"128","article-title":"Current epidemiology and growing resistance of Gram-negative pathogens","volume":"27","author":"Livermore","year":"2012"},{"key":"b41","series-title":"Am J Trop Med Hyg","first-page":"283","article-title":"Assessment of antibiotic resistance among clinical isolates of Enterobacteriaceae in Nepal","volume":"110","author":"Basnet","year":"2024"},{"key":"b42","series-title":"J Nepal Health Res Counc","first-page":"173","article-title":"Bacteriological profile and antimicrobial susceptibility pattern among isolates obtained from body fluids","volume":"17","author":"Shrestha","year":"2019"},{"key":"b43","series-title":"J Pathog","first-page":"4065603","article-title":"Multidrug resistant and extensively drug resistant bacteria: A study","volume":"2016","author":"Basak","year":"2016"},{"key":"b44","series-title":"Antimicrob Resist Infect Control","first-page":"42","article-title":"Multidrug resistant Enterobacteriaceae and extended spectrum \u03b2-lactamase producing Escherichia coli: a cross-sectional study in National Kidney Center, Nepal","volume":"4","author":"Yadav","year":"2015"},{"key":"b45","series-title":"PLoS One","first-page":"e0294646","article-title":"Assessment of four in\u00a0vitro phenotypic biofilm detection methods in relation to antimicrobial resistance in aerobic clinical bacterial isolates","volume":"18","author":"Basnet","year":"2023"},{"key":"b46","series-title":"BMC Infect Dis","first-page":"746","article-title":"Trends in antimicrobial resistance of bacterial pathogens in Harare, Zimbabwe, 2012\u20132017: A secondary dataset analysis","volume":"19","author":"Mhondoro","year":"2019"},{"key":"b47","series-title":"Infect Drug Resist","first-page":"5679","article-title":"Trends and correlation between antimicrobial resistance and antibiotics consumption in a specialist children\u2019s hospital from 2016 to 2021","volume":"15","author":"Gong","year":"2022"},{"key":"b48","series-title":"One Health Adv","first-page":"8","article-title":"Current status and trends of antimicrobial resistance among clinical isolates in China: A retrospective study of CHINET from 2018 to 2022","volume":"1","author":"Yang","year":"2023"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/4\/article-p749.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/4\/article-p749.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/113\/4\/article-p749.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T17:29:40Z","timestamp":1759339780000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/113\/4\/article-p749.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":48,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.25-0116","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"type":"print","value":"0002-9637"},{"type":"electronic","value":"1476-1645"}],"subject":[],"published":{"date-parts":[[2025,10,1]]}}}