High drug resistance among gram-negative bacteria in sputum samples from an intensive care unit in Nepal

Setting: Tribhuvan University Teaching Hospital, Kathmandu, Nepal Objectives: Among intensive care unit (ICU) patients with sputum culture between 14th April 2018- 13th April 2019, to report the number (proportion) of Pseudomonas, Acinetobacter, Burkholderia, Stenotrophomonas (PABS) species. Also, among those with PABS species, to assess antimicrobial resistance pattern, demographic and clinical characteristic associated with resistance to at least one antibiotic and ICU exit outcomes. Design: Hospital-based, cross-sectional study using secondary data. Results: Of 166 who underwent sputum culture, 104(63%) had bacterial growth, of which, 67(64%) showed PABS species. Of the positive cultures, Pseudomonas, Acinetobacter, Burkholderia and Stenotrophomonas was present in 32 (30.7%), 31 (29.8%), 1(1%) and 3(2.8%) respectively. Pseudomonas showed high level of resistance to levofloxacin (61%), cefepime (50%) and amikacin (50%). Acinetobacter, was largely resistant to cefepime (95%), imipenem (92%) and levofloxacin (86%). None of the clinical and demographic characteristics among those with PABS infection were significantly associated with resistance. Of the 67 with PABS infection, 32 (48%) died. Conclusion: The study showed a high prevalence of Pseudomonas, Acinetobacter and emergence of Stenotrophomonas in sputum cultures of patients admitted in ICU. This highlights the need for monitoring of PABS and associated resistance patterns to reduce mortality in ICU inpatients.