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

<b>Setting:</b> Tribhuvan University Teaching Hospital, Kathmandu, Nepal <b>Objectives:</b> Among intensive care unit (ICU) patients with sputum culture between 14^th April 2018- 13^th April 2019, to report the number (proportion) of <i>Pseudomonas</i><i>, Acinetobacter, Burkholderia, Stenotrophomonas</i> (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. <b>Design: </b>Hospital-based, cross-sectional study using secondary data. <b>Results:</b> Of 166 who underwent sputum culture, 104(63%) had bacterial growth, of which, 67(64%) showed PABS species. Of the positive cultures, <i>Pseudomonas</i><i>, Acinetobacter, Burkholderia and Stenotrophomonas</i> was present in 32 (30.7%), 31 (29.8%), 1(1%) and 3(2.8%) respectively.<i> Pseudomonas</i> showed high level of resistance to levofloxacin (61%), cefepime (50%) and amikacin (50%). <i>Acinetobacter</i>, 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. <b>Conclusion:</b> The study showed a high prevalence of <i>Pseudomonas</i>, <i>Acinetobacter</i> and emergence of <i>Stenotrophomonas</i> 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.