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Table 1 Number of different bacterial pathogens isolated and reported by the AMR surveillance by participating laboratories during 1999 to 2012

From: The challenges and successes of implementing a sustainable antimicrobial resistance surveillance programme in Nepal

Year

Vibrio cholerae*

Shigellaspp.**

Streptococcus pneumoniae***

Haemophilus influenzae****

Neisseria gonorrhoeae*****

Salmonellaspp.******

ESBL Escherichia coli*******

Total

1999

61

8

55

2

18

NI

NI

144

2000

244

33

155

25

36

NI

NI

493

2001

4

40

141

57

21

NI

NI

263

2002

25

48

54

115

9

44

NI

295

2003

78

36

56

56

22

745

NI

993

2004

290

43

83

25

2

510

NI

953

2005

62

51

132

60

14

692

NI

1010

2006

32

23

92

38

5

1611

NI

1801

2007

204

37

120

185

5

1512

NI

2063

2008

148

17

189

136

16

1697

NI

2203

2009

109

20

213

101

13

1307

14

1764

2010

45

9

165

35

7

1525

86

1872

2011

1

11

163

71

6

1018

76

1346

2012

35

14

257

27

7

1102

447

1889

Total

1338

390

1875

933

181

11763

623

17103

  1. Susceptibility of all consecutive isolates collected in the participating laboratories was determined by disk diffusion method [8].
  2. *Susceptibilities for tetracycline, erythromycin, ciprofloxacin, furazolidone, cotrimoxazole, nalidixic acid and ampicillin were determined; a shift in serovars with changing antimicrobial resistance trends was observed for V. cholerae, yet the El Tor biotype remained predominant.
  3. **Susceptibilities for ampicillin, ciprofloxacin, cotrimoxazole, nalidixic acid, mecillinam, and azithromycin were determined. S. dysenteriae was the predominant species during 1999 – 2004 and S. flexneri during 2005 – 2009. S. dysenteriae was predominant in eastern Nepal, while S. flexneri dominated in the western Nepal. Ciprofloxacin resistant S. dysenteriae was common before 2005, which then decreased up to 2007, and re-emerged in 2008. An overall multiresistance rate of 33-75% in shigella isolates was found with individual temporal and species variations from S. dysenteriae to S. flexneri.
  4. ***Susceptibilities for penicillin, ampicillin, erythromycin, ciprofloxacin, cotrimoxazole, chloramphenical, and ceftriaxone were determined; S. pneumoniae maintained a persistently high level of resistance (58-74%) to cotrimoxazole. Amoxicillin resistance increased to 13% in 2010. One-third of the pneumococcal strains were isolated from children below 15 years with 21% of all isolates from children less than five years of age.
  5. ****Susceptibilities for penicillin, ampicillin, amoxi-clav, ciprofloxacin, cotrimoxazole, erythromycin, chloramphenicol, azithromycin and ceftriaxone were determined. Cotrimoxazole resistance remained high (up to 60%) while more than a quarter of the isolates were resistant to at least ampicillin, penicillin and erythromycin. Penicillin resistance reached 100% in 2010.
  6. *****Susceptibilities for penicillin, tetracycline, ciprofloxacin, spectinomycin, azithromycin and ceftriaxone were determined. Prevalence of resistance was high for ciprofloxacin (14-30%) and tetracycline (more than 70%). Ceftriaxone remained 100% susceptible.
  7. ******Susceptibilities for ampicillin, tetracycline, ciprofloxacin, cotrimoxazole, nalidixic acid, chloramphenicol, and ceftriaxone were determined. Increasing resistance of S. Typhi and S. Paratyphi A to nalidixic acid was observed (the resistance rate was higher among S. Paratyphi A than among S. Typhi. The prevalence of S. Paratyphi A increased annually indicating changing epidemiology. Multi drug resistance (MDR-resistance to ampicillin, chloramphenicol and cotrimoxazole) at a time among salmonella isolates declined from 2002 onwards, and newly emerged MDR isolates (resistant to fluoroquinolone [ciprofloxacin, ofloxacin] and nalidixic acid with additional resistance to tetracycline and cotrimoxazole) were identified in 2005, 2006, 2008, 2009 and 2010. MDR phenomenon has increased again from 2009 (7%) and 2010 (8%). Chloromphenicol sensitivity re-emerged (96% in 2010).
  8. *******All isolates exhibited 100% resistance towards quinolones viz. norfloxacin and ofloxacin followed by 99% resistance to ciprofloxacin. ESBL E.coli were found to be susceptible to gentamicin (67%) followed by vhloramphenicol(66%) and amikacin(59%).
  9. NI, not included in the surveillance.
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BMC Public Health

ISSN: 1471-2458

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