Open AccessAntibiotic resistance in patients with chronic ear discharge awaiting surgery in Nepal
Author(s) -
Rajiv Ranjan Karn,
R Acharya,
Amit Rajbanshi,
Sanjay Kumar Singh,
Sanjeev Kumar Thakur,
Shreni Shah,
Apoorv Singh,
Rajeev Shah,
Santosh Upadhyaya Kafle,
Meika Bhattachan,
Arpine Abrahamyan,
Hemant Deepak Shewade,
Rony Zachariah
Publication year - 2021
Publication title -
public health action
Language(s) - English
Resource type - Journals
ISSN - 2220-8372
DOI - 10.5588/pha.21.0029
Subject(s) - medicine , amikacin , antibiotics , vancomycin , chronic suppurative otitis media , antibiotic resistance , surgery , staphylococcus aureus , microbiology and biotechnology , bacteria , genetics , biology
SETTING: Biratnagar Eye Hospital, Biratnagar, Nepal, which offers ear surgery for chronic suppurative otitis media (CSOM). OBJECTIVE: In patients with CSOM awaiting surgery, to determine the 1) sociodemographic characteristics 2) bacterial isolates and their antibiotic resistance patterns and 3) characteristics of those refused surgery, including antibiotic resistance. DESIGN: A cohort study using hospital data, January 2018–January 2020. RESULTS: Of 117 patients with CSOM and awaiting surgery, 64% were in the 18–35 years age group, and 79% were cross-border from India. Of 118 bacterial isolates, 80% had Pseudomonas aeruginosa and 16% had Staphylococcus aureus . All isolates showed multidrug resistance to nine of the 12 antibiotics tested. The lowest antibiotic resistance in P. aeruginosa was for vancomycin (29%) and moxifloxacin (36%), and for S. aureus , this was vancomycin (9%) and amikacin (17%). Fourteen (12%) patients underwent surgery: myringoplasty ( n = 7, 50%), cortical mastoidectomy with tympanostomy ( n = 4, 29%) and modified radical mastoidectomy ( n = 3, 21%). Those infected with P. aeruginosa and with resistance to over six antibiotics were significantly more likely to be refused for surgery. CONCLUSION: Patients awaiting ear surgery were predominantly infected with multidrug-resistant P. aeruginosa and were consequently refused surgery. This study can help inform efforts for improving surgical uptake and introducing cross-border antimicrobial resistance surveillance.