Oxford University Clinical Research Unit (OUCRU-NP), Kathmandu.
Abhilasha Karkey is currently working as a Medical Microbiologist at the Oxford University Clinical Research Unit (OUCRU-NP), Kathmandu. Her academic career over the last decade has incorporated periods of rigorous university training and spanned a variety disciplines, including field research experience in community and hospital settings. After successfully completing an MSc from the Liverpool School of Tropical Medicine, she went on to work for Médecins Sans Frontières for four years in various missions across Africa and Asia in emergency conflict situations. She then went on to gain her Doctoral degree from the University of Oxford and started working for her current institution. She is involved with infectious disease research projects that involve enteric fever and antimicrobial resistance among various Gram negative pathogens. Currently, she is an OAK Scientific Leadership Fellow and her research focuses on looking at nosocomial infections and antibiotic resistance patterns within the population.
Statement of the Problem: In 2011 Patan Hospital in Nepal witnessed massive outbreaks of NDM-1 Klebsiella pneumoniae sepsis among neonates in the neonatal intensive care unit. Since then, massive efforts have been made to understand the epidemiology of microorganisms causing bloodstream infections within the local population. Through a 23 year retrospective data analysis, we are trying to understand what significant changes have occurred in the spectrum of organisms and their susceptibility patterns over the years. Additionally, through a prospective study, we will try to understand the epidemiology of multidrug resistant hospital acquired bloodstream infections and identify the risks for bloodstream infections and mortality within Patan Hospital
Methodology & Theoretical Orientation: A 23 year retrospective analysis of all blood cultures taken at Patan Hospital between April 1992 and December 2014 were analyzed. To measure the overall impact of antimicrobial resistance on the outcome of BSI, a prospective hospital wide study is being conducted. Additionally all neonates admitted to the NICU are being enrolled to investigate the risk factors for development of BSI.
Findings: 23 year data documents showed changes in the epidemiology of bloodstream infections in Patan hospital from 1992 to 2014 which include (i) an increase in absolute number of blood cultures positive for Enterobacteriaceae non Salmonella and Gram positive, (ii) an overall increase in resistance to single antimicrobials between 1992 and 2014, (iii) an increase in multidrug resistance (MDR), including an acceleration in the rate of MDR acquisition for Gram positive, and (iv) the high prevalence of MDR isolates in community-acquired infections.