Spectrum of Pathogens and Their Resistance Profiles in Sputum and Pus Samples: A Retrospective Study From an Eastern
Rahi Bikram Thapa1, Prakash Chandra Karkee2, Sabin Shrestha3
1Hospital Development and Medical Services Division Ministry of Health Koshi Biatnagar Koshi Province Nepal.
Background And Aims:
Respiratory and soft tissue infections remain major public health challenges both globally and in Nepal, increasingly complicated by rising antimicrobial resistance (AMR). The emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) pathogens has made effective treatment more difficult, underscoring the need for localized resistance data to guide therapy. This study aimed to investigate the distribution and AMR profiles of pathogens isolated from sputum and pus samples, with particular emphasis on MDR and XDR strains.
Methods:
A retrospective study was conducted from December 2024 to April 2025, analyzing 615 sputum and 45 pus samples from patients at Madan Bhandari Hospital and Trauma Center in Eastern Nepal. Bacterial identification and antimicrobial susceptibility testing were performed according to validated government-approved guidelines (AMR Bacteriology Standard Operating Procedure, 2024). MDR and XDR strains were classified based on the criteria provided by the European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC).
Results:
A total of 66 sputum (10.73%) and 17 pus (37.78%) samples showed positive bacterial growth. Pseudomonas aeruginosa (40.9%) and Klebsiella pneumoniae (39.4%) were the most prevalent pathogens in sputum samples, while Staphylococcus aureus (64.7%) dominated pus samples. The resistance patterns revealed 10.6% of sputum isolates as MDR, 7.6% as XDR, and 11.7% XDR in pus isolates. High resistance rates were observed to common antibiotics such as cefixime, cefepime, and aztreonam, while meropenem demonstrated effectiveness against many resistant strains. Gentamicin and doxycycline showed good efficacy against S. aureus and other pathogens in both samples.
Conclusion:
The notable prevalence of MDR and XDR pathogens, along with antibiotic resistance, underscores the need for updated treatment guidelines. Meropenem remains effective for severe infections, while gentamicin and doxycycline are suitable for targeted therapies. Strengthening antimicrobial stewardship, diagnostics, and infection control is crucial to address AMR in Eastern Nepal.
Insights
Antimicrobial resistance (AMR) is a growing threat in Nepal, with multidrug-resistant (MDR) and extensively drug-resistant (XDR) pathogens found in respiratory and soft tissue infections. Meropenem, gentamicin, and doxycycline show effectiveness against these resistant strains, guiding updated treatment strategies.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Public Health
Background:
- Respiratory and soft tissue infections pose significant global and Nepalese public health challenges.
- Rising antimicrobial resistance (AMR), including multidrug-resistant (MDR) and extensively drug-resistant (XDR) pathogens, complicates treatment.
- Localized resistance data is crucial for effective therapeutic guidance.
Purpose of the Study:
- To investigate the distribution of pathogens from sputum and pus samples.
- To determine the antimicrobial resistance (AMR) profiles of isolated pathogens.
- To specifically identify MDR and XDR strains in Eastern Nepal.
Main Methods:
- Retrospective analysis of 660 samples (615 sputum, 45 pus) from December 2024 to April 2025.
- Bacterial identification and antimicrobial susceptibility testing using government-approved guidelines.
- Classification of MDR and XDR strains according to ECDC and CDC criteria.
Main Results:
- Positive bacterial growth in 10.73% of sputum and 37.78% of pus samples.
- Prevalent pathogens: *Pseudomonas aeruginosa* and *Klebsiella pneumoniae* (sputum), *Staphylococcus aureus* (pus).
- 10.6% sputum and 11.7% pus isolates were MDR/XDR; high resistance to cefixime, cefepime, aztreonam; meropenem, gentamicin, doxycycline showed efficacy.
Conclusions:
- High prevalence of MDR/XDR pathogens necessitates updated treatment guidelines.
- Meropenem is effective for severe infections; gentamicin and doxycycline for targeted therapies.
- Enhanced antimicrobial stewardship, diagnostics, and infection control are vital for combating AMR in Eastern Nepal.
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