Urine antibiogram and antimicrobial susceptibility pattern in a provincial hospital of Nepal: a cross-sectional study

The National Action Plan on antimicrobial resistance (AMR) strategic priority of Nepal focuses on strengthening the surveillance system for the containment of AMR within the country, as such, this study aims to report the prevalence of bacterial isolate and antimicrobial susceptibility pattern.

A hospital-based retrospective cross-sectional study was conducted using routine urine culture and antimicrobial susceptibility records from Hetauda Hospital, Nepal, from May 28, 2023, to September 8, 2023. Clinically significant uropathogens were identified using standard microbiological procedures, and antimicrobial susceptibility testing was performed using the modified Kirby-Bauer disk diffusion method. Susceptibility results were interpreted according to the CLSI M100 criteria used by the hospital laboratory during the study period. Data were analysed descriptively using frequencies, percentages, and relevant denominators.

Out of 3893 patient samples, 1162 (29.84%) bacterial isolates were detected. Gram-negative bacteria accounted for 67.81% of the isolates, with Escherichia coli (47.16%) being the most common, followed by Klebsiella sps. (14.54%). AST has revealed varying patterns across different antibiotics and bacterial species. Escherichia coli (E. coli) emerged as the predominant pathogen showing variable susceptibility across antibiotic classes, with highest sensitivity to amikacin (83.90%) and notable resistance to fluoroquinolones and cephalosporins, highlighting significant challenges in empirical therapy. Notably, 20.40% of the isolates were classified as MDR, with Proteus vulgaris showing the highest MDR rate (46.15%).

This study highlights the prevalence of urinary bacterial isolates (E. coli) and multidrug-resistant strains (Proteus vulgaris) at Hetauda Hospital, with considerable resistance to cephalosporins and fluoroquinolones. These findings support AST-guided prescribing, local antimicrobial stewardship, and development of a hospital antibiogram. The results are contextually relevant to Nepal's AMR policy agenda, but they should be interpreted as hospital-level data rather than as provincial or national surveillance estimates.