title: High prevalence of multidrug resistance in bacterial uropathogens from Kathmandu, Nepal.
abstract: BACKGROUND
  Urinary Tract Infection (UTI) is one of the most common infectious diseases and people of all age-groups and geographical locations are affected. The impact of disease is even worst in low-resource developing countries due to unaware of the UTIs caused by multidrug-resistant (MDR) pathogens and the possibility of transfer of MDR traits between them. The present study aimed to determine the prevalence of MDR bacterial isolates from UTI patients, the antibiotic resistance pattern and the conjugational transfer of multidrug resistance phenotypes in  Escherichia coli (E. coli).
  
  
  RESULTS
  Two hundred and nineteen bacterial isolates were recovered from 710 urine samples at Kathmandu Model hospital during the study period. All samples and isolates were investigated by standard laboratory procedures. Among the significant bacterial growth (30.8%, 219 isolates), 41.1% isolates were MDR. The most prevailing organism, E. coli (81.3%, 178 isolates) was 38.2% MDR, whereas second most common organism, Citrobacter spp. (5%, 11 isolates) was found 72.7% MDR. Extended-spectrum β-lactamase (ESBL) production was detected in 55.2% of a subset of MDR E. coli isolates. Among the 29 MDR E. coli isolates, plasmids of size ranging 2-51 kb were obtained with different 15 profiles. The most common plasmid of size 32 kb was detected in all of the plasmid-harbored E. coli strains. The majority of E. coli isolates investigated for the multidrug resistance transfer were able to transfer plasmid-mediated MDR phenotypes along with ESBL pattern with a frequency ranging from 0.3 × 10-7 to 1.5 × 10-7 to an E. coli HB101 recipient strain by conjugation. Most of the donor and recipient strain showed high levels of minimum inhibitory concentration (MIC) values for commonly-used antibiotics.
  
  
  CONCLUSIONS
  The high prevalence of multidrug resistance in bacterial uropathogens was observed. Particularly, resistance patterns were alarmingly higher for amoxycillin, co-trimoxazole, flouroquinolones and third-generation cephalosporins, which necessitate the re-evaluation of first and second line therapies for UTI. In addition, conjugational co-transfer of MDR phenotypes with ESBL-positive phenotypes was observed in MDR E. coli.
authors.affiliation: Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal. pankaj.baral@gmail.com.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Baral
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Neupane
authors.forename: Bishnu Prasad
authors.initials: BP
authors.lastname: Marasini
authors.forename: Kashi Ram
authors.initials: KR
authors.lastname: Ghimire
authors.forename: Binod
authors.initials: B
authors.lastname: Lekhak
authors.forename: Basudha
authors.initials: B
authors.lastname: Shrestha