Jenish Neupane

Background: Globally common, lower respiratory tract infections (LRTIs) are especially difficult to manage in developing countries, where identifying the specific cause and determining the correct antibiotic treatment are major challenges. Methods: A cross-sectional study was conducted on patients with lower respiratory tract infections (LRTIs). A total of 1912 sputum samples were investigated for bacterial growth using standard microbiological methods. Isolates were identified through cultural, microscopic, and biochemical analyses, and subsequently subjected to antibiotic susceptibility testing. Results: Overall bacterial prevalence in sputum was found to be 11.7%. K. pnuemoniae was the predominant isolate recovered from 4.6% specimens. Altogether, isolates from 11 different genera were recovered in the study. Bacterial prevalence was more among male (13.8%) and people from age group 76-90 (16.7%). Similarly, bacterial LRTIs were found more prevalent during spring (14.4%) and summer (12.7%) seasons. All these associations were found statistically significant (p-value<0.01). AST pattern revealed most of the first and second-line drugs were ineffective against isolated organisms. For GNB, amikacin among first and second-line was found to be the most effective drug, whereas for S. aureus, ceftazidime and cefepime (100%) were found to be effective drug.Conclusion: Detection of bacterial agents from sputum and understanding the resistance pattern can be a basis for successful antimicrobial therapy and mapping a way-forward to mitigate the issue of MDR in Nepal.

Like the world over, Nepal was also hard hit by the second wave of COVID-19. We audited the clinical care provided to COVID-19 patients admitted from April to June 2021 in a tertiary care hospital of Nepal. This was a cohort study using routinely collected hospital data. There were 620 patients, and most (458, 74%) had severe illness. The majority (600, 97%) of the patients were eligible for admission as per national guidelines. Laboratory tests helping to predict the outcome of COVID-19, such as D-dimer and C-reactive protein, were missing in about 25% of patients. Nearly all (>95%) patients with severe disease received corticosteroids, anticoagulants and oxygen. The use of remdesivir was low (22%). About 70% of the patients received antibiotics. Hospital exit outcomes of most (>95%) patients with mild and moderate illness were favorable (alive and discharged). Among patients with severe illness, about 25% died and 4% were critically ill, needing further referral. This is the first study from Nepal to audit and document COVID-19 clinical care provision in a tertiary care hospital, thus filling the evidence gap in this area from resource-limited settings. Adherence to admission guidelines was excellent. Laboratory testing, access to essential drugs and data management needs to be improved.

The long-term effects of COVID-19 among survivors is a matter of concern. This research aimed to study persistent symptoms in post-COVID-19 patients attending a follow-up clinic at a tertiary care hospital in Nepal. All patients, presenting to the outpatient clinic during the study duration of six weeks, with history of positive reverse transcriptase- polymerase chain reaction for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) at least two weeks prior to presentation, were included. The duration of follow-up ranged from 15 till 150 days with the mean duration of 28 days after diagnosis of COVID-19. Of 118 patients, 43 (36.4%) had a history of mild COVID-19, 15 (12.8%) had moderate, and 60 (50.8%) had severe. At the time of presentation, 97 (82.2%) patients reported that they had at least one persistent/new symptom beyond two weeks from the diagnosis of COVID-19. Dyspnea, fatigue, chest heaviness, and cough were the commonest persistent complaints in 48 (40.7%), 39 (33.1%), 33 (28%), and 32 (27.1%) patients, respectively. The findings in our study highlight the need for extended monitoring of post-COVID-19 patients following discharge, in order to understand and mitigate long-term implications of the disease.