A Decade-Long Analysis of Trends in Antimicrobial Resistance in a Neurosurgical Hospital in Kathmandu, Nepal

Multidrug-resistant (MDR) bacteria cause infections with higher risks of morbidity, mortality, and financial burden. Understanding the antimicrobial resistance patterns of these pathogens is crucial for effective treatment and managing resistance. Therefore, this retrospective study examined the prevalence, causes, and trends in antimicrobial resistance in bacterial infections at a neurosurgical hospital in Nepal. We analyzed the demographics, bacteriological profiles, and antimicrobial susceptibility results in patients who visited Dirghayu Guru Hospital and Research Center, Kathmandu, Nepal, between January 2014 and January 2024, using SPSS, version 17.00. Among 4758 patients, 465 (9.77%) had infections caused by 571 bacteria. Of them, 435 (93.55%) patients had urinary tract infections, 89 (19.14%) had bloodstream infections, and 31 (6.67%) had respiratory tract infections. Klebsiella pneumoniae (n = 172, 30.12%) was the predominant bacteria. Proportions of drug-resistant Enterobacterales and gram-positive cocci among drug-resistant bacteria against tetracyclines were 83.33% and 45.83%, cephalosporins were 78.02% and 40.45%, quinolones were 72.25% and 50.00%, aminoglycosides were 65.14% and 43.53%, carbapenems were 62.96% and 30.00%, penicillins were 54.55% and 57.89%, and penicillin with beta-lactamase inhibitors (PwBLIs) were 40.54% and 42.31%, respectively. Proportions of drug-resistant nonfermenters among drug-resistant bacteria showed 100.00% resistance to these antimicrobials. MDR isolates (n = 118, 20.67%) were 100.00% susceptible to piperacillin-tazobactam and 83.33% to polymyxin B. Over the years, resistance increased for cephalosporins (48.15%-60.53%) but decreased for carbapenems (50.00%-33.33%), penicillins (64.29%-42.31%), PwBLIs (50.00%-12.50%), aminoglycosides (60.00%-49.12%), tetracyclines (100.00%-16.67%), and polymyxins (76.22%-16.67%). One-tenth of hospital-visiting patients had bacterial infections, with three-fourths involving Enterobacterales and one-fifth involving MDR bacteria. In recent years, resistance to cephalosporins has increased, whereas resistance to other beta-lactams, aminoglycosides, and polymyxins has decreased.