A Multisectoral Approach to Investigate a Burden of Antimicrobial Resistance in a Sub-Urban Area of Nepal – A Feasibility Study

Antimicrobial resistance (AMR) has been becoming an issue which has a great impact on people’s health and obtaining increasing focus around the globe. Under the appeal of the World Health Organization (WHO), most countries in the world have developed an action plan which aims to control health care associated infections and constrain AMR. The use of antibiotics has been steadily increasing in Nepal over a period. Such use of antibiotics is not only limited in humans but also in poultry and agriculture as well. The first choice of getting medicines in Nepal is the local medicine shops or lower-level health facilities. Some of the recent literature reports that there is the high prevalence of multidrug resistance in bacterial uro-pathogens. Particularly, resistance patterns were alarmingly higher for commonly used drugs such as amoxicillin, co-trimoxazole, fluoroquinolones and third generation cephalosporins, which necessitate the re-evaluation of first- and second-line therapies prescribed. Moreover, conjugational co-transfer of multidrug-resistant (MDR) phenotypes with ESBL-positive phenotypes was reported in MDR Escherichia coli. However, there are several antibiotics resistant cases reported from the hospital within the patients especially children and adults living in the rural and semi-urban areas visiting the health facilities. But the challenge always exists when it comes to collection of data on antimicrobial use and antimicrobial surveillance. Hence, it is high time to explore the factors associated with antibiotic resistance, start to research on the burden of antibiotic resistance and implement evidence-based interventions targeting the general population, pharmacists, physicians, paramedics, and stakeholders in the targeted areas of Nepal. In addition to that, this needs to be addressed through a multi-sectoral approach in a country like Nepal.

Study Duration: 07/2021-12/2021

Objectives:
The objective of this study is to identify local drivers of antimicrobial resistance in human and animal populations in Dhulikhel Municipality and to estimate the burden of antimicrobial resistance in Dhulikhel Municipality.

Outcomes:
In our study, E. coli was isolated from 85.9% of human fecal samples, of which 14% were resistant to ≥3 class of antimicrobials (multidrug resistant). Of the 368 E. coli isolates, resistance to ampicillin (40.0%), tetracycline (20.7%) and cefotaxime (15.5%) were most prevalent. The major drivers of AMR were lack of awareness of AMR, weak regulations on sales of antimicrobials, poor adherence to prescribed medications, and incomplete dosage due to financial constraints. These findings indicate the need for strict implementation of a national drug act to limit the over-the-counter sales of antimicrobials. Additionally, awareness campaigns with a multimedia mix are essential for educating people on AMR.

Team Members:

Principal Investigator(s): Dr. Sony Shakya Shrestha

Co-Investigator(s): Dr. Rajeev Shrestha, Dr. Archana Shrestha, Dr. Abha Shrestha, Pramesh Koju, Dr. Akina Shrestha, Surendra Kumar Madhup, Sunaina Shrestha, Sandip KC

Project Coordinator/Quality Assurance Manager: Nishan Katuwal

Research Assistant(s): Sudichhya Tamrakar, Pooja Tamang, Supriya Kharel, Anisha Rai

Supported by: World Health Organisation (WHO)-TDR
Collaborating Partners: Dhulikhel Municipality