Original Article

J Nepal Health Res Counc 2022 Jul-Sep; 20 (56): 664-71

Antimicrobial Susceptibility Pattern in Opportunistic

Pathogens Isolated from Immunocompromised
Patients
Ajaya Basnet,1 Arun Bahadur Chand,2 Nayanum Pokhrel,3 Sadikchya Acharya,1 Parbati Gurung,1 Laxmi Kant
Khanal,4 Kundu Shrestha,5 Lok Bahadur Shrestha,6 Bijendra Raj Raghubanshi2
1
Department of Medical Microbiology, Shi-Gan International College of Science and Technology, Tribhuvan
University, Kathmandu, Bagmati, Nepal, 2Department of Clinical Microbiology, KIST Medical College and
Teaching Hospital, Lalitpur, Bagmati, Nepal, 3Research Section, Nepal Health Research Council, Kathmandu,
Bagmati, Nepal, 4Department of Clinical Microbiology, Nepal Medical College and Teaching Hospital,
Kathmandu, Bagmati, Nepal, 5Department of Anaesthesia and Critical care, Nepal Armed Police Force
Hospital, Kathmandu, Bagmati, Nepal, 6School of Medical Sciences and The Kirby Institute, University of
New South Wales, Sydney, Australia.

ABSTRACT

Background: Brought with the advancements in transplantation science and the development of immunosuppressive
agents, immunocompromised patients characterized with defective immunity have increased throughout the world
with increased risk for opportunistic infections. This study provides an overview of the antimicrobial susceptibility
pattern among opportunistic pathogens isolated from immunocompromised patients.
Methods: Clinical and laboratory records of immunocompromised patients [patients with chronic kidney disease
neutropenia, diabetes, rheumatic heart disease acquired immune deficiency syndrome hepatitis B, hepatitis C, who
were subjected to microbiological culture analysis in the Department of Clinical Microbiology, KIST Medical College
and Teaching Hospital, for 2 years (January 2019 and December 2020) were analyzed.
Results: Out of 8,402 immunocompromised patients, 954 (11.4%) patients were subjected to microbiological
culture analysis. Among 954 patients, 253 (26.5%) patients [median(interquartile range) age: 52(31-67) years; male
138 (54.5%)] were infected. A total of 295 pathogens were isolated from 1,331 cultured samples. Infections due
to Escherichia coli (n=71, 24.1%), Klebsiella spp. (n=55, 18.6%), Acinetobacter calcoaceticus-baumannii complex (n=35,
11.9%), Candida albicans (n=30, 10.2%), and Staphylococcus aureus (n=28, 9.5%) were frequently observed. Among
the bacterial isolates (n=239), 81.6% (n=195) of bacteria were β-lactamase producers, 51.0% (n=122) were multi-
drug resistant, 9.2% (n=195) were extensively-drug resistant, 0.8% (n=195) were pan-drug resistant, and 35.7%
(n=10) of S. aureus were methicillin-resistant Staphylococcus aureus.
Conclusions: The majority of infection in immunocompromised patients is caused by Gram-negative bacteria, and
is often associated with a higher number of β-lactamase producers and multi-drug resistant organisms. Prescriptions
of antibiotics on the grounds of antimicrobial stewardship might help to reduce the burden of antimicrobial resistance.
Keywords: Antimicrobial resistance; immunocompromised host; opportunistic infections.

INTRODUCTION to immunocompetent hosts.1-3 Such infections are

often associated with an increase in disease severity,
Immunocompromised hosts, who possess a weak
prolonged hospital admission, and increased mortality.4
immune system either as a result of genetically
heterogeneous impairment in immune systems or
The prolonged and aggressive antibiotic treatment in
due to organ transplantation, are relatively at an
the immunocompromised hosts has expanded the global
increased risk for opportunistic infections as compared

Correspondence: Mr Arun Bahadur Chand, Department of Clinical Microbiology, KIST

Medical College and Teaching Hospital, Lalitpur, Nepal. Email: [email protected],
Phone: +977 9851216148.

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 Antimicrobial Susceptibility Pattern in Opportunistic Pathogens Isolated from Immunocompromised Patients

health risk.5 The rapid emergence of antimicrobial- Mueller-Hinton agar as per the guideline of The Clinical
resistant microbes and failure to discover the newer and Laboratory Standards Institute.10
antimicrobial agents to treat the infection associated
with multidrug-resistant (MDR), extensively-drug MDR was defined as acquired non-susceptibility to
resistant (XDR), pan-drug resistant (PDR), methicillin- at least one agent in three or more antimicrobial
resistant Staphylococcus aureus (MRSA), and β-lactamase categories, XDR was defined as non-susceptibility to at
producers has prompted immunocompromised hosts to least one agent in all but two or fewer antimicrobial
be at particularly high risk for developing and dying of categories (i.e. bacterial isolates remain susceptible
sepsis.6-8 to only one or two categories) and PDR was defined
as non-susceptibility to all agents in all antimicrobial
In this article, we have presented the prevalence, categories.7 The β-lactamase producer was defined as
organism profile, and antimicrobial susceptibility the bacterium that had resistance to any one group
pattern among opportunistic pathogens isolated from of β-lactam antibiotics, such as penicillin derivative,
immunocompromised patients. cephalosporins, monobactams, and carbapenems.10
MRSA was defined as resistance (a zone size ≤ 19mm)
of S. aureus to cefoxitin.10
METHODS
A hospital-based retrospective study was conducted in Data analysis was performed using the Statistical
the Department of Microbiology of Kist Medical College Package for the Social Sciences software version 17.0.
and Teaching Hospital (KISTMCTH), Gwarko, Lalitpur.
The study was approved by the Institutional Review
RESULTS
Committee (Ref. number: 0770788) of KISTMCTH.
Patients with immunocompromised conditions such as Out of 8,402 immunocompromised patients investigated
chronic kidney disease (CKD), neutropenia, rheumatic over a 2-year period, patients with immunocompromised
heart disease (RHD), diabetes, hepatitis B (HB), hepatitis conditions such as neutropenia (n=5628, 67.0%), diabetes
C (HC), and acquired immunodeficiency syndrome (n=1983, 23.6), CKD (n=542, 6.5%), RHD (n=204, 2.3%),
(AIDS), of any age and sex, visiting the hospital from hepatitis B (n=26, 0.3%), hepatitis C (n=13, 0.2%), and
February 1, 2019, to January 31, 2021, were traced and AIDS (n=6, 0.1%) were found. Among them, 954 (11.4%)
analyzed for microbiological culture and sensitivity.   patients were clinically suspected for infection and
hence underwent a subsequent panel of microbiological
Microbiological samples such as blood, urine, investigations to confirm the presence of microbial
sputum, and other body fluids obtained from the infections (Table 1).
immunocompromised patients were subjected to
culture. All samples were inoculated onto blood agar, A total of 1,331 clinical samples from 954
chocolate agar, and MacConkey agar, except for the immunocompromised patients were processed for
urine samples, which were inoculated on cysteine microbiological findings. There were 619 (46.6%) blood,
lactose electrolyte-deficient agar. The inoculated agar 372 (27.9%) urine, 228 (17.1%) sputum, and other
plates were aerobically incubated at 35 ± 2°C for 24 infrequent body fluids that were processed for culture
hours. Fastidious bacteria such as Streptococcus spp. analysis (Table 2). Out of 954 microbiologically analyzed
were identified by gram staining (Gram-positive cocci), patients, 253 (26.5%) patients (mean age: 48.9 ± 23.9,
catalase test (catalase non-producing), bile esculin male sex: 138 [54.5%]) were infected with microbes.
test (esculin hydrolyzed by Enterococcus spp.), and Concerning the infected immunocompromised patients,
bacitracin and optochin sensitivity test. Moraxella spp there were 124 (42.0%) patients with CKD, 60 (20.3%)
were also identified by gram staining (Gram-negative with neutropenia, 59 (20.0%) with diabetes, 6 (2.0%)
coccobacilli), catalase test (catalase-producing), with RHD, 3 (1.0%) with hepatitis B, and 1 (0.3%) with
oxidase test (oxidase-producing), and nitrate reduction hepatitis C (Table 2). Samples such as sputum (n=99,
test (nitrate-reducing). Conclusively, all of the isolated 33.6%), urine (n=95, 32.2%), and blood (n=38, 12.9%)
microbial colonies were identified based on the colony were most commonly positive for the microbiological
characteristics, gram staining, and biochemical tests culture. There were 207 (70.2%) patients likely to be
following the standard microbiological guidelines.9 infected by one species identified, 26 (8.8%) patients
likely to be infected by two of the species identified,
After identification, antimicrobial susceptibility testing and 20 (6.8%) patients likely to be infected by at least 3
was performed by Kirby Bauer disc diffusion method on species (Table 2).

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Table 1. Demographics of immunocompromised and infected patients.

Immunocompromised patients
Total Microbiologically Infected
Variables
(n = 8402) analyzed (n = 253)
n (%) (n = 954) n (%) n (%)
Mean 41.1 ± 22.3 42.9 ± 24.0 48.9 ± 23.9
Age (years) Median
41 (24-59) 42 (23-63) 52 (31-67)
(Q1-Q3)
< 10 849 (10.1) 84 (8.8) 15 (5.9)
10-20 560 (6.7) 77 (8.1) 15 (5.9)
20-30 1506 (17.9) 168 (17.6) 32 (12.6)
Age groups
30-40 1176 (14.0) 127 (13.3) 34 (13.4)
(years)
40-50 1109 (13.2) 112 (11.7) 23 (9.09)
50-60 1197 (14.2) 107 (11.2) 33 (13.0)
≥ 60 2005 (23.9) 279 (29.3) 101 (39.9)
Male 4040 (48.1) 507 (53.1) 138 (54.5)
Gender
Female 4362 (51.9) 447 (46.9) 115 (45.5)
AIDS 6 (0.1) 2 (0.2) 0 (0)
HB 26 (0.3) 9 (0.9) 3 (1.19)
HC 13 (0.2) 5 (0.5) 1 (0.4)
IMC state RHD 204 (2.4) 17 (1.8) 6 (2.37)
CKD 542 (6.5) 282 (29.6) 124 (49)
Neutropenia 5628 (67.0) 459 (48.1) 60 (23.7)
Diabetes 1983 (23.6) 180 (18.9) 59 (23.3)
IMC = immunocompromised, AIDS = Acquired immunodeficiency syndrome, CKD = Chronic Kidney Disease, RHD =
Rheumatic Heart Disease, HB = Hepatitis B, HC = Hepatitis C

Table 2. Culture results based upon the type of samples.

Samples Type of infection
Samples Processed Positive culture 1 microbe 2 microbe ≥ 3 microbe
n (%) n (%) n n n
Blood 619 (46.6) 38 (12.9) 33 3 2
Others 21 (1.6) 3 (1.0) 3 0 0
Urine 372 (27.9) 95 (32.2) 73 10 12
Sputum 228 (17.2) 99 933.6) 88 8 3
Wound 12 (0.9) 5 (1.7) 4 1 0
Pus 20 (1.5) 11 (3.7) 5 4 2
CSF 19 (1.4) - - - -
Ascitic fluid 19 (1.4) 1 (0.3) 0 0 1
Pleural fluid 10 (0.7) 1 (0.3) 1 0 0
Catheter tips 11 (0.8) - - - -
Total 1331 253 207 26 20

The majority of infections were caused by E. coli (n=71, 24.1%), Klebsiella spp. (n=55, 18.6%), Acinetobacter calcoaceticus-
baumannii complex (ACB complex) (n=35, 11.9%), C. albicans (n=30, 10.2%), and S. aureus (n=28, 9.5%). There were 239
(81.0%) cases of bacterial infection, 44 (14.9%) of fungal infections, and 12 (4.1%) of polymicrobial infections (≥ 3 three
different species, specifically in the urine samples, which were neither identified nor tested for sensitivity) (Table 3).

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Table 3. Organisms isolated from different clinical samples.

Sputum Urine Blood Wound Pus Ascitic fluid Pleural fluid Others
Pathogens
(n=114) (n=109) (n=45) (n=6) (n=13) (n=2) (n=1) (n=5)
ACB complex (n=35) 23 1 6 1 2 1 0 1
Pseudomonas spp.
9 7 1 0 0 1 0 0
(n=18)
Proteus spp. (n=2) 0 2 0 0 0 0 0 0
Salmonella spp. (n=2) 0 0 2 0 0 0 0 0
Klebsiella spp. (n=55) 31 15 3 2 4 0 0 0
Enterobacter spp. (n=8) 3 2 2 0 1 0 0 0
Escherichia coli (n=71) 14 50 3 1 1 0 1 1
Citrobacter spp. (n=8) 5 0 3 0 0 0 0 0
Moraxella spp. (n=1) 1 0 0 0 0 0 0 0
Staphylococcus aureus
5 0 18 0 4 0 0 1
(n=28)
Streptococcus spp.
0 1 1 0 0 0 0 0
(n=2)
Enterococcus spp. (n=9) 0 4 4 0 1 0 0 0
Candida albicans (n=30) 18 10 0 2 0 0 0 0
Candida non-albicans
4 5 2 0 0 0 0 2
(n=13)
Aspergillus spp. (n=1) 1 0 0 0 0 0 0 0
Multiple organisms
0 12 0 0 0 0 0 0
(n=12)
ACB complex = Acinetobacter calcoaceticus-baumannii complex

Table 4. Antibiotic resistance profile of the Gram-negative bacterial isolates.

E. coli Klebsiella ACB complex Pseudomonas Citrobacter Enterobacter
Antibiotics
(n=71) spp. (n=55) (n=35) spp. (n=18) spp. (n=8) spp. (n=8)
Ampicillin 86.0 92.0 100.0 100.0 100.0 100.00
Amoxicillin-Clavulanic acid 57.1 62.5 100.0 - 12.5 66.7
Ceftriaxone 86.4 55.3 95.5 50 100.0 100.0
Cefotaxime 74.5 48.1 81.3 - 100.0 100.0
Ceftazidime 67.8 100.0 100.0 28.6 100.0 100.0
Cefepime 100.0 100.0 100.0 - 100.0 -
Nalidixic Acid 93.5 0 - - - 100.0
Ciprofloxacin 83.6 43.2 62.5 0 100.0 37.5
Ofloxacin 91.1 48.3 95.2 100.0 100.0 -
Norfloxacin 79.4 0 - - - 0
Norfloxacin 100.0 100.0 - - - -
Gentamicin 27.7 16.7 36.7 14.3 100.0 28.8
Amilkacin 18.4 58.9 39.4 12.5 12.5 -
Meropenem 4.3 25.0 100.0 28.6 100.0 -
Imipenem 55.6 71.4 90.9 - 100.0 -
Tetracyclin - 100.0 100.0 100.0 - -
Cotrimoxazole 80.3 42.3 78.8 100.0 87.5 75.0
Chloramphenicol - 75.0 18.2 - 0 0
Colistin 0 4.0 0 - 0 0
Polymixin B 0 0 0 - 0 0
Nitrofurantoin 5.17 66.7 - - - 100.0
Piperacillin/Tazobactem 50.0 66.7 10.0 25.0 - -
Tigecycline 0 0 42.1 - 0 0

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nalidixic acid, ciprofloxacin, and ofloxacin was observed

Table 5. Antibiotic resistance profile of the Gram-
for Proteus spp. Salmonella spp., and Moraxella spp.
positive bacterial isolates.
Hundred percent of S. aureus were resistant to penicillin,
S. aureus Enterococcus
Antibiotics ceftriaxone, ceftazidime, cefepime, ofloxacin,
(n=28) spp. (n=9)
imipenem, amoxicillin-clavulanic acid, and cefotaxime-
Penicillin 100.0 71.43 clavulanic, while 100% sensitivity was observed for
Ampicillin 92.6 33.33 tigecycline and vancomycin (Table 5). Streptococcus
Amoxycilli-clavulanic spp. exhibited 100% resistances to penicillin, cefoxitin,
100.0 - cefotaxime, ceftazidime, ofloxacin, gentamicin,
acid
cotrimoxazole, and meropenem. Such higher incidences
Cloxacillin 20.0 -
of antibiotic resistance could be due to fewer (n=2)
Cefoxitin 33.4 -
Streptococcus spp.
Cefotaxime 75.0 100.00
Ceftriaxone 100.0 75.00
Ceftazidime 100.0 100.00
Cefepime 100.0 -
Ciprofloxacin 37.5 100
Ofloxacin 100.0 83.33
Levofloxacin 11.11 -
Gentamicin 53.9 100.00
Amikacin 84.6 100
Clindamycin 50.0 -
Erythromycin 60.0 -
Chloramphenicol 6.3 12.50
Cotrimoxazole 29.4 100.00
Meropenem 91.7 100.00
Imipenem 100.00 -
Cefotaxime-clavulanic
100.00 -
acid
Vancomycin 0 0
Tigecycline 0 0

Fig 1. Types of antibiotic resistance.

Out of 239 bacterial isolates, 195 (81.6%) organisms
were β-lactamase producers, 122 (51.0%) were MDR, 22
(9.2%) were XDR, 2 (0.8%) were PDR, and 10 (35.7%) S. DISCUSSION
auresu were MRSA (Fig 1).
With the varying patterns of infection in
immunocompromised patients,1 the facilities of late
Bacteria-specific drug susceptibility profile has been
prognosis and/or prolonged aggressive treatment
summarized in Table 4 and Table 5. Hundred percent
practices have created challenges for practitioners,
of E. coli and Klebsiella spp. were resistant to cefepime
either by changing drug susceptibilities or by evolving
and levofloxacin, while absolute non-resistance was
standards for empirical use of the antimicrobial agents
observed for polymixin B and tigecycline. Similarly, the
against pathogens.6 Despite such facts, there are still
ACB complex showed 100% resistance to ampicillin,
limited numbers of studies concerning the burden
amoxicillin clavulanic acid combination, ceftazidime,
of microbial infection and/or superinfection among
cefepime, meropenem, and tetracycline, and 100%
immunocompromised patients. Therefore, we aimed
sensitivity to both colistin and polymixin B. Absolute
to analyze the prevalence of opportunistic infections,
(100%) resistance in Pseudomonas spp. was also
organism profile, and antimicrobial susceptibility
observed for ampicillin, ofloxacin, tetracycline, and
patterns among immunocompromised patients.
cotrimoxazole (Table 4). Absolute resistance for
ampicillin, cefotaxime, ceftriaxone, ceftazidime,

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The mean age of the immunocompromised patients in patients.13 Wisplinghoff et al.23 mentions that infections
this study was 41.1 years±22.3, which is inconsistent in immunocompromised hosts are commonly associated
with the findings of Trivedi et al.11 (55 years±14.8). with S. pneumoniae, H. influenzae, and S. aureus and
The immunocompromised patients of the age group most often with Salmonella spp., Pseudomonas spp.,
≥ 60 years (34.2%) were mostly infected, which could and Mycoplasma spp. Such infections may be due to
be attributed to the significant loss of innate immune abnormalities in either cell-mediated immunity or
and poor T-cell function.12 In this study, the majority defects in antibody or complement response developed
of males (54.5%) with the immunocompromised against the pathogen in the immunocompromised
condition were infected. This could be attributed to the host, nevertheless, resulting in pneumonia, chronic
behavioral factors such as higher levels of drinking and or disseminated fungal or viral infections, and severe
smoking among men compared to women and sex-based mycobacterial disease.24
immunological differences, mediated by sex hormone
and X chromosome.13 Our study revealed a variable degree of resistance
to many of the routinely used drugs. Tetracycline
The culture positivity rate in this study was higher for the (100%), cefepime (100%), ampicillin (95.8%), and
patients with CKD (42.0%) as compared to the patients ceftazidime (94.9%) had the highest overall resistance
with neutropenia (20.3%), diabetes (20.0%), RHD (2.0%), rate for Gram-negative bacteria. Similarly, Gram-
hepatitis B (1.0%), and hepatitis C (0.3%). In contrast to positive bacteria showed absolute non-sensitivity
our findings, several studies reported varying incidences to cefepime, ceftazidime, ceftriaxone, cefotaxime-
of bacterial infection in patients with neutropenia (21.3- clavulanic acid combination, and imipenem. Such
35.4%),14,15 CKD (13.8-17.2%),13 diabetes (19.4-63.4%),11,16 higher resistances to antibiotics among bacteria could
hepatitis B (28.1-36.8%),17,18 and hepatitis C (38.3- be due to the modification in their cell permeability;
78.6%).19,20 The increased rate of bacterial infections in drug degradation/alteration by enzymes such as beta-
patients with CKD from our study could be accredited lactamase, aminoglycoside-modifying enzymes, or
to dialysis-related problems like repeated skin puncture acetyltransferases; and efflux pump expression, which
and reduced immunity.21 Additionally, the observation of results in reduced intracellular drug accumulation.25,26
fewer microbial infections in hepatitis-infected patients In this study, while Gram-negative bacteria showed
and no microbial infections in HIV-infected patients in better sensitivity towards polymyxin B (100%), colistin
this study was due to the lower frequency of hepatitis- (99.08%), and tigecycline (92.7%), Gram-positive
infected and HIV-infected patients visiting the hospital. bacteria showed better sensitivity towards vancomycin
(100%), tigecycline (100%), and chloramphenicol (92%).
We observed respiratory tract infections (39.43%) as An absolute resistance of E. coli and Klebsiella spp. to
the obvious source of infection in immunocompromised cefepime and levofloxacin was observed. Both of them
patients, which contrasts with the finding of Adhikari et were sensitive to polymyxin B and tigecycline. ACB
al.,22 who had reported urinary tract infection (36.57%) complex showed 100% resistance to ampicillin,
to be the commonest infection among such patients. amoxiclav, ceftazidime, cefepime, meropenem, and
Though the lower incidence of bloodstream infection tetracycline, and 100% sensitivity to both colistin and
(16.57%) from our study was similar to the findings from polymixin B. A study mentions ACB complex as a highly
several studies,15,22 it was inconsistent with the findings antimicrobial-resistant pathogen, and accredited its
of Taj et al.14 (46.01%), who have reported a higher potency to its property of clonal expansion.27 A high level
rate of bloodstream infections in immunocompromised of resistance in β-lactam antibiotics was also observed
patients. The probable reason for the lower rate of in a study by Shrestha et al.,7 who had reported 35%
bloodstream infection in our study could be accountable of E. coli and K. pneumoniae to be a β-lactamases
to the fact that many patients could have received producers. Nevertheless, such ability of Gram-negative
empirical antibiotics before blood culture analysis.14 bacteria to alter the outer membrane, either by
changing the hydrophobic properties or by mutations
Most of the immunocompromised patients from this in porins, which hinders the passage for drugs, makes
study were infected with E. coli (24.1%), Klebsiella spp. them more resistant to antibiotics than Gram-positive
(18.6%), ACB complex (11.9%), C. albicans (10.2%), pathogens.28 Concerning the Gram-positive bacteria in
and S. aureus (9.5%). Similar pathogens were also this study, hundred percent of S. aureus were sensitive
isolated from the National Kidney Center of Nepal to vancomycin and tigecycline. While Enterococcus spp.
during a study in CKD patients22 and several other was moderately resistant to ampicillin and ofloxacin in
studies conducted in diabetic patients11 and neutropenic this study, other Streptococcus spp. was resistant to

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 Antimicrobial Susceptibility Pattern in Opportunistic Pathogens Isolated from Immunocompromised Patients

them. 3. Alvarez B, Arcos J, Fernandez-Guerrero ML.

Pulmonary infectious diseases in patients with primary
The incidence rate of MDR (51.0%), XDR (9.2%), PDR immunodeficiency and those treated with biologic
(0.8%), and MRSA (35.7%) were comparable to the immunomodulating agents. Curr Opin Pulm Med.
findings of Shrestha et al.,7 who had also reported the 2011;17(3):172-9. [PubMed | Full Text]
incidence rate of MDR, XDR, PDR, and MRSA to be 40%,
10%, 0%, and 30%, respectively. Very high incidences of 4. Klein EY, Monteforte B, Gupta A, Jiang W, May L, Hsieh
β-lactamase producers (81.6%) observed in this study YH, et al. The frequency of influenza and bacterial
were discordant with the findings of Shrestha et al.,7 coinfection: a systematic review and meta‐analysis.
who had reported 35% of E. coli and Klebsiella spp. as Influenza Other Respir Viruses. 2016;10(5):394-403.
the β-lactamase producers. [PubMed | Full Text ]

This study suffers from several limitations. Firstly, 5. DeNegre AA, Ndeffo Mbah ML, Myers K,
patients, who have cancer and are on chemotherapy, Fefferman NH. Emergence of antibiotic resistance in
or who have had a solid organ transplant such as kidney immunocompromised host populations: A case study
or heart transplant, and are taking medication to keep of emerging antibiotic resistant tuberculosis in AIDS
their transplant were not included. Secondly, this is patients. PloS One. 2019;14(2):e0212969. [PubMed |
a single-center cross-sectional study comprising the Full Text]
Nepalese population who visited the study site seeking
medical care, and therefore the findings may not be 6. Moriyama B, Henning SA, Childs R, Holland SM,
generalizable in the worldwide context. Hence, further Anderson VL, Morris JC, et al. High-dose continuous
well-designed studies with a larger sample size are infusion β-lactam antibiotics for the treatment of
required. resistant Pseudomonas aeruginosa infections in
immunocompromised patients. Ann Pharmacother.
2010;44(5):929-35. [PubMed | Full Text]
CONCLUSIONS
This study showed an infection rate of 26.5% in 7. Shrestha LB, Bhattarai NR, Khanal B. Bacteriological
immunocompromised patients. E.coli, Klebsiella spp., Profile and Antimicrobial Susceptibility Pattern among
ACB complex, C. albicans, and S. aureus are the Isolates Obtained From Body Fluids. Nepal Health Res
frequently encountered organisms, most of which Counc. 2019;17(2):173-7. [PubMed | Full Text]
are β-lactamase producers and multi-drug resistant.
Bacterial infections showing considerable resistance to 8. Lin GL, McGinley JP, Drysdale SB, Pollard AJ.
the commonly used antibiotics call for the strategies Epidemiology and immune pathogenesis of viral sepsis.
to prescribe antibiotics on the grounds of antimicrobial Front Immunol. 2018;9:2147. [PubMed | Full Text]
stewardship principles in order to reduce morbidity and
mortality in immunocompromised patients. 9. Procop GW, Church DL, Hall GS, Janda WM. Koneman's
color atlas and textbook of diagnostic microbiology. Jones
& Bartlett Publishers; 2020 Jun 29.
CONFLICT OF INTEREST
The authors declare no conflict of interest. 10. Clinical and Laboratory Standards Institute. CLSI
document M100S. Performance Standards for
Antimicrobial Susceptibility Testing. 26th ed. Wayne, PA.
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