| Περίληψη: | <p>Bloodstream infections (BSIs) are common cause of morbidity and mortality among patients of all age groups. Of particular concern is the increasing emergence and spread of antimicrobial resistance (AMR) in many Gram-negative bacteria (GNB) that cause BSIs. The aim of this thesis was to determine some of the epidemiological features of BSIs in a tertiary hospital in Nepal providing a specific focus on the molecular aspects of AMR, virulence, and variations in Enterobacter spp., a clinically important GNB associated with BSIs. </p>
<p>To better understand BSIs-causing non-Salmonella GNB and their AMR determinants in this setting, I conducted a retrospective surveillance study, accessing data from 2012 to 2018. I identified a high prevalence of multi-drug resistance (MDR) and several key AMR genes associated with predominant GNB pathogens. The neonatal intensive care unit (NICU) and the emergency room (ER) were the most prevalent hospital departments for BSIs. To gain an insight into the epidemiology of hospital-acquired (HA) BSIs and identify potential preventive measures, I conducted a further prospective study in the NICU. An increased isolation of Enterobacter spp. in the NICU during the study period suggested an outbreak, prompting an outbreak investigation of Enterobacter spp. isolates using whole genome sequencing (WGS). Identification of ER to having the highest burden of BSIs due to Enterobacter spp. demanded for an epidemiological research to understand the genomic determinants of virulence, AMR, and variations of Enterobacter spp.. To address this, I performed a comprehensive WGS analysis of Enterobacter spp. isolated in the ER.</p>
<p>The conclusion of my work is that BSIs due to antimicrobial resistant non-Salmonella GNB is an expanding problem in our hospital, highlighting the need for a continued AMR surveillance. I found that Enterobacter spp. was an emerging MDR pathogen causing BSIs in this hospital. The complex transmission dynamics of Enterobacter spp. observed in ER warranted for a more comprehensive genomic investigation complemented with demographic and clinical data of patients to better disaggregate the epidemiology of BSIs in ER.</p>
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