Spectrum of Pathogens and Their Resistance Profiles in Sputum and Pus Samples: A Retrospective Study From an Eastern Hospital of Nepal

ABSTRACT Background and Aims Respiratory and soft tissue infections remain major public health challenges both globally and in Nepal, increasingly complicated by rising antimicrobial resistance (AMR). The emergence of multidrug‐resistant (MDR) and extensively drug‐resistant (XDR) pathogens has made effective treatment more difficult, underscoring the need for localized resistance data to guide therapy. This study aimed to investigate the distribution and AMR profiles of pathogens isolated from sputum and pus samples, with particular emphasis on MDR and XDR strains. Methods A retrospective study was conducted from December 2024 to April 2025, analyzing 615 sputum and 45 pus samples from patients at Madan Bhandari Hospital and Trauma Center in Eastern Nepal. Bacterial identification and antimicrobial susceptibility testing were performed according to validated government‐approved guidelines (AMR Bacteriology Standard Operating Procedure, 2024). MDR and XDR strains were classified based on the criteria provided by the European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC). Results A total of 66 sputum (10.73%) and 17 pus (37.78%) samples showed positive bacterial growth. Pseudomonas aeruginosa (40.9%) and Klebsiella pneumoniae (39.4%) were the most prevalent pathogens in sputum samples, while Staphylococcus aureus (64.7%) dominated pus samples. The resistance patterns revealed 10.6% of sputum isolates as MDR, 7.6% as XDR, and 11.7% XDR in pus isolates. High resistance rates were observed to common antibiotics such as cefixime, cefepime, and aztreonam, while meropenem demonstrated effectiveness against many resistant strains. Gentamicin and doxycycline showed good efficacy against S. aureus and other pathogens in both samples. Conclusion The notable prevalence of MDR and XDR pathogens, along with antibiotic resistance, underscores the need for updated treatment guidelines. Meropenem remains effective for severe infections, while gentamicin and doxycycline are suitable for targeted therapies. Strengthening antimicrobial stewardship, diagnostics, and infection control is crucial to address AMR in Eastern Nepal.