Rapid Emergence of Multidrug-Resistance among Gram Negative Isolates at a Tertiary Pediatric and Maternity Hospital in Ulaanbaatar, Mongolia

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Susanna Felsenstein
Sarantsetseg Bira
Narangerel Altanmircheg
Enkhtur Shonkuuz
Ariuntuya Ochirpurev
David Warburton


Introduction: Information on microbiological and susceptibility profiles of clinical isolates in Mongolia is scarce, hampering infection control and clinical care.

Methods: Species and resistance profiles of 6334 clinical gram negative isolates, collected at Mongolia’s National Center for Maternal and Child Health between 2014 and 2017 were analyzed.

Results: Annual proportion of multidrug-resistance among E. coli and Enterobacter isolates increased from 2.8% to 16.6% and 3.5% to 22.6% respectively; Klebsiella isolates exhibiting susceptibilities suggestive of extended spectrum beta-lactamase (ESBL) production from 73% to 94%. By 2017, 60.6% of Klebsiella isolates were multidrug-resistant, most originated from intensive care wards.  Enterobacteriaceae exhibiting susceptibility patterns suggestive of ESBL production and multidrug-resistant organisms were common and their incidence increased rapidly.

Conclusion: These findings will serve to build strategies to strengthen microbiological surveillance, diagnostics and infection control; and to develop empiric therapy and stewardship recommendations for Mongolia’s largest Children’s and Maternity hospital.

Article Details

How to Cite
Felsenstein, S., Bira, S., Altanmircheg, N., Shonkuuz, E., Ochirpurev, A., & Warburton, D. (2020). Rapid Emergence of Multidrug-Resistance among Gram Negative Isolates at a Tertiary Pediatric and Maternity Hospital in Ulaanbaatar, Mongolia. Central Asian Journal of Global Health, 9(1). https://doi.org/10.5195/cajgh.2020.371
Author Biographies

Susanna Felsenstein, Department of Paediatric Infectious Diseases and Immunology, Liverpool, United Kingdom

1.Susanna Felsenstein, MSc, DTM&H, Senior Lecturer (corresponding author)

    University College Cork, Department of Pediatrics

    Wilton, Cork, Republic of Ireland

    Tel.: +353 21-492- 2000

    Fax.: +353 21 -492- 2399

    E-mail: susanna.felsenstein@hse.ie; sfelsenstein@protonmail.com

Sarantsetseg Bira, Central Laboratory Department, National Center for Maternal and Child Health, Ulaanbaatar, Mongolia

MD, Master Degree of Medical Sciences

    Head of Central Laboratory Department at NCMCH

Narangerel Altanmircheg, Central Laboratory Department, National Center for Maternal and Child Health, Ulaanbaatar, Mongolia

    Central Laboratory Department, NCMCH

    Khuvisgalchdiin street, Bayangol District, 

    Ulaanbaatar, Mongolia, 160660

Enkhtur Shonkuuz, Critical Care Medicine, National Center for Maternal and Child Health, Ulaanbaatar, Mongolia

Clinical Professor of Pediatrics, Critical Care Medicine

    Head of postgraduate training program in pediatrics at NCMCH

    Director General of the NCMCH

    Khuvisgalchdiin street, Bayangol District, 

    Ulaanbaatar, Mongolia, 16060

Ariuntuya Ochirpurev, Health emergencies and food safety, Office of the WHO Representative in Mongolia, Ulaanbaatar, Mongolia

Technical officer, Health emergencies and food safety,

Office of the WHO Representative in Mongolia

Olympic Street-2, Sukhbaatar district,

Ulaanbaatar, Mongolia

David Warburton, Keck School of Medicine, University of Southern California, USA; Ostrow School of Dentistry, University of Southern California, USA

 Professor of Pediatrics, Surgery and Craniofacial Biology
    Director, Developmental Biology and Regenerative Medicine Program

Director, FIC, NIEHS Center for Global Pollution Health Impact Across the Lifespan

Director NHLBI LungMAP Center

Director Department of the Army Device Development Center
Saban Research Institute, Children’s Hospital Los Angeles
Keck School of Medicine and Ostrow School of  Dentistry
University of Southern California


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