Microbiological and Susceptibility Profile of Clinical Gram Positive Isolates at a Tertiary Pediatric and Maternity Hospital in Ulaanbaatar, Mongolia

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


Introduction: Information on microbiological and susceptibility profiles of Monoglian bacterial isolates is scarce. Resistance profiles, patient demographics and microbiological work-up of gram positive isolates were analyzed in order to develop infection control activities and policies at the National Center for Maternity and Children’s Health (NCMCH) in Ulaanbataar, Mongolia.

Methods: All gram positive isolates of specimens submitted to the microbiology laboratory at NCMCH between January 2014 and August 2017 were included. Data collected included demographic data, specimen type, in-/outpatient status, hospital ward of sample origin, and antimicrobial susceptibility testing profile. Susceptibility testing was performed by trained microbiologists at the NCMCH microbiology laboratory. T-test, Mann-Whitney, Chi-square and Fisher exact tests were used as appropriate.

Results: Of 11,889 isolates, 4012 (33.7%) were gram positive, with most identified as S. aureus (62.6%, n=2512). Rates of methicillin resistance (MRSA) remained stable at a quarter, but was significantly higher among inpatients (inpatients: 630/2002, 31.5%; outpatients 67/290, 23.1%; p?0.05) and sterile site isolates (sterile: 83/171, 48.5%; non-sterile: 416/1678, 24.8%; p?0.01). The vast majority of S. pneumoniae isolates (12/14; 85%) was found to be penicillin resistant by oxacillin disk diffusion. While identification of Group B streptococci was rare (n=137) due to of lack of diagnostic measures available, the number of enterococcal isolates identified increased signifi-cantly due to implementation of improved microbiological work-up (2015: n=7; 2016: n=26; 2017: n=83).

Conclusion: Compared with published studies from neighboring nations, the rates of antimicrobial resistance among gram positive isolates at NCMCH, particularly with respect to S. aureus and S. pneumoniae, were much higher. Further improvement of microbiological diagnostics and collabo-ration of stakeholders is required to address the pressing infection control and stewardship issues and to ensure reliable identification of relevant pathogens in Mongolia.

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How to Cite
Felsenstein, S., Bira, S., Altanmircheg, N., Shonkhuuz, E., Ochirpurev, A., & Warburton, D. (2019). Microbiological and Susceptibility Profile of Clinical Gram Positive Isolates at a Tertiary Pediatric and Maternity Hospital in Ulaanbaatar, Mongolia. Central Asian Journal of Global Health, 8(1). https://doi.org/10.5195/cajgh.2019.380
Author Biographies

Susanna Felsenstein, Cork University Hospital University College Cork, Wilton, Cork, Republic of Ireland

Consultant Paediatrician, Senior Lecturer, MSc, DTMH

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

    Head of Central Laboratory Department at NCMCH

    Khuvisgalchdiin street, Bayangol District, 

    Ulaanbaatar, Mongolia, 160660

    Tel: 976-99932133

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

National Center for Maternal and Child Health.

Central Laboratory Department, NCMCH

    Khuvisgalchdiin street, Bayangol District, 

    Ulaanbaatar, Mongolia.

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

    National Center for Maternal and Child Health.

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

    Tel: 976-99059825

    Fax: 976-11-362633 

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

Tel: 976-99038010

Fax: 976-11-324683

David Warburton, University of Southern California 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 Assistant Tel: 323 361 5422

Keck School of Medicine,

University of Southern California, USA

Ostrow School of Dentistry,

University of Southern California, USA


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