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Predominance of multi-drug resistant bacterial pathogens causing surgical site infections in Muhimbili National Hospital, Tanzania.

Manyahi J, Matee MI, Majigo M, Moyo S, Mshana SE, Lyamuya EF - BMC Res Notes (2014)

Bottom Line: Majority (97%) of the Gram negative bacteria were resistant to more than four categories (classes) of antibiotics.A high proportion (63%) of the isolates causing SSIs in this tertiary hospital were MDR, of which (90%) were resistant to more than four classes of antibiotics.In the light of these findings, an urgent and significant change in antibiotic prescription policy is required at this National hospital.

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Affiliation: Department of Microbiology/Immunology, Muhimbili University of Health and Allied Sciences, P, O, Box 65001, Dar es Salaam, Tanzania. manyahijoel@yahoo.com.

ABSTRACT

Background: Surgical site infections (SSIs) remain a common and widespread problem contributing to a significant morbidity and mortality, attributed partly by the increase in antimicrobial resistance among the etiological agents. This study was done to determine the spectrum of bacterial isolates and their susceptibility patterns causing SSIs at Muhimbili National Hospital, Tanzania.

Methods: This descriptive cross sectional study was conducted between September, 2011 and February, 2012. Pus swabs or pus were cultured on blood agar (Oxoid, UK) and MacConkey agar (Oxoid, UK) and incubated aerobically at 37°C for 18-24 hours. Bacterial identification was done using API 20E and VITEK and antimicrobial susceptibility was determined by Kirby Bauer disc diffusion.

Results: Of the 100 patients, from whom wound swabs were collected, 90 (90%) had positive aerobic bacterial growth. A total of 147 pathogenic bacteria were isolated, including 114 (77.5%) gram negative and 33(22.5%) gram positive organisms. The most prevalent bacterial species were Pseudomonas aeruginosa (16.3%), followed by Staphylococcus aureus (12.2%) and Klebsiella pneumoniae (10.8%). Of the 18 S. aureus , 8 (44%) were methicillin resistant Staphylococcus aureus (MRSA) and three of them (17%) were carrying both MRSA and induced clindamycin resistance (ICR). Extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae were observed in 23 (79.3%) of the 29 isolates tested. Majority of Escherichia coli 12 (92.3%) and K. pneumoniae 11 (69%) isolates were ESBL producers. About 63% (93/147) were multiple-drug resistance (MDR) isolates, and the overall MDR among Gram positive and Gram negative bacteria was 60.6% (20/33) and 61.4%, (73/114), respectively. The prevalence of MDR for E. coli, A. baumannii and P. stuartii was 100% each. Majority (97%) of the Gram negative bacteria were resistant to more than four categories (classes) of antibiotics.

Conclusion: A high proportion (63%) of the isolates causing SSIs in this tertiary hospital were MDR, of which (90%) were resistant to more than four classes of antibiotics. In the light of these findings, an urgent and significant change in antibiotic prescription policy is required at this National hospital.

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Isolation frequency of pathogenic bacterial isolates from post-operative wound infections (N = 147).
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Figure 1: Isolation frequency of pathogenic bacterial isolates from post-operative wound infections (N = 147).

Mentions: Of the 100 wound swabs collected, 90% had bacterial growth. More than half (52.2%, 47/90) had pure bacterial growth (mono isolate). Gram negative organisms were more prevalent than gram positive bacteria accounting for 77.5% (114/147) of all isolates. The most predominant Gram negative organism was P. aeruginosa comprising 16.3% (24/147) of all bacterial isolates. K. pneumoniae 10.8% (16/147) and Proteus mirabilis 10.8% (16/147) were the next two common Gram negative organisms [Figure 1]. Most (92.3%) of the 13 Escherichia coli and 11/16 (69%) of K. pneumoniae isolates were ESBLs producing strains. Of the Gram positive isolates, S.aureus was the leading cause of SSIs accounting 12.2% (18/147) of all isolates, followed by coagulase negative Staphylococci (6.8%) and Enterococcus faecalis (3.4%). Of the 18 S. aureus isolates, 44.4% (8/18) were MRSA strains and three of them had induced clindamycin resistance (ICR).


Predominance of multi-drug resistant bacterial pathogens causing surgical site infections in Muhimbili National Hospital, Tanzania.

Manyahi J, Matee MI, Majigo M, Moyo S, Mshana SE, Lyamuya EF - BMC Res Notes (2014)

Isolation frequency of pathogenic bacterial isolates from post-operative wound infections (N = 147).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4126906&req=5

Figure 1: Isolation frequency of pathogenic bacterial isolates from post-operative wound infections (N = 147).
Mentions: Of the 100 wound swabs collected, 90% had bacterial growth. More than half (52.2%, 47/90) had pure bacterial growth (mono isolate). Gram negative organisms were more prevalent than gram positive bacteria accounting for 77.5% (114/147) of all isolates. The most predominant Gram negative organism was P. aeruginosa comprising 16.3% (24/147) of all bacterial isolates. K. pneumoniae 10.8% (16/147) and Proteus mirabilis 10.8% (16/147) were the next two common Gram negative organisms [Figure 1]. Most (92.3%) of the 13 Escherichia coli and 11/16 (69%) of K. pneumoniae isolates were ESBLs producing strains. Of the Gram positive isolates, S.aureus was the leading cause of SSIs accounting 12.2% (18/147) of all isolates, followed by coagulase negative Staphylococci (6.8%) and Enterococcus faecalis (3.4%). Of the 18 S. aureus isolates, 44.4% (8/18) were MRSA strains and three of them had induced clindamycin resistance (ICR).

Bottom Line: Majority (97%) of the Gram negative bacteria were resistant to more than four categories (classes) of antibiotics.A high proportion (63%) of the isolates causing SSIs in this tertiary hospital were MDR, of which (90%) were resistant to more than four classes of antibiotics.In the light of these findings, an urgent and significant change in antibiotic prescription policy is required at this National hospital.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Microbiology/Immunology, Muhimbili University of Health and Allied Sciences, P, O, Box 65001, Dar es Salaam, Tanzania. manyahijoel@yahoo.com.

ABSTRACT

Background: Surgical site infections (SSIs) remain a common and widespread problem contributing to a significant morbidity and mortality, attributed partly by the increase in antimicrobial resistance among the etiological agents. This study was done to determine the spectrum of bacterial isolates and their susceptibility patterns causing SSIs at Muhimbili National Hospital, Tanzania.

Methods: This descriptive cross sectional study was conducted between September, 2011 and February, 2012. Pus swabs or pus were cultured on blood agar (Oxoid, UK) and MacConkey agar (Oxoid, UK) and incubated aerobically at 37°C for 18-24 hours. Bacterial identification was done using API 20E and VITEK and antimicrobial susceptibility was determined by Kirby Bauer disc diffusion.

Results: Of the 100 patients, from whom wound swabs were collected, 90 (90%) had positive aerobic bacterial growth. A total of 147 pathogenic bacteria were isolated, including 114 (77.5%) gram negative and 33(22.5%) gram positive organisms. The most prevalent bacterial species were Pseudomonas aeruginosa (16.3%), followed by Staphylococcus aureus (12.2%) and Klebsiella pneumoniae (10.8%). Of the 18 S. aureus , 8 (44%) were methicillin resistant Staphylococcus aureus (MRSA) and three of them (17%) were carrying both MRSA and induced clindamycin resistance (ICR). Extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae were observed in 23 (79.3%) of the 29 isolates tested. Majority of Escherichia coli 12 (92.3%) and K. pneumoniae 11 (69%) isolates were ESBL producers. About 63% (93/147) were multiple-drug resistance (MDR) isolates, and the overall MDR among Gram positive and Gram negative bacteria was 60.6% (20/33) and 61.4%, (73/114), respectively. The prevalence of MDR for E. coli, A. baumannii and P. stuartii was 100% each. Majority (97%) of the Gram negative bacteria were resistant to more than four categories (classes) of antibiotics.

Conclusion: A high proportion (63%) of the isolates causing SSIs in this tertiary hospital were MDR, of which (90%) were resistant to more than four classes of antibiotics. In the light of these findings, an urgent and significant change in antibiotic prescription policy is required at this National hospital.

Show MeSH
Related in: MedlinePlus