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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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Trend of pathogenic bacterial isolated from SSI in 2005 and 2012.
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Figure 2: Trend of pathogenic bacterial isolated from SSI in 2005 and 2012.

Mentions: This report on antimicrobial resistance from the national hospital in Tanzania demonstrates the predominance of gram negative bacterial isolates in SSIs (77.5%). Predominately Pseudomonas aeruginosa being the commonest followed by K. pneumoniae (10.8%) and Proteus mirabilis (10.8%). On the other hand S.aureus which was the commonest Gram positive organism accounted for (12.2%). This observation is in contrast to finding in previous studies from the same setting which reported Gram positive predominantly S. aureus as the most common SSI bacterial pathogen [7,18] (Figure 2).


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)

Trend of pathogenic bacterial isolated from SSI in 2005 and 2012.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Trend of pathogenic bacterial isolated from SSI in 2005 and 2012.
Mentions: This report on antimicrobial resistance from the national hospital in Tanzania demonstrates the predominance of gram negative bacterial isolates in SSIs (77.5%). Predominately Pseudomonas aeruginosa being the commonest followed by K. pneumoniae (10.8%) and Proteus mirabilis (10.8%). On the other hand S.aureus which was the commonest Gram positive organism accounted for (12.2%). This observation is in contrast to finding in previous studies from the same setting which reported Gram positive predominantly S. aureus as the most common SSI bacterial pathogen [7,18] (Figure 2).

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