scholarly journals Prevalence, Distribution, and Antibiotic Susceptibilities of Nosocomial Infections at a Tertiary Hospital in Port Harcourt, Nigeria

2020 ◽  
Vol 41 (S1) ◽  
pp. s359-s359
Author(s):  
Catherine Nonyelum Stanley ◽  
Inimuvie Ekada

Background: Previously, many infections could be treated effectively based on the clinician’s past clinical experience. The development of resistance to essentially all of the antimicrobial agents currently in use in clinical practice has made this scenario more of the exception than the norm. Selecting an appropriate antimicrobial agent has become increasingly more challenging; the clinician has to navigate through the variety of available agents in the face of increasing antimicrobial resistance. The diagnostic laboratory now plays very important role in clinical practice. To ensure safe and effective empirical treatment, a surveillance study of the susceptibility pattern of common pathogens and appropriate use of antibiotics is imperative. Objective: We report on the prevalence, distribution, and antibiotic susceptibility patterns of nosocomial pathogens isolated at the University of Port Harcourt Teaching Hospital (UPTH) and the effectiveness of the antibiotics commonly prescribed at the hospital in treating these infections. Methods: A retrospective cross-sectional study of specimens received at the microbiology laboratory was conducted over a 6-month period, from October 2015 to March 2016, using urine, blood, and semen specimens. In total, 5,160 samples received and analyzed at the laboratory within the study period were assessed. Results: Of the 5,160 specimens analyzed, 881(17.07%) were positive for bacteria: 691(78.43%) from urine, 86 (9.76%) from blood, and 104 (11. 81%) from semen. Escherichia coli (35.74%), Klebsiella pneumoniae (52.33%), and Staphylococcus aureus (65.4%) were the most frequently isolated pathogens from urine, blood, and semen, respectively. Widespread multidrug resistance was observed among the organisms. Klebsiella pneumoniae, S. aureus, and E. coli isolated from urine were resistant to amoxicillin/clavulanate, cefuroxime, ceftazidime, ciprofloxacin, ampicillin, gentamycin, and ceftriaxone. A review of the pattern of prescribing antibiotics revealed that in the emergency unit, ceftriaxone (34.09%) and metronidazole (30.09%) were most frequently prescribed, whereas in the general outpatient department, metronidazole (19.09%), amoxicillin (16.61%), amoxicillin/clavulanate (9.39%), and ofloxacin (9.39%) were often prescribed. S. aureus was susceptible to only ceftriaxone, whereas K. pneumoniae and E. coli were susceptible only to ofloxacin. Conclusions: Most of the isolated pathogens were not susceptible to the frequently prescribed antibiotics. Empirical prescribing of antibiotics without current epidemiological data of pathogens in the hospital can only further exacerbate the problem of antimicrobial resistance. The need for periodic epidemiological surveillance and rational use of antibiotics anchored on a good antibiotic stewardship program is therefore strongly recommended.Funding: NoneDisclosures: None

Author(s):  
Catherine N. Stanley ◽  
Inimuvie Ekada

Background: Many infections could previously be treated effectively based on the clinicians past clinical experience. The development of resistance to essentially all of the antimicrobial agents currently in use in clinical practice has made this scenario more of the exception than the norm. Selecting an appropriate antimicrobial agent has become increasingly more challenging as the clinician has to navigate through the variety of available agents in the face of increasing antimicrobial resistance. The diagnostic laboratory plays very important role in clinical practice.   To ensure safe and effective empirical treatment, a surveillance study of the susceptibility pattern of common pathogens and appropriate use of antibiotics is imperative. This current study reports on the prevalence, distribution and antibiotic susceptibility patterns of nosocomial pathogens isolated at the University of Port Harcourt Teaching Hospital (UPTH) and the effectiveness of the antibiotics commonly prescribed at the hospital in treating these infections. Methods: A retrospective cross-sectional study of specimens received at the Microbiology Laboratory was conducted over a six-month period, from October 2015 to March 2016 using urine, blood and semen specimens respectively. A total of 5,160 samples received and analyzed at the laboratory within the study period were assessed. Results: Out of the 5160 specimens analyzed, 881(17.07%) were positive for bacteria out of which 691(78.43%), 86(9.76%), 104 (11. 81%) were from urine, blood and semen respectively. Escherichia coli (35.74%), Klebsiella pneumoniae (52.33%) and Staphylococcus aureus (65.4%) were the most frequently isolated pathogens from urine, blood and semen respectively. Wide spread multiple-drug resistance was observed among the organisms. Klebsiella pneumoniae, S. aureus, and E. coli isolated from urine were resistant to amoxicillin/clavulanate, cefuroxime, ceftazidime, ciprofloxacin, ampicillin, gentamycin and ceftriaxone. A review of the pattern of prescribing antibiotics revealed that in the Accidents and Emergency unit, ceftriaxone (34.09%) and metronidazole (30.09%) were most frequently prescribed while in the General Out-Patient Department, metronidazole (19.09%), amoxicillin (16.61%), amoxicillin/clavulanate (9.39%) and ofloxacin (9.39%) were often prescribed. S. aureus was susceptible to only ceftriaxone while K. pneumoniae and E. coli were susceptible only to ofloxacin. Conclusion: Most of the isolated pathogens were not susceptible to the frequently prescribed antibiotics. Empirical prescribing of antibiotics without current epidemiological data of pathogens in the hospital can only further exacerbate the problem of antimicrobial resistance. The need for epidemiological surveillance and rational use of antibiotics in the Hospital is therefore strongly recommended.


2021 ◽  
Vol 19 (3) ◽  
pp. 513-524
Author(s):  
Natcha Chawnan ◽  
◽  
Kannika Na Lampang ◽  
Raktham Mektrirat ◽  
Nattakarn Awaiwanont ◽  
...  

This research aimed to assess the occurrence of bacterial pathogens and their antimicrobial resistance in dogs presenting with canine periapical tooth abscesses. Sample swabs were performed on 45 dogs who had undergone dental surgery between January 2019 and August 2020 at the Veterinary Teaching Hospital, Chiang Mai University. Samples were analyzed within 24 hours at Veterinary Diagnostic Laboratory, Chiang Mai University to identify any bacterial species and to investigate their potential antimicrobial susceptibility according to CLSI guidelines. A high proportion of gram-negative and facultative species were identified. Out of the 17 species obtained, Pseudomonas aeruginosa (34.6 %) was determined to be the predominant species followed by Escherichia coli (15.4%) and Klebsiella pneumoniae (11.5%), respectively. P. aeruginosa was highly resistant (100.0%) to ampicillin and clindamycin, while E. coli and K. pneumoniae were found to be highly resistant (100.0%) to clindamycin in terms of antimicrobial susceptibility. However, E. coli was more resistant to enrofloxacin, gentamicin, and norfloxacin than K. pneumoniae. When focusing on the resistance rates of all species, clindamycin exhibited the highest degree of resistance, followed by ampicillin and amoxicillin, respectively. Amoxicillin-clavulanate is an empirical antibiotic in our area that has exhibited a resistance rate of 48.7%. The outcomes of our study have suggested that fluoroquinolone and aminoglycoside could be used to treat canine periapical tooth abscesses. However, the renal effect of these drugs must be considered. Importantly, antibiotic selection must depend upon the results of bacterial culture and antimicrobial susceptibility tests in order to reduce any potential antimicrobial resistance issues.


2007 ◽  
Vol 73 (20) ◽  
pp. 6566-6576 ◽  
Author(s):  
Moussa S. Diarra ◽  
Fred G. Silversides ◽  
Fatoumata Diarrassouba ◽  
Jane Pritchard ◽  
Luke Masson ◽  
...  

ABSTRACT The effects of feed supplementation with the approved antimicrobial agents bambermycin, penicillin, salinomycin, and bacitracin or a combination of salinomycin plus bacitracin were evaluated for the incidence and distribution of antibiotic resistance in 197 commensal Escherichia coli isolates from broiler chickens over 35 days. All isolates showed some degree of multiple antibiotic resistance. Resistance to tetracycline (68.5%), amoxicillin (61.4%), ceftiofur (51.3%), spectinomycin (47.2%), and sulfonamides (42%) was most frequent. The levels of resistance to streptomycin, chloramphenicol, and gentamicin were 33.5, 35.5, and 25.3%, respectively. The overall resistance levels decreased from day 7 to day 35 (P < 0.001). Comparing treatments, the levels of resistance to ceftiofur, spectinomycin, and gentamicin (except for resistance to bacitracin treatment) were significantly higher in isolates from chickens receiving feed supplemented with salinomycin than from the other feeds (P < 0.001). Using a DNA microarray analysis capable of detecting commonly found antimicrobial resistance genes, we characterized 104 tetracycline-resistant E. coli isolates from 7- to 28-day-old chickens fed different growth promoters. Results showed a decrease in the incidence of isolates harboring tet(B), bla TEM, sulI, and aadA and class 1 integron from days 7 to 35 (P < 0.01). Of the 84 tetracycline-ceftiofur-resistant E. coli isolates, 76 (90.5%) were positive for bla CMY-2. The proportions of isolates positive for sulI, aadA, and integron class 1 were significantly higher in salinomycin-treated chickens than in the control or other treatment groups (P < 0.05). These data demonstrate that multiantibiotic-resistant E. coli isolates can be found in broiler chickens regardless of the antimicrobial growth promoters used. However, the phenotype and the distribution of resistance determinants in E. coli can be modulated by feed supplementation with some of the antimicrobial agents used in broiler chicken production.


2010 ◽  
Vol 54 (7) ◽  
pp. 3043-3046 ◽  
Author(s):  
Stephen P. Hawser ◽  
Samuel K. Bouchillon ◽  
Daryl J. Hoban ◽  
Robert E. Badal ◽  
Rafael Cantón ◽  
...  

ABSTRACT From 2002 to 2008, there was a significant increase in extended-spectrum beta-lactamase (ESBL)-positive Escherichia coli isolates in European intra-abdominal infections, from 4.3% in 2002 to 11.8% in 2008 (P < 0.001), but not for ESBL-positive Klebsiella pneumoniae isolates (16.4% to 17.9% [P > 0.05]). Hospital-associated isolates were more common than community-associated isolates, at 14.0% versus 6.5%, respectively, for E. coli (P < 0.001) and 20.9% versus 5.3%, respectively, for K. pneumoniae (P < 0.01). Carbapenems were consistently the most active drugs tested.


2017 ◽  
Vol 37 (11) ◽  
pp. 1253-1260 ◽  
Author(s):  
Caroline Pissetti ◽  
Gabriela Orosco Werlang ◽  
Jalusa Deon Kich ◽  
Marisa Cardoso

ABSTRACT: The increasing antimicrobial resistance observed worldwide in bacteria isolated from human and animals is a matter of extreme concern and has led to the monitoring of antimicrobial resistance in pathogenic and commensal bacteria. The aim of this study was to evaluate the antimicrobial resistance profile of Escherichia coli isolated from pig carcasses and to assess the occurrence of relevant resistance genes. A total of 319 E. coli isolates were tested for antimicrobial susceptibility against different antimicrobial agents. Moreover, the presence of extended-spectrum β-lactamase (ESBL) and inducible ampC-β-lactamase producers was investigated. Eighteen multi-resistant strains were chosen for resistance gene detection and PFGE characterization. The study showed that resistance to antimicrobials is widespread in E. coli isolated from pig carcasses, since 86.2% of the strains were resistant to at least one antimicrobial and 71.5% displayed multi-resistance profiles. No ampC-producing isolates were detected and only one ESBL-producing E. coli was identified. Genes strA (n=15), floR (n=14), aac(3)IVa (n=13), tetB (n=13), sul2 (n=12), tetA (n=11), aph(3)Ia (n=8) and sul3 (n=5) were detected by PCR. PFGE analysis of these multi-resistant E. coli strains showed less than 80% similarity among them. We conclude that antimicrobial multi-resistant E. coli strains are common on pig carcasses and present highly diverse genotypes and resistance phenotypes and genotypes.


2021 ◽  
Vol 11 (3) ◽  
pp. 650-658
Author(s):  
Mohammed Yahia Alasmary

Background: To explore the prevalence of urinary tract infections (UTIs) among female patients in the Najran region of Saudi Arabia and determine their antimicrobial resistance pattern. Methods: This study was conducted on 136 urine samples collected from outpatient departments (OPDs) of the different government hospitals in the Najran region of Saudi Arabia. Over one year, the results of susceptibility testing reports of outpatient midstream urine samples from three government hospitals were prospectively evaluated. Results: Of 136 urine samples, only 123 (90.45%) were found to show significant growth for UTIs, from which 23 different uropathogens were identified. Escherichia coli (58.5%) was the most commonly isolated organism, followed by Klebsiella pneumoniae (8.1%). The isolated microorganism showed increased resistance patterns from 3.3% to 62.6%, with an overall resistance of 27.19%. Meropenem was the most effective antimicrobial, followed by amikacin and ertapenem (0.47%, 0.91%, and 1.5% resistance, respectively). At the same time, ampicillin and cephazolin were the least (62.6% and 59.5% resistance, respectively) effective. Overall, eleven (8.94%) uropathogens isolates were ESBLs, among which there were eight (6.5%) Escherichia coli, one (0.81%) Klebsiella pneumoniae, one (0.81%) Klebsiella oxytoca, and one (0.81%) Citrobacter amalonaticus. Conclusions: E. coli remains the most commonly isolated causative uropathogens, followed by Klebsiella species. The prevalence of pathogenic E. coli and Klebsiella species underscores the importance of developing cost-effective, precise, and rapid identification systems to minimize public exposure to uropathogens. Antibiotic susceptibility data revealed that most of the isolates were resistant to the majority of the antibiotics. The patients with UTIs in the Najran region of Saudi Arabia are at a high risk of antibiotic resistance, leading to significant problems in outpatient department (OPD) treatment outcomes and raising the alarm for the physician to change their empiric treatment.


2019 ◽  
Vol 12 (8) ◽  
pp. 1311-1318 ◽  
Author(s):  
Dusadee Phongaran ◽  
Seri Khang-Air ◽  
Sunpetch Angkititrakul

Aim: This study aimed to determine the prevalence and antimicrobial resistance pattern of Salmonella spp., and the genetic relatedness between isolates from broilers and pigs at slaughterhouses in Thailand. Materials and Methods: Fecal samples (604 broilers and 562 pigs) were collected from slaughterhouses from April to July 2018. Salmonella spp. were isolated and identified according to the ISO 6579:2002. Salmonella-positive isolates were identified using serotyping and challenged with nine antimicrobial agents: Amoxicillin/clavulanate (AMC, 30 μg), ampicillin (AMP, 10 μg), ceftazidime (30 μg), chloramphenicol (30 μg), ciprofloxacin (CIP, 5 μg), nalidixic acid (NAL, 30 μg), norfloxacin (10 μg), trimethoprim/sulfamethoxazole (SXT, 25 μg), and tetracycline (TET, 30 μg). Isolates of the predominant serovar Salmonella Typhimurium were examined for genetic relatedness using pulsed-field gel electrophoresis (PFGE). Results: Salmonella was detected in 18.05% of broiler isolates and 37.54% of pig isolates. The most common serovars were Kentucky, Give, and Typhimurium in broilers and Rissen, Typhimurium, and Weltevreden in pigs. Among broilers, isolates were most commonly resistant to antibiotics, NAL, AMP, TET, AMC, and CIP. Pig isolates most commonly exhibited antimicrobial resistance against AMP, TET, and SXT. Based on PFGE results among 52 S. Typhimurium isolates from broilers and pigs, a high genetic relatedness between broiler and pig isolates (85% similarity) in Cluster A and C from PFGE result was identified. Conclusion: The results revealed high cross-contamination between these two animal species across various provinces in Thailand. Keywords: antimicrobial resistance, broilers, pigs, pulsed-field gel electrophoresis, Salmonella spp.


2021 ◽  
Vol 12 ◽  
Author(s):  
Yasmine H. Tartor ◽  
Norhan K. Abd El-Aziz ◽  
Rasha M. A. Gharieb ◽  
Hend M. El Damaty ◽  
Shymaa Enany ◽  
...  

Antimicrobial resistance is a major concern in the dairy industry. This study investigated the prevalence, antimicrobial resistance phenotypes, and genome sequencing of Gram-negative bacteria isolated from clinical (n = 350) and subclinical (n = 95) bovine mastitis, and raw unpasteurized milk (n = 125). Klebsiella pneumoniae, Aeromonas hydrophila, Enterobacter cloacae (100% each), Escherichia coli (87.78%), and Proteus mirabilis (69.7%) were the most prevalent multidrug-resistant (MDR) species. Extensive drug-resistance (XDR) phenotype was found in P. mirabilis (30.30%) and E. coli (3.33%) isolates. Ten isolates (four E. coli, three Klebsiella species and three P. mirabilis) that displayed the highest multiple antibiotic resistance (MAR) indices (0.54–0.83), were exposed to whole-genome sequencing (WGS). Two multilocus sequence types (MLST): ST2165 and ST7624 were identified among the sequenced E. coli isolates. Three E. coli isolates (two from clinical mastitis and one from raw milk) belonging to ST2165 showed similar profile of plasmid replicon types: IncFIA, IncFIB, IncFII, and IncQ1 with an exception to an isolate that contained IncR, whereas E. coli ST7624 showed a different plasmid profile including IncHI2, IncHI2A, IncI1α, and IncFII replicon types. ResFinder findings revealed the presence of plasmid-mediated colistin mcr-10 and fosfomycin fosA5 resistance genes in a K. pneumoniae (K1) isolate from bovine milk. Sequence analysis of the reconstructed mcr-10 plasmid from WGS of K1 isolate, showed that mcr-10 gene was bracketed by xerC and insertion sequence IS26 on an IncFIB plasmid. Phylogenetic analysis revealed that K1 isolate existed in a clade including mcr-10-harboring isolates from human and environment with different STs and countries [United Kingdom (ST788), Australia (ST323), Malawi (ST2144), Myanmar (ST705), and Laos (ST2355)]. This study reports the first emergence of K. pneumoniae co-harboring mcr-10 and fosA5 genes from bovine milk in the Middle East, which constitutes a public health threat and heralds the penetration of the last-resort antibiotics. Hence, prudent use of antibiotics in both humans and animals and antimicrobial surveillance plans are urgently required.


2020 ◽  
Vol 28 (2) ◽  
pp. 81
Author(s):  
Raouia Ben Rhouma ◽  
Ahlem Jouini ◽  
Amira Klibi ◽  
Safa Hamrouni ◽  
Aziza Boubaker ◽  
...  

The purpose of this study was to identify <em>Escherichia coli</em> isolates in diarrhoeic and healthy rabbits in Tunisia and characterise their virulence and antibiotic resistance genes. In the 2014-2015 period, 60 faecal samples from diarrhoeic and healthy rabbits were collected from different breeding farms in Tunisia. Susceptibility to 14 antimicrobial agents was tested by disc diffusion method and the mechanisms of gene resistance were evaluated using polymerase chain reaction and sequencing methods. Forty <em>E. coli</em> isolates were recovered in selective media. High frequency of resistance to tetracycline (95%) was detected, followed by different levels of resistance to sulphonamide (72.5%), streptomycin (62.5%), trimethoprim-sulfamethoxazole (60%), nalidixic acid (32.5%), ampicillin (37.5%) and ticarcillin (35%). <em>E. coli</em> strains were susceptible to cefotaxime, ceftazidime and imipenem. Different variants of bla<sub>TEM</sub>, <em>tet</em>, <em>sul</em> genes were detected in most of the strains resistant to ampicillin, tetracycline and sulphonamide, respectively. The presence of class 1 integron was studied in 29 sulphonamide-resistant <em>E. coli</em> strains from which 15 harboured class 1 integron with four different arrangements of gene cassettes, <em>dfrA17</em>+<em>aadA5</em> (n=9), <em>dfrA1</em> + <em>aadA1</em> (n=4), <em>dfrA12</em> + <em>addA2</em> (n=1), <em>dfrA12</em>+<em>orf</em>+<em>addA2</em> (n=1). The <em>qnrB</em> gene was detected in six strains out of 13 quinolone-resistant <em>E. coli</em> strains. Seventeen <em>E. coli</em> isolates from diarrhoeic rabbits harboured the enteropathogenic eae genes associated with different virulence genes tested (<em>fimA</em>, <em>cnf1</em>, <em>aer</em>), and affiliated to B2 (n=8) and D (n=9) phylogroups. Isolated <em>E. coli</em> strains from healthy rabbit were harbouring <em>fim A</em> and/or <em>cnf1</em> genes and affiliated to A and B1 phylogroups. This study showed that <em>E. coli</em> strains from the intestinal tract of rabbits are resistant to the widely prescribed antibiotics in medicine. Therefore, they constitute a reservoir of antimicrobial-resistant genes, which may play a significant role in the spread of antimicrobial resistance. In addition, the eae virulence gene seemed to be implicated in diarrhoea in breeder rabbits in Tunisia.


2013 ◽  
Vol 7 (12) ◽  
pp. 922-928 ◽  
Author(s):  
Nguyen Hoang Thu Trang ◽  
Tran Vu Thieu Nga ◽  
James I Campbell ◽  
Nguyen Trong Hiep ◽  
Jeremy Farrar ◽  
...  

Background: Extended-spectrum β-lactamases (ESBLs) are enzymes capable of hydrolyzing oxyimino-β-lactams and inducing resistance to third generation cephalosporins. The genes encoding ESBLs are widespread and generally located on highly transmissible resistance plasmids. We aimed to investigate the complement of ESBL genes in E. coli and Klebsiella pneumoniae causing nosocomial infections in hospitals in Ho Chi Minh City, Vietnam. Methodology: Thirty-two non-duplicate isolates of E. coli and Klebsiella pneumoniae causing nosocomial infections, isolated between March and June 2010, were subjected to antimicrobial susceptibility testing. All isolates were PCR-amplified to detect the blaSHV, blaTEM and blaCTX-M ESBL genes and subjected to plasmid analysis. Results: We found that co-resistance to multiple antimicrobials was highly prevalent, and we report the predominance of the blaCTX-M-15 and blaCTX-M-27 genes, located on highly transmissible plasmids ranging from 50 to 170 kb in size. Conclusions: Our study represents a snap shot of ESBL-producing enteric bacteria causing nosocomial infections in this setting. We suggest that antimicrobial resistance in nosocomial E. coli and Klebsiella pneumoniae is rampant in Vietnam and ESBL organisms are widespread. In view of these data and the dramatic levels of antimicrobial resistance reported in Vietnam we advocate an urgent review of antimicrobial use in the Vietnamese healthcare system.


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