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Mundamshimu JS, Malale K, Kidenya BR, Gunda DW, Bwemelo L, Mwashiuya M, Omar SS, Mlowe N, Kiyumbi M, Ngocho JS, Balandya E, Sunguya B, Mshana SE, Mteta K, Bartlett J, Lyamuya E, Mmbaga BT, Kalluvya S. Failure to Attain HIV Viral Suppression After Intensified Adherence Counselling-What Can We Learn About Its Factors? Infect Drug Resist 2023; 16:1885-1894. [PMID: 37020794 PMCID: PMC10069435 DOI: 10.2147/idr.s393456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/06/2023] [Indexed: 03/31/2023] Open
Abstract
Background Introduction and expansion of antiretroviral therapy (ART) have turned the tide of HIV pandemic, thus helping people living with HIV (PLHIV) achieve viral suppression. This success may need to be complemented by intensified adherence counseling (IAC) to improve adherence to treatment. However, some PLHIV still face higher than acceptable viral loads despite being on treatment. Purpose We investigated the factors associated with the failure to suppress HIV viral load after three months of IAC sessions. Patients and Methods This cross-sectional study analyzed secondary data from PLHIV-attended care and treatment clinics in Mwanza between January 2018 and December 2019 who had unsuppressed VL after being on ART for at least six months. We identified PLHIV in first-line ART with viral load evaluation before receiving IAC and had viral load results done at 90 days after IAC. We conducted descriptive statistics to examine the magnitude of viral suppression. Wilcoxon signed-rank test used to compare the median viral load before and after IAC sessions, and logistic regressions predicted the factors associated with failure. Results This study included 212 subjects. After intervention, most participants 85.9% (182) had significantly improved adherence compared to baseline. More than half 75.5% (160) of the participants had viral suppression after the intervention. Participants aged 18-25 years (AOR = 5.6, 95% CI, 1.1-29.6), unstable client during ART initiation (AOR = 0.3, 95% CI, 0.13-0.62), and poor adherence to ART (AOR = 4, 95% CI, 1.3-12.3) remained the main predictors of virological failure after IAC intervention. Conclusion Even though virological suppression is influenced by ART adherence, the findings in this study have shown co-existence of other factors to be addressed. Unstable during ART initiation is a new factor identified in this study.
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Affiliation(s)
| | - Kija Malale
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Benson R Kidenya
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Daniel W Gunda
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Logious Bwemelo
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | | | | | - Neema Mlowe
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Magwa Kiyumbi
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - James S Ngocho
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Emmanuel Balandya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Bruno Sunguya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Stephen E Mshana
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Kien Mteta
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - John Bartlett
- Kilimanjaro Christian Medical University College, Mosh, Tanzania
- Duke Global Health Institute, Duke University Medical Center, Durham, NC, USA
| | - Eligius Lyamuya
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Blandina Theophil Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Samuel Kalluvya
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
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Mwakyabala JG, Mtemisika CI, Mshana S, Mwakyoma AA, Silago V. Characterisation of genes encoding for extended spectrum β-lactamase in Gram-negative bacteria causing healthcare-associated infections in Mwanza, Tanzania. Afr J Lab Med 2023; 12:2107. [PMID: 37151814 PMCID: PMC10157427 DOI: 10.4102/ajlm.v12i1.2107] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/27/2023] [Indexed: 05/09/2023] Open
Abstract
Healthcare-associated infections (HCAIs) caused by extended spectrum β-lactamase-producing Gram-negative bacteria (ESBL-GNB) increase morbidity and mortality. This cross-sectional study characterised ESBL genes (bla CTX-M, bla TEM and bla SHV) among 30 ceftriaxone-resistant GNB causing HCAIs between January 2022 and July 2022 by multiplex polymerase chain reaction assay at the zonal referral hospital in Mwanza, Tanzania. Twenty-five (83.3%) had at least one ESBL gene, of which 23/25 (92.0%) carried the bla CTX-M gene. Seventy-two percent (18/25) of the GNB-ESBL isolates carried more than one ESBL gene, of which the majority (88.8%; n = 16/25) carried the bla CTX-M and bla TEM genes. Extended spectrum β-lactamase genes, particularly bla CTX-M, are common among ceftriaxone-resistant GNB causing HCAIs. What this study adds This study revealed the distribution of genes (bla CTX-M, bla TEM and bla SHV) coding for ESBL production among ceftriaxone resistant GNB causing HCAIs However, all ESBL producing GNB were susceptible towards ceftriaxone-sulbactam indicating that ceftriaxone-sulbactam may be empirically prescribed for treating patients with HCAIs.
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Affiliation(s)
- Jenipher G Mwakyabala
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania
| | - Conjester I Mtemisika
- Molecular Biology Laboratory, Central Pathology Laboratory, Bugando Medical Centre, Mwanza, United Republic of Tanzania
| | - Stacy Mshana
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania
| | - Adam A Mwakyoma
- Department of Clinical Microbiology, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Vitus Silago
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, United Republic of Tanzania
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Low Ciprofloxacin Concentrations Select Multidrug-Resistant Mutants Overproducing Efflux Pumps in Clinical Isolates of Pseudomonas aeruginosa. Microbiol Spectr 2022; 10:e0072322. [PMID: 36000896 PMCID: PMC9603996 DOI: 10.1128/spectrum.00723-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Low antibiotic concentrations present in natural environments are a severe and often neglected threat to public health. Even if they are present below their MICs, they may select for antibiotic-resistant pathogens. Notably, the minimal subinhibitory concentrations that select resistant bacteria, and define the respective sub-MIC selective windows, differ between antibiotics. The establishment of these selective concentrations is needed for risk-assessment studies regarding the presence of antibiotics in different habitats. Using short-term evolution experiments in a set of 12 Pseudomonas aeruginosa clinical isolates (including high-risk clones with ubiquitous distribution), we have determined that ciprofloxacin sub-MIC selective windows are strain specific and resistome dependent. Nonetheless, in all cases, clinically relevant multidrug-resistant (MDR) mutants emerged upon exposure to low ciprofloxacin concentrations, with these concentrations being below the levels reported in ciprofloxacin-polluted natural habitats where P. aeruginosa can be present. This feature expands the conditions and habitats where clinically relevant quinolone-resistant mutants can emerge. In addition, we established the lowest concentration threshold beyond which P. aeruginosa, regardless of the strain, becomes resistant to ciprofloxacin. Three days of exposure under this sub-MIC "risk concentration" led to the selection of MDR mutants that displayed resistance mechanisms usually ascribed to high selective pressures, i.e., the overproduction of the efflux pumps MexCD-OprJ and MexEF-OprN. From a One-Health viewpoint, these data stress the transcendent role of low drug concentrations, which can be encountered in natural ecosystems, in aggravating the antibiotic resistance problem, especially when it comes to pathogens of environmental origin. IMPORTANCE It has been established that antibiotic concentrations below MICs can select antibiotic-resistant pathogens, a feature of relevance for analyzing the role of nonclinical ecosystems in antibiotic resistance evolution. The range of concentrations where this selection occurs defines the sub-MIC selective window, whose width depends on the antibiotic. Herein, we have determined the ciprofloxacin sub-MIC selective windows of a set of Pseudomonas aeruginosa clinical isolates (including high-risk clones with worldwide distribution) and established the lowest concentration threshold, notably an amount reported to be present in natural ecosystems, beyond which this pathogen acquires resistance. Importantly, our results show that this ciprofloxacin sub-MIC selects for multidrug-resistant mutants overproducing clinically relevant efflux pumps. From a One-Health angle, this information supports that low antimicrobial concentrations, present in natural environments, may have a relevant role in worsening the antibiotic resistance crisis, particularly regarding pathogens with environmental niches, such as P. aeruginosa.
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Tusabe F, Kesande M, Amir A, Iannone O, Ayebare RR, Nanyondo J. Bacterial contamination of healthcare worker’s mobile phones: a case study at two referral hospitals in Uganda. GLOBAL SECURITY: HEALTH, SCIENCE AND POLICY 2022. [DOI: 10.1080/23779497.2021.2023321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Fred Tusabe
- Global Health Security Department, Infectious Diseases Institute Uganda, Kampala, Uganda
| | - Maureen Kesande
- Global Health Security Department, Infectious Diseases Institute Uganda, Kampala, Uganda
| | - Afreenish Amir
- Microbiology Department, National Institute of Health Pakistan, Islamabad, Pakistan
| | - Olivia Iannone
- Policy Department, Barbaricum LLC Washington, Washington, DC, USA
| | | | - Judith Nanyondo
- Global Health Security Department, Infectious Diseases Institute Uganda, Kampala, Uganda
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Damiano P, Salema EJ, Silago V. The susceptibility of multidrug resistant and biofilm forming Klebsiella pneumoniae and Escherichia coli to antiseptic agents used for preoperative skin preparations at zonal referral hospital in Mwanza, Tanzania. Malawi Med J 2021; 33:59-64. [PMID: 34422235 PMCID: PMC8360282 DOI: 10.4314/mmj.v33i1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Non-susceptibility of bacteria to antiseptic agents used for preoperative skin preparations threaten the effectiveness of prevention of surgical site infections. Data concerning susceptibility of multidrug resistant bacteria strains to antiseptic agents was limited at our setting. This study presents the susceptibility of extended spectrum β-lactamases producing Klebsiella pneumoniae and Escherichia coli (with and without biofilm formation) to antiseptic agents used for preoperative skin preparations at zonal referral hospital in Mwanza, Tanzania. Methods This cross-sectional descriptive study was conducted through July 2020. Presumptive extended spectrum beta-lactamase producing Klebsiella pneumoniae and Escherichia coli were recovered for this study. Disc combination method was used to confirm production of ESBL while tube method was used to detect biofilms formation. Then, isolates were tested for susceptibility towards 10% povidone iodine, 70% methylated spirit, 50% hydrogen peroxide (6% of industrial H2O2 diluted in equal volume with sterile distilled water) and 2% chlorhexidine. STATA software version 13.0 was used for data analysis. Results A total of 31 presumptive ESBL producers were recovered and phenotypically confirmed, whereas 54.8% (n=17) were K. pneumoniae and 45.2% (n=14) were E. coli. Five (35.7%) E. coli and seven (41.2%) K. pneumoniae had positive biofilms test results. Four (12.9%) bacteria were non-susceptible to antiseptic agents used for preoperative skin preparations. However, none exhibited resistance towards 10% PVP-I. Conclusion In this study we highlight the existence of multidrug resistant Gram-negative bacteria with resistance to antiseptic agents used for preoperative skin preparation at a zonal referral hospital in Mwanza, Tanzania.
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Affiliation(s)
- Prisca Damiano
- Department of Pharmaceutical Microbiology, School of Pharmacy, Catholic University of Health and Allied Sciences, Tanzania
| | - Erick J Salema
- Department of Pharmaceutical Microbiology, School of Pharmacy, Catholic University of Health and Allied Sciences, Tanzania
| | - Vitus Silago
- Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences
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Pappa O, Kefala AM, Tryfinopoulou K, Dimitriou M, Kostoulas K, Dioli C, Moraitou E, Panopoulou M, Vogiatzakis E, Mavridou A, Galanis A, Beloukas A. Molecular Epidemiology of Multi-Drug Resistant Pseudomonas aeruginosa Isolates from Hospitalized Patients in Greece. Microorganisms 2020; 8:microorganisms8111652. [PMID: 33114400 PMCID: PMC7693957 DOI: 10.3390/microorganisms8111652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 12/13/2022] Open
Abstract
Resistant Pseudomonas aeruginosa isolates are one of the major causes of both hospital-acquired infections (HAIs) and community-acquired infections (CAIs). However, management of P. aeruginosa infections is difficult as the bacterium is inherently resistant to many antibiotics. In this study, a collection of 75 P. aeruginosa clinical isolates from two tertiary hospitals from Athens and Alexnadroupolis in Greece was studied to assess antimicrobial sensitivity and molecular epidemiology. All P. aeruginosa isolates were tested for susceptibility to 11 commonly used antibiotics, and the newly introduced Double Locus Sequence Typing (DLST) scheme was implemented to elucidate the predominant clones. The tested P. aeruginosa isolates presented various resistant phenotypes, with Verona Integron-Mediated Metallo-β-lactamase (VIM-2) mechanisms being the majority, and a new phenotype, FEPR-CAZS, being reported for the first time in Greek isolates. DLST revealed two predominant types, 32-39 and 8-37, and provided evidence for intra-hospital transmission of the 32-39 clone in one of the hospitals. The results indicate that DLST can be a valuable tool when local outbreaks demand immediate tracking investigation with limited time and financial resources.
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Affiliation(s)
- Olga Pappa
- Department of Biomedical Sciences, University of West Attica, 12243 Egaleo, Greece; (A.M.K.); (M.D.); (C.D.); (A.M.)
- Central Public Health Laboratory, National Public Health Organization, 16672 Athens, Greece;
- Correspondence: or (O.P.); or (A.B.)
| | - Anastasia Maria Kefala
- Department of Biomedical Sciences, University of West Attica, 12243 Egaleo, Greece; (A.M.K.); (M.D.); (C.D.); (A.M.)
| | - Kyriaki Tryfinopoulou
- Central Public Health Laboratory, National Public Health Organization, 16672 Athens, Greece;
| | - Marios Dimitriou
- Department of Biomedical Sciences, University of West Attica, 12243 Egaleo, Greece; (A.M.K.); (M.D.); (C.D.); (A.M.)
| | - Kostas Kostoulas
- Laboratory of Microbiology, ‘Sotiria’ General Hospital, 152 Mesogeion Avenue, 11527 Athens, Greece; (K.K.); (E.M.); (E.V.)
| | - Chrysa Dioli
- Department of Biomedical Sciences, University of West Attica, 12243 Egaleo, Greece; (A.M.K.); (M.D.); (C.D.); (A.M.)
| | - Eleni Moraitou
- Laboratory of Microbiology, ‘Sotiria’ General Hospital, 152 Mesogeion Avenue, 11527 Athens, Greece; (K.K.); (E.M.); (E.V.)
| | - Maria Panopoulou
- Laboratory of Microbiology, School of Medicine, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece;
| | - Evaggelos Vogiatzakis
- Laboratory of Microbiology, ‘Sotiria’ General Hospital, 152 Mesogeion Avenue, 11527 Athens, Greece; (K.K.); (E.M.); (E.V.)
| | - Athena Mavridou
- Department of Biomedical Sciences, University of West Attica, 12243 Egaleo, Greece; (A.M.K.); (M.D.); (C.D.); (A.M.)
| | - Alex Galanis
- Department of Molecular Biology and Genetics, Health Science School, Democritus University of Thrace, 68100 Alexandroupolis, Greece;
| | - Apostolos Beloukas
- Department of Biomedical Sciences, University of West Attica, 12243 Egaleo, Greece; (A.M.K.); (M.D.); (C.D.); (A.M.)
- Institute of Infection & Global Health, University of Liverpool, Liverpool L69 7BE, UK
- Correspondence: or (O.P.); or (A.B.)
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Water as a Source of Antimicrobial Resistance and Healthcare-Associated Infections. Pathogens 2020; 9:pathogens9080667. [PMID: 32824770 PMCID: PMC7459458 DOI: 10.3390/pathogens9080667] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 12/13/2022] Open
Abstract
Healthcare-associated infections (HAIs) are one of the most common patient complications, affecting 7% of patients in developed countries each year. The rise of antimicrobial resistant (AMR) bacteria has been identified as one of the biggest global health challenges, resulting in an estimated 23,000 deaths in the US annually. Environmental reservoirs for AMR bacteria such as bed rails, light switches and doorknobs have been identified in the past and addressed with infection prevention guidelines. However, water and water-related devices are often overlooked as potential sources of HAI outbreaks. This systematic review examines the role of water and water-related devices in the transmission of AMR bacteria responsible for HAIs, discussing common waterborne devices, pathogens, and surveillance strategies. AMR strains of previously described waterborne pathogens including Pseudomonas aeruginosa, Mycobacterium spp., and Legionella spp. were commonly isolated. However, methicillin-resistant Staphylococcus aureus and carbapenem-resistant Enterobacteriaceae that are not typically associated with water were also isolated. Biofilms were identified as a hot spot for the dissemination of genes responsible for survival functions. A limitation identified was a lack of consistency between environmental screening scope, isolation methodology, and antimicrobial resistance characterization. Broad universal environmental surveillance guidelines must be developed and adopted to monitor AMR pathogens, allowing prediction of future threats before waterborne infection outbreaks occur.
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Rippon MG, Rogers AA, Westgate S. Treating drug-resistant wound pathogens with non-medicated dressings: an in vitro study. J Wound Care 2019; 28:629-638. [DOI: 10.12968/jowc.2019.28.9.629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objective: To assess the in vitro antimicrobial performance of a non-medicated hydro-responsive wound dressing (HRWD) on the sequestration and killing of wound relevant microorganisms found on the World Health Organization (WHO) priority pathogens list. Methods: Suspensions of Pseudomonas aeruginosa, Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus (MRSA) were placed on petri dishes. Dressings were each placed on top, incubated for 30 minutes and then removed from the inoculated petri dish. The surface of the dressings previously in contact with the bacterial suspensions were placed directly onto a tryptone soy agar (TSA) plate and incubated for 24 hours. Dressings were then removed from the TSA plate and the level of bacterial growth on the plates was assessed. Sequestered microorganism viability was assessed using LIVE/DEAD viability kits and visualisation by epifluorescence. Results: Our results indicated that HRWDs sequester and retain Pseudomonas aeruginosa, Acinetobacter baumannii and MRSA within the dressing. Non-medicated HRWDs containing bound PHMB (polyhexamethylene biguanide, HRWD+PHMB) killed the microorganisms sequestered within the dressing matrix. Conclusion: These data suggest that non-medicated HRWD+PHMB is an effective against WHO priority pathogens and promoting goal of antimicrobial stewardship in wound care.
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Affiliation(s)
- Mark G. Rippon
- 1 Visiting Clinical Research Fellow; Huddersfield University, Queensgate, Huddersfield, UK
| | - Alan A. Rogers
- 2 Medical Communications Consultant; Flintshire, North Wales, UK
| | - Samantha Westgate
- 3 Chief Executive Officer Perfectus Biomed Limited, Daresbury Laboratories, SciTech Daresbury, Cheshire, UK
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Moremi N, Claus H, Vogel U, Mshana SE. The role of patients and healthcare workers Staphylococcus aureus nasal colonization in occurrence of surgical site infection among patients admitted in two centers in Tanzania. Antimicrob Resist Infect Control 2019; 8:102. [PMID: 31236269 PMCID: PMC6580651 DOI: 10.1186/s13756-019-0554-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/06/2019] [Indexed: 11/25/2022] Open
Abstract
Background Colonization with Staphylococcus aureus has been identified as a risk for subsequent occurrence of infection. This study investigated the relationship between S. aureus colonization of patients and healthcare workers (HCWs), and subsequent surgical site infections (SSI). Methods Between December 2014 and September 2015, a total of 930 patients and 143 HCWs were enrolled from the Bugando Medical Centre and Sekou Toure hospital in Mwanza, Tanzania. On admission and discharge nasal swabs, with an additional of wound swab for those who developed SSI were collected from patients whereas HCWs were swabbed once. Identification and antimicrobial susceptibility testing were done by VITEK-MS and VITEK-2, respectively. Detection of Panton Valentine leukocidin (PVL) and mecA genes was done by PCR. S. aureus isolates were further characterized by spa typing and Multi-Locus Sequence Typing (MLST). Results Among 930 patients screened for S. aureus on admission, 129 (13.9%) were positive of which 5.4% (7/129) were methicillin-resistant S. aureus (MRSA). Amongst 363 patients rescreened on discharge, 301 patients had been tested negative on admission of whom 29 (9.6%) turned positive after their hospital stay. Three (10.3%) of the 29 acquired S. aureus were MRSA. Inducible Clindamycin resistance occurred more often among acquired S. aureus isolates than among isolates from admission [34.5% (10/29) vs. 17.1% (22/129), P = 0.018]. S. aureus contributed to 21.1% (n = 12) of the 57 cases of investigated SSIs among 536 patients followed. Seven out of eight S. aureus carriage/infection pairs had the same spa and sequence types. The previously reported dominant PVL-positive ST88 MRSA strain with spa type t690 was detected in patients and HCW. Conclusion A significant proportion of patients acquired S. aureus during hospitalization. The finding of more than 90% of S. aureus SSI to be of endogenous source underscores the need of improving infection prevention and control measures including screening and decolonization of high risk patients.
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Affiliation(s)
- Nyambura Moremi
- 1Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany.,2Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
| | - Heike Claus
- 1Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Ulrich Vogel
- 1Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Stephen E Mshana
- 2Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
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Irek EO, Amupitan AA, Obadare TO, Aboderin AO. A systematic review of healthcare-associated infections in Africa: An antimicrobial resistance perspective. Afr J Lab Med 2018; 7:796. [PMID: 30568902 PMCID: PMC6296034 DOI: 10.4102/ajlm.v7i2.796] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 09/20/2018] [Indexed: 12/25/2022] Open
Abstract
Background Healthcare-associated infection (HCAI) is a global health challenge, not only as an issue of patient safety but also as a major driver of antimicrobial resistance (AMR). It is a major cause of morbidity and mortality with economic consequences. Objective This review provides an update on the occurrence of HCAI, as well as the contribution of emerging AMR on healthcare delivery in Africa. Methods We searched PubMed, Cochrane database, African Journals Online and Google Scholar for relevant articles on HCAI in Africa between 2010 and 2017. Preferred reporting items of systematic reviews and meta-analyses guidelines were followed for selection. Thirty-five eligible articles were considered for the qualitative synthesis. Results Of the 35 eligible articles, more than half (n = 21, 60%) were from East Africa. Klebsiella spp., Staphylococcus aureus, Escherichia coli and Pseudomonas spp. were the common pathogens reported in bloodstream infection, (catheter-associated) urinary tract infection, surgical site infection and healthcare-associated pneumonia. Among these various subtypes of HCAI, methicillin-resistant S. aureus (3.9% – 56.8%) and extended-spectrum beta-lactamase producing Gram-negative bacilli (1.9% – 53.0%) were the most reported antimicrobial resistant pathogens. Conclusion This review shows a paucity of HCAI surveillance in Africa and an emergence of AMR priority pathogens. Hence, there is a need for a coordinated national and regional surveillance of both HCAI and AMR in Africa.
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Affiliation(s)
- Emmanuel O Irek
- Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria
| | - Adewale A Amupitan
- Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria
| | - Temitope O Obadare
- Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria
| | - Aaron O Aboderin
- Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria.,Department of Medical Microbiology and Parasitology, Obafemi Awolowo University, Ile-Ife, Osun, Nigeria
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Matinyi S, Enoch M, Akia D, Byaruhanga V, Masereka E, Ekeu I, Atuheire C. Contamination of microbial pathogens and their antimicrobial pattern in operating theatres of peri-urban eastern Uganda: a cross-sectional study. BMC Infect Dis 2018; 18:460. [PMID: 30200891 PMCID: PMC6131813 DOI: 10.1186/s12879-018-3374-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Microbial contamination of hospital environment, especially in operating theatres (OT) and other specialized units has greatly contributed to continuous and multiple exposure to nosocomial infections by patients and the public. We purposed to assess microbial contamination of operating theatres and antibacterial sensitivity pattern of bacteria isolated from theatres of Mbale Regional Referral Hospital, Eastern Uganda. METHODS We employed a laboratory based cross-sectional study design. Swabbing of different surfaces and settle plate establishment in 4 various operating theatres was carried out. A total of 109 samples were collected, 31 air samples and 78 swabs from four operating theatres. Samples were collected in the mornings after disinfection prior to start of daily operations. Antibacterial sensitivity testing of isolated bacterial pathogens was performed by Kirby Bauer disc diffusion method following standard operating procedure. Colony counts for the settle plates were carried out using a colony counter. RESULTS All the four theatres had their mean colony counts exceeding the acceptable limit of 5 cfu/dm2/h. Gynaecology theatre had up to 261 cfu/dm2/h and Ophthalmology operating theatre had approximately 43 cfu/dm2/h. A total of 14 different organisms were isolated with Pseudomonas spp. [23.9%]; Bacillus spp. [17.5%] and Aspergillus spp. [15.8%] being the most common contaminants respectively. Other isolates included Enterococcus spp., Rhizopus spp. and Coagulate Negative Staphylococcus isolates especially from settle plates. Most bacterial isolates showed considerable resistance to antibacterial agents. Pseudomonas spp. was resistant to chloramphenicol (53.6%) and cotrimoxazole (57.1%). Most of the bacterial pathogens were sensitive to imipenem [83.3%]. CONCLUSIONS There is moderate contamination of operating theatres of Mbale Regional Referral Hospital. Common organisms were Pseudomonas, Bacillus, and Aspergillus spps. Resistance was observed against chloramphenicol and cotrimoxazole. More caution is necessary to carefully disinfect the operating theatres at Regional referral settings and similar tertiary health care centres with more emphasis on obstetrics and gynecology theatres. Diagnosis and care of patients at such clinical settings should consider the possibility of antibiotic resistance.
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Affiliation(s)
- Sandra Matinyi
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara of Science and Technology, (MUST), Mbarara, Uganda
| | - Muwanguzi Enoch
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara of Science and Technology, (MUST), Mbarara, Uganda
| | - Deborah Akia
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara of Science and Technology, (MUST), Mbarara, Uganda
| | - Valentine Byaruhanga
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara of Science and Technology, (MUST), Mbarara, Uganda
| | - Edson Masereka
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara of Science and Technology, (MUST), Mbarara, Uganda
| | - Isaac Ekeu
- Department of Medical Laboratory Sciences, Faculty of Medicine, Mbarara of Science and Technology, (MUST), Mbarara, Uganda
| | - Collins Atuheire
- Department of Biosecurity, Ecosystems and Veterinary Public Health, College of Veterinary Medicine, Animal Resources & Biosecurity, Makerere University, Kampala, P.O Box 7076, Uganda
- Department of Public Health, School of Allied Health Sciences, Kampala International University, Western Campus, Bushenyi, Uganda
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High carriage rate of extended-spectrum beta-lactamase-producing Enterobacteriaceae among patients admitted for surgery in Tanzanian hospitals with a low rate of endogenous surgical site infections. J Hosp Infect 2018; 100:47-53. [PMID: 29852267 DOI: 10.1016/j.jhin.2018.05.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 05/22/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Despite the high reported rates of surgical site infections (SSIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (EPE) in low-income countries, including Tanzania, the role of EPE carriage in subsequent occurrence of SSIs is not known. This study investigated the rates of EPE carriage among surgical patients at the time of admission and discharge, and linked EPE genotype with SSIs. METHODS EPE were confirmed among isolates from rectal and wound/pus swabs using VITEK-2. Polymerase chain reaction and sequencing were performed to detect beta-lactamase genes. Multi-locus sequence typing was used to determine the genotypes of EPE isolates. RESULTS Among 930 patients enrolled, EPE carriage was significantly higher on discharge than admission (36.4% vs 23.7%, P<0.001). Of 272 patients who tested negative on admission, 78 (28.7%) acquired EPE during hospitalization. History of hospital stay within the previous three months was an independent predictor of EPE acquisition [hazard ratio 2, 95% confidence interval (CI) 1.04-3.98, P=0.038]. Of the 536 patients who were successfully followed-up after surgery, 78 (14.6%, 95% CI 11.6-17.5) developed SSIs. Of 57 SSIs investigated, 33 (58%) were caused by enteric Gram-negative bacteria, of which 63.6% (21/33) were EPE. Escherichia coli sequence type (ST)131 pandemic clone and Klebsiella pneumoniae ST391 predominated among wound isolates. The blaCTX-M-15 gene was detected in 37 (97.3%) of 38 ESBL isolates. Male sex was an independent predictor of SSI (odds ratio 2.92, 95% CI 1.73-4.91, P<0.001). CONCLUSION These findings warrant implementation of strict infection control measures, antimicrobial stewardship and exploration of the transmission dynamics of EPE in surgical wards.
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