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Odewale G, Jibola-Shittu MY, Ojurongbe O, Olowe RA, Olowe OA. Genotypic Determination of Extended Spectrum β-Lactamases and Carbapenemase Production in Clinical Isolates of Klebsiella pneumoniae in Southwest Nigeria. Infect Dis Rep 2023; 15:339-353. [PMID: 37367193 DOI: 10.3390/idr15030034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/22/2023] [Accepted: 06/05/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION Klebsiella pneumoniae is a major pathogen implicated in healthcare-associated infections. Extended-spectrum β-lactamase (ESBL) and carbapenemase-producing K. pneumoniae isolates are a public health concern. This study investigated the existence of some ESBL and carbapenemase genes among clinical isolates of K. pneumoniae in Southwest Nigeria and additionally determined their circulating clones. MATERIALS AND METHODS Various clinical samples from 420 patients from seven tertiary hospitals within Southwestern Nigeria were processed between February 2018 and July 2019. These samples were cultured on blood agar and MacConkey agar, and the isolated bacteria were identified by Microbact GNB 12E. All K. pneumoniae were confirmed by polymerase chain reaction (PCR) using the 16s rRNA gene. Antibiotic susceptibility testing (AST) was done on these isolates, and the PCR was used to evaluate the common ESBL-encoding genes and carbapenem resistance genes. Genotyping was performed using multi-locus sequencing typing (MLST). RESULTS The overall prevalence of K. pneumoniae in Southwestern Nigeria was 30.5%. The AST revealed high resistance rates to tetracyclines (67.2%), oxacillin (61.7%), ampicillin (60.2%), ciprofloxacin (58.6%), chloramphenicol (56.3%), and lowest resistance to meropenem (43.0%). All isolates were susceptible to polymyxin B. The most prevalent ESBL gene was the TEM gene (47.7%), followed by CTX-M (43.8%), SHV (39.8%), OXA (27.3%), CTX-M-15 (19.5%), CTX-M-2 (11.1%), and CTX-M-9 (10.9%). Among the carbapenemase genes studied, the VIM gene (43.0%) was most detected, followed by OXA-48 (28.9%), IMP (22.7%), NDM (17.2%), KPC (13.3%), CMY (11.7%), and FOX (9.4%). GIM and SPM genes were not detected. MLST identified six different sequence types (STs) in this study. The most dominant ST was ST307 (50%, 5/10), while ST258, ST11, ST147, ST15, and ST321 had (10%, 1/10) each. CONCLUSION High antimicrobial resistance in K. pneumoniae is a clear and present danger for managing infections in Nigeria. Additionally, the dominance of a successful international ST307 clone highlights the importance of ensuring that genomic surveillance remains a priority in the hospital environment in Nigeria.
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Affiliation(s)
- Gbolabo Odewale
- Department of Microbiology, Federal University, Lokoja P.M.B. 1154, Kogi State, Nigeria
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso P.M.B. 4000, Oyo State, Nigeria
| | | | - Olusola Ojurongbe
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso P.M.B. 4000, Oyo State, Nigeria
- Centre for Emerging and Re-Emerging Infectious Diseases (CERID-LAUTECH), Ladoke Akintola University of Technology, Ogbomoso P.M.B. 4000, Oyo State, Nigeria
| | - Rita Ayanbolade Olowe
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso P.M.B. 4000, Oyo State, Nigeria
| | - Olugbenga Adekunle Olowe
- Department of Medical Microbiology and Parasitology, Ladoke Akintola University of Technology, Ogbomoso P.M.B. 4000, Oyo State, Nigeria
- Centre for Emerging and Re-Emerging Infectious Diseases (CERID-LAUTECH), Ladoke Akintola University of Technology, Ogbomoso P.M.B. 4000, Oyo State, Nigeria
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Chukwu EE, Awoderu OB, Enwuru CA, Afocha EE, Lawal RG, Ahmed RA, Olanrewaju I, Onwuamah CK, Audu RA, Ogunsola FT. High prevalence of resistance to third-generation cephalosporins detected among clinical isolates from sentinel healthcare facilities in Lagos, Nigeria. Antimicrob Resist Infect Control 2022; 11:134. [PMID: 36348431 PMCID: PMC9640893 DOI: 10.1186/s13756-022-01171-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022] Open
Abstract
Background Antimicrobial resistance (AMR) in bacterial pathogens is a worldwide concern that demands immediate attention. Most information on AMR originates from high-income countries and little is known about the burden in Africa, particularly Nigeria. Using four sentinel sites (General hospitals) in Lagos State, this study sought to estimate the burden of AMR. Methods This is a hospital-based surveillance using secondary health care centres. Four sites were randomly selected and included in the study. Clinical isolates were collected over a period of 6 months for each site from August 2020 to March 2021. All isolates were characterised and analysed for resistance to 15 antibiotics using the Kirby-Baur method. Multiplex PCR assay was used for the detection of Extended spectrum beta lactamase genes. Data analysis was done using SPSS version 27.0. Results Four hundred and ninety-nine (499) patients consented and participated in this study, consisting of 412 (82.6%) females and 87 (17.4%) males. The mean age ± SD of the participants was 33.9 ± 13.8 with a range of 1–89 years. The majority (90.8%) of the participants were outpatients. Two hundred and thirty-two (232) isolates were obtained from 219 samples, comprising of 120 (51.7%) Gram positive and 112 (48.3%) Gram negative organisms. Key bacterial pathogens isolated from this study included Staphylococcus aureus (22.8%), Escherichia coli (16.4%), Staphylococcus spp. (15.9%), Enterococcus spp. (7.3%) and Klebsiella pneumoniae (6.5%). There was high prevalence of multi-drug resistance (79.3%) among the isolates with 73.6% of Staphylococcus aureus phenotypically resistant to methicillin and 70% possessed the MecA gene. 76.5% of Enterococcus spp. isolated were Vancomycin resistant. Overall, resistance to Cephalosporins was most frequently/commonly observed (Cefotaxime 87.5%). Conclusion A high incidence of AMR was identified in clinical bacteria isolates from selected general hospitals in Lagos State, highlighting the necessity for the implementation of national action plans to limit the prevalence of AMR. Surveillance via collection of isolates has a lot of promise, especially in resource-limited environments. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01171-2.
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Affiliation(s)
- Emelda E. Chukwu
- grid.416197.c0000 0001 0247 1197Antimicrobial Resistance Research group, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria
| | - Oluwatoyin B. Awoderu
- grid.416197.c0000 0001 0247 1197Antimicrobial Resistance Research group, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria
| | - Christian A. Enwuru
- grid.416197.c0000 0001 0247 1197Antimicrobial Resistance Research group, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria
| | - Ebelechukwu E. Afocha
- grid.416197.c0000 0001 0247 1197Antimicrobial Resistance Research group, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria
| | - Rahman G. Lawal
- grid.416197.c0000 0001 0247 1197Antimicrobial Resistance Research group, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria
| | - Rahaman A. Ahmed
- grid.416197.c0000 0001 0247 1197Center for Human Virology and Genomics, Microbiology Department, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria
| | - Ishola Olanrewaju
- grid.416197.c0000 0001 0247 1197Antimicrobial Resistance Research group, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria
| | - Chika K. Onwuamah
- grid.416197.c0000 0001 0247 1197Center for Human Virology and Genomics, Microbiology Department, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria
| | - Rosemary A. Audu
- grid.416197.c0000 0001 0247 1197Antimicrobial Resistance Research group, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria ,grid.416197.c0000 0001 0247 1197Center for Human Virology and Genomics, Microbiology Department, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria
| | - Folasade T. Ogunsola
- grid.416197.c0000 0001 0247 1197Antimicrobial Resistance Research group, Nigerian Institute of Medical Research, Yaba, Lagos State Nigeria ,grid.411782.90000 0004 1803 1817Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Idi-Araba, Nigeria
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Molecular characterization of Enterobacteriaceae isolated from gingivitis and periodontitis patients and the antimicrobial activity of mouth wash agents. SCIENTIFIC AFRICAN 2022. [DOI: 10.1016/j.sciaf.2022.e01106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Duru C, Olanipekun G, Odili V, Kocmich N, Rezac A, Ajose TO, Medugu N, Umoru D, Onuchukwu C, Munir H, Jibir BW, Farouk Z, Gambo S, Hassan-Hanga F, Olaosebikan R, Ebruke B, Esimone C, Obaro S. Molecular characterization of invasive Enterobacteriaceae from pediatric patients in Central and Northwestern Nigeria. PLoS One 2020; 15:e0230037. [PMID: 33104733 PMCID: PMC7588054 DOI: 10.1371/journal.pone.0230037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background Bacteremia is a leading cause of mortality in developing countries, however, etiologic evaluation is infrequent and empiric antibiotic use not evidence-based. Here, we evaluated the patterns of ESBL resistance in children enrolled into a surveillance study for community acquired bacteremic syndromes across health facilities in Central and Northwestern Nigeria. Method Blood culture was performed for children aged less than 5 years suspected of having sepsis from Sept 2008-Dec 2016. Blood was incubated using the BACTEC00AE system and Enterobacteriacea identified to the species level using Analytical Profile Index (API20E®). Antibiotic susceptibility profile was determined by the disc diffusion method. Real time PCR was used to characterize genes responsible for ESBL production. Result Of 21,000 children screened from Sept 2008-Dec 2016, 2,625(12.5%) were culture-positive. A total of 413 Enterobacteriaceae available for analysis were screened for ESBL. ESBL production was detected in 160 Enterobacteriaceae, high resistance rates were observed among ESBL-positive isolates for Ceftriaxone (92.3%), Aztreonam (96.8%), Cefpodoxime (96.3%), Cefotaxime (98.8%) and Trimethoprim/sulfamethoxazole (90%), while 87.5%, 90.7%, and 91.9% of the isolates were susceptible to Imipenem, Amikacin and Meropenem respectively. Frequently detected resistance genes were blaTEM—83.8% (134/160), and, blaCTX-M 83.1% (133/160) followed by blaSHVgenes 66.3% (106/160). Co-existence of blaCTX-M, blaTEM and blaSHV was seen in 94/160 (58.8%), blaCTX-M and blaTEM in 118/160 (73.8%), blaTEM and blaSHV in 97/160 (60.6%) and blaCTX-M and blaSHV in 100/160 (62.5%) of isolates tested. Conclusion Our results indicate a high prevalence of bacteremia from ESBL Enterobacteriaceae in this population of children. These are resistant to commonly used antibiotics and careful choice of antibiotic treatment options is critical. Further studies to evaluate transmission dynamics of resistance genes could help in the reduction of ESBL resistance in these settings.
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Affiliation(s)
- Carissa Duru
- International Foundation Against Infectious Diseases in Nigeria, Abuja, Nigeria
- * E-mail: (CD); (SO)
| | - Grace Olanipekun
- International Foundation Against Infectious Diseases in Nigeria, Abuja, Nigeria
| | - Vivian Odili
- International Foundation Against Infectious Diseases in Nigeria, Abuja, Nigeria
| | - Nicholas Kocmich
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Amy Rezac
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
| | - Theresa O. Ajose
- International Foundation Against Infectious Diseases in Nigeria, Abuja, Nigeria
| | - Nubwa Medugu
- Department of Medical Microbiology and Parasitology, National Hospital Abuja, International Foundation Against Infectious Diseases in Nigeria, Abuja, Nigeria
| | | | | | - Huda Munir
- Aminu Kano Teaching Hospital, Kano, Nigeria
| | | | | | - Safiya Gambo
- Murtala Muhammed Specialist Hospital, Kano, Nigeria
| | | | - Rasaq Olaosebikan
- International Foundation Against Infectious Diseases in Nigeria, Abuja, Nigeria
| | - Bernard Ebruke
- International Foundation Against Infectious Diseases in Nigeria, Abuja, Nigeria
| | | | - Stephen Obaro
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, United States of America
- * E-mail: (CD); (SO)
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Tanko N, Bolaji RO, Olayinka AT, Olayinka BO. A systematic review on the prevalence of extended-spectrum beta lactamase-producing Gram-negative bacteria in Nigeria. J Glob Antimicrob Resist 2020; 22:488-496. [PMID: 32348900 DOI: 10.1016/j.jgar.2020.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE There are numerous reported cases of extended-spectrum beta-lactamases (ESBLs) producing Enterobacteriaceae in Nigeria. Yet, there are regions in Nigeria where cases of ESBL were under-reported. The review aims to assess the prevalence of ESBL-producing Gram-negative bacteria in Nigeria and the genes involved. METHODS An extensive literature search was carried out through an electronic database including PubMed, Scopus, Google Scholar and African Journals Online (AJOL). Articles published between January 2004 and November 2019 were included in the study. The titles and abstracts of the retrieved articles were reviewed, and then the full texts of the selected articles were reviewed. Articles were divided according to geopolitical zones. RESULTS Among the 217 articles identified, 60 studies (10 from north-central, 4 from northeast, 7 from the northwest, 17 from the southeast, 10 from south-south, and 12 from southwest Nigeria) were included. The highest prevalence recorded was 82.3%, while the lowest was 7.5%. The genes TEM, SHV, and CTX-M were the predominant variant commonly found. The most frequently used phenotypic detection method is the double disc synergy test (DDST). CONCLUSION ESBL-producing Gram-negative bacteria in hospital and community settings in Nigeria were commonly found. The prevalence of ESBL is very high, with one of the geopolitical zones under-reported. Future research should be conducted in these zones where there are scant studies, and a holistic approach involving the clinicians, researchers, laboratory scientists, and patients will go a long way in reducing the dissemination of this resistance mechanism.
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Affiliation(s)
- Nuhu Tanko
- Department of Pharmaceutics and Pharmaceutical Microbiology, Faculty of Pharmaceutical Sciences, Usmanu Danfodiyo University, Sokoto, Nigeria.
| | - Rebecca Olajumoke Bolaji
- Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | | | - Busayo Olalekan Olayinka
- Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, Ahmadu Bello University, Zaria, Nigeria
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Phylogenetic grouping and biofilm formation of multidrug resistant Escherichia coli isolates from humans, animals and food products in South-West Nigeria. SCIENTIFIC AFRICAN 2019. [DOI: 10.1016/j.sciaf.2019.e00158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Neemann K, Olateju EK, Izevbigie N, Akaba G, Olanipekun GM, Richard JC, Duru CI, Kocmich NJ, Samson KK, Rezac-Elgohary A, Anigilaje EA, Yunusa T, Megafu CON, Ajose TO, Medugu N, Meza J, Obaro S. Neonatal outcomes associated with maternal recto-vaginal colonization with extended-spectrum β-lactamase producing Enterobacteriaceae in Nigeria: a prospective, cross-sectional study. Clin Microbiol Infect 2019; 26:463-469. [PMID: 31336200 DOI: 10.1016/j.cmi.2019.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/12/2019] [Accepted: 07/13/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of this study was to assess the prevalence of maternal recto-vaginal extended-spectrum β-lactamase producing Enterobacteriacea (ESBL-E) colonization, identify risk factors for maternal and neonatal ESBL-E colonization, and subsequent impact on neonatal mortality. METHODS A prospective, cross-sectional study was conducted at the University of Abuja Teaching Hospital from April 2016 to May 2017. Maternal-neonatal pairs were screened for ESBL-E exposure at time of delivery. Neonatal mortality was assessed at 28 days. RESULTS A total of 1161 singleton deliveries were evaluated. In total, 9.7% (113/1161) of mothers and 4.3% (50/1161) of infants had ESBL-E-positive cultures at delivery. Maternal antibiotic exposure was associated with ESBL-E recto-vaginal colonization (18.6% (21/113) vs. 8.4% (88/1048), p < 0.001)). Maternal ESBL-E colonization (adjusted odds ratio (AOR) 14.85; 95% CI 7.83-28.15) and vaginal delivery (AOR 6.35; 95% CI 2.63-17.1) were identified as a risk factor for positive ESBL-E neonatal surface cultures. Neonatal positive ESBL-E surface cultures were a risk factor for neonatal mortality (stillbirths included, AOR 4.84; 95% CI 1.44-16.31). The finding that maternal ESBL-E recto-vaginal colonization appeared protective in regards to neonatal mortality (AOR 0.22; 95% CI .06-0.75) requires further evaluation. CONCLUSIONS Maternal ESBL-E recto-vaginal colonization is an independent risk factor for neonatal ESBL-E colonization and neonates with positive ESBL-E surface cultures were identified as having increased risk of neonatal mortality.
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Affiliation(s)
- K Neemann
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA.
| | - E K Olateju
- Department of Pediatrics, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - N Izevbigie
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - G Akaba
- Department of Obstetrics and Gynecology, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - G M Olanipekun
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - J C Richard
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - C I Duru
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - N J Kocmich
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - K K Samson
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - A Rezac-Elgohary
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - E A Anigilaje
- Department of Pediatrics, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - T Yunusa
- Department of Medical Microbiology, University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - C O N Megafu
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - T O Ajose
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - N Medugu
- International Foundation Against Infectious Diseases in Nigeria (IFAIN), Abuja, Nigeria
| | - J Meza
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE, USA
| | - S Obaro
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, USA
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Adeyankinnu FA, Motayo BO, Akinduti A, Akinbo J, Ogiogwa JI, Aboderin BW, Agunlejika RA. A Multicenter Study of Beta-Lactamase Resistant Escherichia coli and Klebsiella pneumoniae Reveals High Level Chromosome Mediated Extended Spectrum β Lactamase Resistance in Ogun State, Nigeria. Interdiscip Perspect Infect Dis 2014; 2014:819896. [PMID: 24790598 PMCID: PMC3982411 DOI: 10.1155/2014/819896] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 01/11/2014] [Accepted: 02/10/2014] [Indexed: 11/29/2022] Open
Abstract
As a result of the ever increasing problem of multiresistant bacteria, we instituted a surveillance program with the aim of identifying the basic molecular properties of ESBL in our environment. About 197 isolates of Escherichia coli and Klebsiella pneumoniae were selected and tested for ESBL production and antimicrobial susceptibility. Plasmid profiles were determined and curing ability was tested. ESBL prevalence was 26.4% for all isolates tested, with E. coli having a greater proportion. There was absolute resistance to ampicilin, tetracycline, and co-trimaxole among tested isolates. There was above average susceptibility to the 2nd and 3rd generation cephalosporins. Plasmid profiles of tested isolates ranged from 9 kbp to 26 kbp with average of 14.99 ± 2.3 kbp for E. coli and 20.98 ± 1.8 kbp K. pneumoniae, 9.6% of ESBL positive E. coli plasmids were cured, while 3.9% of K. pneumoniae plasmids were cured after treatment. The present study shows an upsurge in ESBL acquisition by gram negative bacteria and evidence of cocirculation of varying subtypes of ESBL with both plasmid transmissible and chromosome encoded subtypes. This calls for universal surveillance and more effort towards molecular epidemiology of this public health treatment.
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Affiliation(s)
| | - Babatunde O. Motayo
- Microbiology Unit, Pathology Department, Federal Medical Centre, Abeokuta, Nigeria
| | - Akinniyi Akinduti
- Department of Vet Microbiology and Parasitology, Federal University of Agriculture, Abeokuta, Nigeria
| | - John Akinbo
- Microbiology Unit, Pathology Department, Federal Medical Centre, Abeokuta, Nigeria
| | - Joseph I. Ogiogwa
- Microbiology Unit, Pathology Department, Federal Medical Centre, Abeokuta, Nigeria
| | - Bukola W. Aboderin
- Microbiology Unit, Pathology Department, Federal Medical Centre, Abeokuta, Nigeria
| | - R. A. Agunlejika
- Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
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Healthcare-associated infections in sub-Saharan Africa. J Hosp Infect 2013; 85:257-67. [DOI: 10.1016/j.jhin.2013.09.008] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 09/01/2013] [Indexed: 11/18/2022]
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