Methicillin resistant Staphylococcus aureus: awareness, knowledge and disposition to screening among healthcare workers in critical care units of a Nigerian hospital

BACKGROUND

Awareness level about methicillin resistant Staphylococcus aureus (MRSA) is high in the western world but the status in developing countries is not well defined.

OBJECTIVE

To assess MRSA awareness level, knowledge and disposition to screening among critical healthcare givers (HCGs) in Nigeria.

METHODS

A self-administered questionnaire was used to assess the level of awareness and knowledge of HCGs in critical care units of the University of Ilorin Teaching Hospital, Ilorin, Nigeria on MRSA and their willingness to submit to screening.

RESULTS

Only 103 (52.0%) of the 198 participants were aware of MRSA but all were favourably disposed to screening for the organism. Awareness was through hospital rounds 65(63.1%) and journals/ textbooks 35(34.0%), and Many, 120 (60.6%) considered MRSA as a threat in the hospital, while only 27 (13.6%) thought otherwise and 51(25.8%) were indifferent. Most HCGs, 124 (87.9%) reported that there were no MRSA control measures in their respective duty post. The age, cadre of work, and number of years in the hospital's critical care units correlated positively with awareness level.

CONCLUSION

Methicillin resistant Staphylococcus aureus awareness level among the HCGs in our hospital is just a little above 50.0% with substantial proportion of them not realizing the medical implication of the organism. However, majority are well disposed to MRSA screening. Inadequate publicity is a major contributor to poor knowledge and awareness. There is need for educational intervention and sensitization programs on MRSA and other infection control techniques for HCGs in developing nations especially Nigeria.

Endometrial tuberculosis in the Nigerian middle belt: an eight-year review

Endometrial tuberculosis (TB) is a known cause of infertility in women which, because of the global increase in the spread of TB, should always be considered when investigating the cause of infertility. We undertook this review in order to determine its incidence among infertile women in the Nigerian middle belt. This is a retrospective study of all histopathological slides of infertile women seen at the University of Ilorin Teaching Hospital, Ilorin, Nigeria, between 1997 and 2004 who were evaluated for infertility by endometrial biopsy. The slides were reviewed and, where necessary, new sections were cut from tissue blocks and stained with haematoxylin and eosin. Ziehl-Neelsen stain used to demonstrate acid-fast bacilli. Clinical reports were extracted from histopathological request form. A total of 661 patients were included in the study. Primary infertility constituted 30%, secondary 69% and unspecified cases 1%. TB endometritis was seen in 0.45%. Endometrial TB is not a frequent cause of infertility in our set-up. However, with the worldwide resurgence of TB, its possible presence should always be taken into consideration.

Non-gonococcal bacterial agents of conjunctivitis and their antibiotic susceptibility patterns in Ilorin, Nigeria

Periodic bacteriological surveillance of purulent ocular discharge is a necessity. To determine the prevalent bacterial agents of purulent conjunctivitis and their antibiotic susceptibility patterns at the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria. All bacterial isolates obtained during routine processing of conjunctival swab specimens were studied at the Department of Microbiology UITH between January and December 2004. The isolates were obtained after inoculation of the specimens onto blood, chocolate and MacConkey agar plates, incubated at 37 degrees C for 18-24hours under aerobic conditions except for chocolate agar plates which were kept in candle extinction jar. The isolates were identified using a combination of colony morphology, biochemical and/or serological tests as applicable. Antibiotic sensitivity testing was performed using the modified Kirby Bauer method. One hundred and four conjunctival swabs from 104 patients were analysed and 72 were bacteriologically positive, giving prevalence rate of 69.2%. The positive samples were from 42 males and 30 females with M:F ratio of 1.4:1. The age range was from 5 hours of life to 80 years. Well over half (61.1%) of the swabs were from neonatal age group. The isolated organisms included Staphylococcus aureus 43.1%, Klebsiella pneumoniae 22.2%, Pseudomonas aeruginosa 3.9%, Streptococcus pneumoniae 11.1%, and Escherichia coli 9.7%. Most of the isolates were sensitive to fluoroquinolones while erythromycin has the least bacterial coverage. The most common bacterial agent of purulent conjunctivitis in Ilorin is Staphylococcus aureus and fluoroquinolones have the best coverage for common bacterial agents of purulent conjunctivitis.

Campylobacter enteritis in Ilorin, Nigeria

BACKGROUND

Campylobacterje junilcoli is one of the most commonly identified bacterial causes of acute gastroenteritis worldwide. In Nigeria, it has been reported in the northern part of the country, extensive work has also been done in the south-west leaving behind the middle-belt of the country.

OBJECTIVE

To determine the role of Campylobacter jejunilcoli as an agent of diarrhoea in the middle-belt of Nigeria.

DESIGN

A prospective case control study.

SETTING

University of Ilorin Teaching Hospital (UITH), private hospitals and primary health centers all in Ilorin, Nigeria.

SUBJECTS

Three hundred and six children with diarrhoea and 100 without diarrhoea were randomly selected.

MAIN OUTCOME MEASURES

Isolation of Campylobacter jejuni/coli from stool samples. Biological characteristics of the isolates.

RESULTS

Twenty five (8.2%) of the patients and none of the controls had the organism. Campylobacter jejuni and C. coli were 56% and 44% respectively. All the isolates were susceptible to erythromycin and ciprofloxacin. None of the isolates harboured plasmids.

CONCLUSION

C. jejunil coli is an important diarrhoea agent in our geographic environment, further characterisation is desired of these local strains.

Bacterial pneumonia in the AIDS patients

OBJECTIVE

To determine the incidence, microbiological pattern and prognostic factor of bacterial pneumonia in AIDS patients.

STUDY DESIGN

Prospective study of AIDS patients from July 2001 to Dec 2002.

METHODOLOGY

Adults AIDS patients on HAART drugs that develop acute fever, cough with bronchial breathing or lung crepitations had diagnostic evaluation that included chest x-ray, paired sputum microscopy, culture and sensitivity, paired blood culture and haematological profiles including CD4' cell count.

RESULTS

Twenty-one patients (22.6%), 9 males and 12 females developed community acquired pneumonia during this 16-month period. Pneumonia was confirmed in 9 patients (42.9%), presumed in 4 (19%) and probable in 8 (38%). Streptococcus pneumoniae accounted for 22% of the cases when immunity was less impaired. Staplhylococcus aureus accounted for another 22 % while Klebsiella pneumoniae, Pseudomonas aeraginosa and Escherichial coli were isolated in 11% each when immunity was severely compromised. Fifteen patients (71.4%) were successfully treated with routine antibiotics. Six cases (28.6%) died. All had anaemia, leucopoenia and low CD4 cell count. Four (66.7%) of this had positive bacterial culture with bacteremia in three of them.

CONCLUSION

Bacterial pneumonia in HIV-infected patients has similar presentation to that in the general population, Staphylococcus aureus and gram-negative bacilli especially Klebsiella pneumoniae were seen in a good proportion of the cases. Outcome of treatment was poor in the presence of positive bacterial culture, anemia, leucopoenia and very low CD4+ lymphocytes.

Bacterial isolates of blood cultures in patients with suspected septicaemia in Ilorin, Nigeria

Periodic bacteriologic surveillance of blood cultures is a necessity. To determine currently prevalent bacterial pathogens of blood cultures in patients with suspected septicaemia in Ilorin. Nigeria. Three thousand and fifty-seven patients from all age and sex groups with clinical suspicion of septicaemia underwent bacteriologic screening of their blood specimen over a 13 month period starting from January. 2003. Twenty point three percent were positive for bacterial growth. An incidence of 41.7 per 1000 admissions was recorded which was a statistically significant (p< 0.05) marginal increase when compared with the previous incidence of 37.9 per 1000 admissions from this centre. Majority of the isolates were gram negative (51.61%) though the single predominant isolate was Staphylococcus aureus (35.85%). Other isolates included Escherichia coli (32.48%), Klebsiella pneumoniae (11.74%), Proteus spp (0.32%), coagulase negative Staphylococcus (1.61%), Salmonella typhi (0.48%). beta-hemolytic Streptococcus (0.48%) and Acinetobacter spp (0.32%). No anaerobe was isolated. Most isolates were sensitive to fluoroquinolones (ofloxacin, perfloxacin and ciprofloxacin) and third generation cephalosporins (ceftriaxone and ceftazidime) except Acinetobacter that was 100% resistant to both groups of antibiotics. Gram positive isolates were resistant to the second generation cephalosporin, cefuroxime. We hereby recommend the use of combination of a third generation cephalosporin and fluoroquinolones where not contraindicated, in the empiric treatment of septicaemia before sensitivity results are available.

Antibiotic disc sensitivity pattern of pseudomonas aeruginosa isolates obtained from clinical specimens in Ilorin, Nigeria

The choice of antibiotics used for first line treatment of infectious disease depends largely on previously known antibiogram within a specified locality among other factors. Antibiotic sensitivity pattern of Pseudomonas aeruginosa isolates obtain from clinical specimen in Ilorin, Nigeria was studied over a 12 month period, starting from January 2003. A total of 102 isolates were recovered from various clinical specimens and their antibiotic sensitivity patterns were determined by disc diffusion method on antibiotic sensitivity agar (ASA). Single antibiotic discs (AD) were used. The isolates were incubated at 37 degrees C for 18-24 hours following inoculation on ASA and application of AD before the results were read. Most isolates were sensitive to ofloxacin (77.6%), cefuroxime (76.6%), ciprofloxacin (75.3%), perfloxacin (66.0%), streptomycin (64.0%) and gentamicin (59.8%). Appreciable resistance to ceftazidime (50.7%) and increasing resistance to gentamicin (40.2%) than is previously known, were recorded. Urinary isolates were generally more resistant than isolates from other sources. Majority of the isolates were recovered from patients attending the general out-patient department of the hospital indicating extension of multi-drug resistant microbial isolates beyond hospital settings. Review of antibiotic sensitivity pattern of clinical isolates regularly and the antibiotics prescribing policy in the country is advocated. Combination of quinolones and aminoglycosides, where these are no contraindications, is recommended for first line treatment of suspected cases of Pseudomonas aeruginosa infections because of non-availability of anti-pseudomonad drugs in the country.