EPIDEMIOLOGY OF BACTERIA COLONIZATION AND ICU-ACQUIRED INFECTION IN A NIGERIAN TERTIARY HOSPITAL

Background: Health care associated infection (HCAI) or Hospital acquired infection is associated with significant morbidity, mortality and cost. The incidence is about 6% and disproportionately higher in critically ill patients who may have been immune-compromised with many invasive procedures already performed. Prevention of HCAI and appropriate management of patients in the intensive care unit (ICU) requires knowledge on the pattern of microbial colonization and infections. The aim of this preliminary study was to provide current data on the pattern of ICU acquired infections in our hospital. Patients and Methods: It was a cross sectional study of patients admitted into the ICU who were expected to stay longer than 48hrs between July 2011 and September 2012. Urine, blood, and tracheal aspirate were collected on days 1, 3 and 5 for microbiological studies. All patients involved in the study had urethral catheter in-situ and received mechanical ventilation in the ICU. Results: Fifty-nine patients were recruited into the study. The mean age of the patients was 30.08 + 19.9yr; while the reasons for admissions were respiratory failure (59.3%), cardiovascular instability, trauma and neurological diseases. About 30% of the samples taken from the study sites on arrival in the ICU had positive culture yields. Organisms cultured included Klebsiella oxytoca, Staphylococcus aureus, and Pseudomonas aeruginosa. The urinary tract had the highest number of isolated organisms- 9(60%), followed by equal number of isolated organisms-3(20%) in the blood and respiratory tract. Eleven (73.3%) of the organisms isolated were Gram-negative bacteria, and 4 (26.7%) were Gram-positive cocci. The commonest bacteria isolates were Staphylococcus aureus (4/26.7%) and Klebsiella oxytoca (4/ 26.7%). A total of 15 ICU- acquired infections were detected in 9 of 59 patients. Conclusion: The HCIA infection rate was 15%, and urinary tract infections (UTI) was the commonest hospital acquired infection in our ICU. Klebsiella oxytoca and Staphylococcus aureus were the commonest organisms

Pattern of multidrug resistant bacteria associated with intensive care unit infections in Ibadan, Nigeria

Background: Patients admitted into the intensive care unit (ICU) usually have impaired immunity and are therefore at high risk of acquiring hospital associated infections. Infections caused by multidrug resistant organisms now constitute a major problem, limiting the choice of antimicrobial therapy.Objectives: This study was aimed at determining the antimicrobial resistance pattern of pathogens causing ICU infections in University College Hospital (UCH), Ibadan, Nigeria. The aetiological agents, prevalence and types ICU infections were also determined.Methods: One year hospital associated infections surveillance was conducted in the ICU of UCH, Ibadan. Blood, urine, tracheal aspirate and wound biopsies specimens were collected under strict asepsis and sent to the Medical Microbiology laboratory of the same institution for immediate processing. All pathogens were isolated and identified by standard microbiological methods. Disk diffusion antibiotic susceptibility testing was performed and interpreted according to Clinical and Laboratory Standards Institute (CLSI) guidelines.Results: The overall prevalence of ICU infections was 30.9% out of which 12.9% were bloodstream infections, 31.5% urinary tract infections, 38.9% pneumonia, and 16.7% skin and soft tissue infections. Klebsiella species and Escherichia coli were the predominant pathogens. Multidrug resistant organisms constituted 59.3% of the pathogens, MDR Klebsiella spp and MDR E. coli were 70.8% and 71.4% respectively. Resistance to Cefuroxime was the highest (92.9%) while Meropenem had the least resistance (21.4%).Conclusion: There is a high prevalence of multidrug resistant bacteria causing ICU infections. Application of more stringent infection control procedures and institution of functional antimicrobial stewardship are recommended to combat this problem.Keywords: Healthcare associated infections, Infection control, Antibiotic resistance, Intensive care uni

Profile of bacterial pathogens contaminating hands of healthcare workers during daily routine care of patients at a tertiary hospital in northern Nigeria

Background: Healthcare associated infections (HAIs) have been recognized as a critical challenge affecting the quality of healthcare services provided. A significant proportion of these infections result from cross-contamination of microorganisms which are often acquired and spread by direct contact with patients or contaminated adjacent environmental surfaces through the hands of healthcare workers (HCWs). The objectives of this study are to profile bacterial pathogens commonly found on the hands of health care workers while routinely attending to patients in thehealthcare facility and to determine their antibiotic susceptibility pattern.Methodology: The fingers of the dominant hand of 300 HCWs at the Barau Dikko Teaching Hospital (BDTH), Kaduna, Nigeria, were imprinted on 5% Sheep blood, MacConkey, and Mannitol salt agar plates and incubated at 37°C for 24 hours. Bacteria isolates were identified by Gram staining and conventional biochemical tests. The susceptibility of isolated bacteria to selected antibiotics was determined by the modified Kirby–Bauer disk diffusion method and interpreted using the 2012 guidelines of the Clinical and Laboratory Standards Institute.Results: Bacteria were isolated from the hands of all 300 HCWs, with coagulase negative staphylococci (CONS) being the most frequent (67.0%, 201/300). Other bacteria identified were Staphylococcus aureus (23.7%, MRSA of 3%), Streptococcus pyogenes (2.7%), and Enterobacteriaceae (6%). The isolates were highly sensitive to ofloxacin 96.7% (290/300), augmentin 87.7% (263/300) and ceftriaxone 87.3% (262/300).Conclusion: This study demonstrates a high rate of contamination of hands of HCWs with potentially pathogenic bacteria, some of which were multidrug resistant. Concerted efforts should be made to implement programs dedicated to improve hand hygiene practices in the tertiary health care facility. Keywords: Hand hygiene, bacterial, pathogen, healthcare workers, healthcare associated infection   French title: Profil d'agents pathogènes bactériens contaminant les mains des travailleurs de la santé lors des soins quotidiens de routine auxpatients d'un hôpital tertiaire dans le nord du Nigéria   Contexte: Les infections associées aux soins de santé (IHA) ont été reconnues comme un défi critique affectant la qualité des services de santé fournis. Une proportion importante de ces infections résulte de la contamination croisée de micro-organismes qui sont souvent acquis et propagés par contact direct avec des patients ou des surfaces environnementales adjacentes contaminées par les mains des travailleurs de la santé (TS). Les objectifs de cette étude sont de dresser le profil des agents pathogènes bactériens que l'on trouve couramment dans les mains des travailleurs de la santé tout en s'occupant régulièrement des patients dans l'établissement de santé et de déterminer leur profil de sensibilité aux antibiotiques.Méthodologie: Les doigts de la main dominante de 300 travailleurs de la santé au Barau Dikko Teaching Hospital (BDTH), Kaduna, Nigéria, ont été imprimés sur des plaques de gélose au sang de mouton à 5%, MacConkey et Mannitol et incubés à 37°C pendant 24 heures. Les isolats de bactéries ont été identifiés par coloration de Gram et tests biochimiques conventionnels. La sensibilité des bactéries isolées aux antibiotiques sélectionnés a  été déterminée par la méthode de diffusion sur disque modifiée de Kirby-Bauer et interprétée en utilisant les lignes directrices de 2012 du Clinical and Laboratory Standards Institute.Résultats: les bactéries ont été isolées des mains des 300 TS, les staphylocoques à coagulase négative (CONS) étant les plus fréquents (67,0%, 201/300). Les autres bactéries identifiées étaient Staphylococcus aureus (23,7%, SARM de 3%), Streptococcus pyogenes (2,7%) et Enterobacteriaceae (6%). Les isolats étaient très sensibles à l'ofloxacine 96,7% (290/300), à l'augmentationin 87,7% (263/300) et à la ceftriaxone 87,3% (262/300).Conclusion: Cette étude démontre un taux élevé de contamination des mains des travailleurs de la santé par des bactéries potentiellement pathogènes, dont certaines étaient multirésistantes. Des efforts concertés devraient être faits pour mettre en œuvre des programmes visant à améliorer les pratiques d'hygiène des mains dans les établissements de soins de santé tertiaires. Mots-clés: hygiène des mains, bactérienne, pathogène, personnel de santé, infection associée aux soins de santé       &nbsp

Enterococcus sp. contamination surveillance in different levels of healthcare in eThekwini District, KwaZulu-Natal (KZN) South Africa.

Doctoral Degree. University of KwaZulu-Natal, Durban.Hospital-acquired infections (HAIs) have been identified as long-standing setbacks affecting hospitals' quality of health care. While one of the major challenges related to HAIs is controlling cross-transmission, the role and significance of the inanimate hospital environment chain of transmission are yet to be unequivocally elucidated. Therefore, this study investigated the functional profile and diverseness of bacteria from various inanimate environmental sources, from two different wards in public hospitals at various healthcare levels in eThekwini District, KwaZulu-Natal, South Africa. True to the study focus on investigating the dissemination of bacteria from equipment within the hospital, the study further used Enterococcus as well-known HAI as target bacteria and described the molecular and genomic profiles of this specie isolated from the hospital environments. Samples were collected for a period of three months (September – November 2017) from the four levels of healthcare in eThekwini district, KwaZulu-Natal. The intensive care unit and peadiatic ward were employed in this study. An overall of 620 swabs were collected from areas frequently touched by healthcare workers (HCWs) and patients. These sites include the occupied bed linen, unoccupied bed linen, drip stands, patient files, ward phones, ventilators, nurses' tables, blood pressure apparatus, sinks, linen room door handle and mops. Swabs were placed in Amies transport medium and transported in a cooler box to the laboratory facility to be processed within four hours. The collected swabs (n=620) were pooled and incubated in tryptone soya broth containing 6.5% NaCl at 36.5oC for 24 hrs and subsequently plated on enterococci chromogenic media. The microbial diversity and functional profiles from the sites were identified using 16S rRNA metagenomics. Positive colonies were sub-cultured on bile esculin azide agar, and screened using standard microbiological methods, including haemolytic, oxidase and catalase, and API. Identifications were confirmed with polymerase chain reaction (PCR) with the added genus-specific tuf-gene and species-specific sodA-gene. Antibiotic resistance patterns in the Enterococcus spp. isolates were determined by the Kirby-Bauer disk diffusion method against 14 antibiotics as recommended by the Clinical and Laboratory Standard Institute (CLSI) guidelines. Thirty-seven samples from E. faecalis showed intermediate Resistance to vancomycin and were further analyzed using molecular tools viz. whole-genome sequencing (WGS) and bioinformatics analyses. This enabled determining the resistome, mobile genetic elements (MGEs), and clonal lineages circulating across the sites, wards, and hospitals. Metagenomics identified a total of 288 species, 190 genera, 105 families, 50 orders, 29 classes and 11 phyla from the samples analyzed. The dominant functional metabolic pathways implicated in causing human infection discovered were the signal transduction mechanisms, citrate cycle (TCA), transcription-factor bisphenol degradation, tyrosine metabolism. A total of 295 Enterococcus spp. isolates were recovered from the hospitals` environmental sites, 83% (n=245) were identified as Enterococcus faecium, 13% (n=38) as Enterococcus faecalis, 2% (n=6) Enterococcus gallinarum and another 2% (n=6) Enterococcus casseliflavus. Notably, the pediatric wards had the highest isolation rate compared to ICU, 64% and 36%, respectively. Overall, the sites with the highest isolation rate were occupied beds and mops (to clean ward floors) with 14.9% (n=44) each. The tertiary hospital were the most affected. The most prominent MDR antibiogram for E. faecium was CIP-RIF-NIT-TET-ERY and for WGS analysis of the E. faecalis samples confirmed that the tet(M) and erm(C) genes were the prevalent antibiotic resistance genes found in hospitals. The isolates harboured mobile genetic elements consisting of plasmids (n =11) and prophages (n=14), predominantly clonally specific. The 37 isolates analyzed consisted of 15 clonal lineages with six major sequence types (ST). Phylogenomic analysis showed that major lineages were mostly conserved within specific hospital environments. This study highlighted the inanimate hospital environment as a possible source of opportunistic nosocomial pathogens using Enterococcus as an illustrative example and emphasized the urgent necessity to optimize infection prevention and control measures to intercept/moderate the spread of bacteria in the hospital environments

Infections and antimicrobial resistance in intensive care units in lower-middle income countries: a scoping review

Background: Intensive care units (ICUs) in lower-middle income countries (LMICs) are suspected to constitute a special risk for patients of acquiring infection due to multiple antibiotic resistant organisms. The aim of this systematic scoping review was to present the data published on ICU-acquired infections and on antimicrobial resistance observed in ICUs in LMICs over a 13-year period. A systematic scoping review was conducted according to the PRISMA extension guideline for scoping reviews and registered in the Open Science Framework. Main body of the abstract: Articles were sought that reported on ICU-acquired infection in LMICs between 2005 and 2018. Two reviewers parallelly reviewed 1961 titles and abstracts retrieved from five data banks, found 274 eligible and finally included 51. Most LMICs had not produced reports in Q1 or Q2 journals in this period, constituting a large gap in knowledge. However, from the reported evidence it is clear that the rate of ICU-acquired infections was comparable, albeit approximately 10% higher, in LMICs compared to high income countries. In contrast, ICU mortality was much higher in LMICs (33.6%) than in high income countries (< 20%). Multidrug-resistant Gram-negative species, especially Acinetobacter baumannii and Pseudomonas aeruginosa, and Klebsiella pneumoniae played a much more dominant role in LMIC ICUs than in those in high income countries. However, interventions to improve this situation have been shown to be feasible and effective, even cost-effective. Conclusions: Compared to high income countries the burden of ICU-acquired infection is higher in LMICs, as is the level of antimicrobial resistance; the pathogen distribution is also different. However, there is evidence that interventions are feasible and may be quite effective in these settings. Protocol Registration The protocol was registered with Open Science Framework (https://osf.io/c8vjk

Pattern of pathogens from surgical wound infections in a Nigerian hospital and their antimicrobial susceptibility profiles

Background: In surgical patients, infection is an important cause of morbidity and mortality. A prospective study to find the pattern of microorganisms responsible for post operative wound infections and their antibiotic susceptibility profile was therefore conducted.Setting and Methods: Surgical wards in Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Isolation, identification and antimicrobial susceptibility screening of organisms were done employing standard microbiological techniques.Results: Bacterial pathogens were isolated from all the specimens while the yeast Candida species (spp) was isolated from 12.4%. Staphylococcus aureus was the most frequent organism isolated accounting for 23 (18.3%) of a total of 126 isolates. Other organisms were Pseudomonas aeruginosa and Bacillus spp 11.1% each; Escherichia coli 10.3%; Candida spp 8.7%; Coagulase negative staphylococci 8.7%; Pseudomonas spp 6.3%; Serratia odorifera 4.7%; Bacteroides 4.0%; Enterococcus spp 3.2%; the remaining isolates were other enterobacteria. Sensitivity of the bacterial isolates to antibiotics varied. In general, resistance to the β-lactam antibiotics was above 98%, whilst more than 70% of isolates were resistant to erythromycin, fusidic acid and tobramycin.Conclusions:The infections were polymicrobic and multidrug resistant. The quinolones, ciprofloxacin and ofloxacin, should be used as frontline drugs in the management of surgical wound infections at the hospital.Keywords: surgical wound infections, susceptibility, bacterial pathogens, antibiotic

Prevalence of hospital acquired enterococci infections in two primary-care hospitals in Osogbo, Southwestern Nigeria

Enterococci are opportunistic bacteria that become pathogenic when they colonize niches where they are not normally found. Of recent, they have become major cause of nosocomial infections, especially of the bloodstream, urinary tract and surgical sites. The aim of this study is to determine the point‐prevalence rate of human enterococci infections among hospitalized patients in Osogbo, Nigeria. The study was conducted between January and June 2009 in two primary‐care hospitals in Osogbo and involved a total of 118 patients who developed clinical evidence of infection at least 48 hours after hospital admission. Appropriate clinical samples were collected from the patients after an informed consent and cultured for isolation/biochemical identification of Enterococcus species at the Bacteriology Laboratory of Ladoke Akintola University of Technology, Osogbo using standard microbiological methods. There were 525 hospital admissions within the time frame of the study of which 118 (22.5%) developed hospital acquired infection (HAI); 58 (49.2%) of which cultured positive for bacterial pathogens. Enterococci were isolated from infective focus in 7 patients, giving a prevalence rate of hospital‐acquired enterococci infection of 5.9%. Two species of Enterococcus were identified; Enterococcus faecalis from urinary tract infection (UTI) and surgical site infection (SSI) of 6 (85.7%) patients and Enterococcus faecium from UTI in 1 (14.3%) patient. Other bacteria recovered from other infective foci were Klebsiella spp 31.0%, Pseudomonas spp 20.7%, Staphylococcus aureus 17.2%, Escherichia coli 12.1%, Staphylococcus epidermidis 3.4%, Streptococcus pneumoniae 1.7% and Serratia spp 1.7%. All the enterococci isolates were multiply antibiotic resistant, and 42.9% were vancomycin‐resistant enterococci (VRE) with the VRE strains showing resistance to wider range of antibiotics than the vancomycin‐sensitive strains. Other Gram‐positive and Gram negative bacterial isolates also demonstrated multiple resistance to all commonly available antibiotics in this community except E. coli and Pseudomonas spp which were relatively sensitive to ciprofloxacin and ceftazidime. This limited study demonstrated a high prevalence rate of multiple antibiotic resistant enterococci infections among hospitalized patients in this environment. There is need for systematic surveillance of hospitals for enterococci infections; prudent use and rational prescription of antibiotics and stringent measures to reduce the prevalence rate by health education on infection control measures such asisolation, cleaning, disinfection and sterilization.Keywords: Nosocomial, Prevalence, Enterococcus, Vancomycin‐Resistance, Primary Car

Health Care Associated Infections (HCAIs) a New Threat for World; U-Turn from Recovery to Death

Health care associated infections also termed as nosocomial infections are notable cause of morbidity and mortality especially in resource limited countries like Pakistan. Newborns and aged people have more probability of being infected by Health care associated infections because of immunosuppressant. Central line associated blood stream infections (CLABSI) are considered as one of the promising negotiator associated with Health Care associated infections. Improper health care setting and unaware medical staff play a championship protagonist in prevalence of health care associated infections. Standard hygienic measures should be adopted to reduce risk of Health care associated infections. So, there is a pressing need to take on control policies by Government to handle this dilemma. This chapter gives new intuition to healthcare associated microbes, infections and provides comprehensive detailed on ironic precaution to scientific community