Secondary bacterial isolates from previously untreated Buruli ulcer lesions and their antibiotic susceptibility patterns in Southern Nigeria

Abstract INTRODUCTION: Mycolactones, secreted by Mycobacterium ulcerans, were previously believed to prevent super infection in Buruli ulcer lesions. However, little is known about secondary bacterial infections in these lesions. This study evaluated contaminating bacterial flora and their antibiotic susceptibility patterns in cases of previously untreated Buruli ulcer disease from three states in Southern Nigeria. METHODS A prospective analysis was conducted between January and June of 2015 using wound swabs from eligible patients with Buruli ulcer disease, confirmed by quantitative-polymerase chain reaction, with active ulcers. Microbiological analyses including isolation of bacteria, species identification of isolates, and drug susceptibility tests were performed. RESULTS Of 51 patients, 27 (52.9%) were female. One or more bacterial species of clinical importance was isolated from each patient. A total of 17 different microbial species were isolated; 76.4% were Gram-negative and 23.6% were Gram-positive isolates. The most common bacterial species detected was Staphylococcus aureus (24%), followed by Aeromonas hydrophila (13%), Pseudomonas aeruginosa (13%), and Klebsiella pneumoniae (11%). Drug susceptibility tests showed a particularly high frequency of resistance to commonly used antimicrobials in Nigeria for Staphylococcus aureus. CONCLUSIONS Super bacterial infections occur in Buruli ulcer lesions in Nigeria, and these infections are associated with high rates of resistance to commonly used antibiotics in the country

National Surveillance Of Surgical Site Infections In Nigeria – Development Of Protocol And Data Collection Tools

Background: Surgical site infections (SSI) significantly impact on morbidity of patients and are known to prolong stay in hospital, add significantly to cost of healthcare and could lead to mortality. It is important therefore to monitor the trends of SSI in order to developstrategies to reduce the burden of the condition. To address this, SSI surveillance is increasingly being carried out in many countries and also serves as an effective measure of quality healthcare in surgical facilities.Aim: Our aim was to develop a protocol and tools that can be used for surveillance of surgical site infections nationally and could be adapted for use in other resource limited settings.Methods: Aworking group with expertise in infection prevention and control, medical microbiology, obstetrics and gynaecology, surgery and epidemiology/public health identified from various Nigerian academic institutions, tertiary hospitals and the implementingpartner African Field Epidemiology Network (AFENET) came together over a period of six months from November 2016 to April 2017 in Abuja, Nigeria to develop SSI surveillance protocol and tools for the country. Literature review of relevant SSI protocols, guidelines, case definitions and surveillance tools were carried out by the group and these were used to guide the development of the case definitions,protocol and tools. The final version was arrived at by consensus using identified best practices and modified to suit the local context.Results: A surveillance protocol and simple data collection tools consisting of the data entry forms and the data summary template worksheet were then developed which has the potential to harmonize SSI surveillance data collection in all surgical healthcare facilities in Nigeria.Conclusions: These documents are anticipated to provide standardized and uniform approach for objective generation of SSI  surveillance report and would serve as a good template for the development of surveillance protocol and tools for other Healthcare Associated Infections. Keywords: Surgical site infections, Protocol development, Data collection tools, HAI Surveillance, Nigeri