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

Cryptosporidiosis In Hiv Infected Patients With Diarrhoea In Osun State Southwestern Nigeria

Aim: Although cryptosporidiosis is said to be rare among adult HIV patients in certain parts of Nigeria, there are no documented studies on the occurrence of this parasite among HIV patients in Southwestern Nigeria. Methods: We conducted a cross sectional study involving 150 patients (100 HIV infected and 50 HIV negative) with diarrhoea from two tertiary and one secondary health institutions in Southwestern Nigeria. Concentrated stool sample from each patient was screened for cryptosporidium oocysts with the modified cold Ziehl Neelsen method while direct sample was screened for other enteric parasites. Results: The overall parasite prevalence rate in the diarrhoea patients is 79.3% (119/150) with Cryptosporidium parvum 52.7%, Ascaris lumbricoides 11.3%, Hookworm 3.3%, Trichuris trichura 2% and Entamoeba histolytica 10%. The parasite prevalence rate in HIV infected patients is 97% while in HIV-negative patients, the rate is 44%. The rate is significantly higher among HIVinfected patients with diarrhoea than among HIV-negative patients with diarrhoea (OR=41.152, 95%CI=11.467-147.68, P<0.0001). However this difference is attributed to Cryptosporidium which was found exclusively among HIV-infected patients. When Cryptosporidium prevalence was excluded from analysis, the parasite prevalence rates between the two groups was not significantly different (X2=0.8002, df=3, P=0.8494). Conclusion: Contrary to a previous report of apparent rarity of cryptosporidium infections in certain parts of Nigeria, this study revealed a high prevalence of this parasitosis among HIV infected patients in Southwestern Nigeria

Access to the World Health Organization-recommended essential diagnostics for invasive fungal infections in critical care and cancer patients in Africa: A diagnostic survey

Background: Invasive fungal infections (IFIs) contribute to significant morbidity and mortality among patients with haemato-oncological conditions, seriously ill hospitalised patients and those in intensive care (ICU). We surveyed for the World Health Organization-recommended essential diagnostic tests for IFIs in these risk groups in Africa. Methods: The Global Action For Fungal Infections (GAFFI) evaluated the different levels of access to both diagnostics for IFIs for populations in Africa, with the aim of building a comparative dataset and a publicly available interactive map. Data was collected through a validated questionnaire administered to a country leader in relevant topics (i.e., HIV, laboratory coordination) and/or Ministry of Health representatives and followed up with 2 rounds of validation by video calls, and later confirmation by email of findings. Results: Initial data was collected from 48 African countries covering 99.65 % of the population. Conventional diagnostics such as blood cultures, direct microscopy and histopathology were often used for diagnosis of IFIs in more than half of the facilities. Bronchoscopy was rarely done or not done in 20 countries (population 649 million). In over 40 African countries (population >850 million), Aspergillus antigen testing was never performed in either the public or private sectors. Computed tomography (CT) imaging is routinely used in 27 (56 %) of countries in the public sector and 21 44 %) in the private sector. However, magnetic resonance imaging remains relatively uncommon in most African countries. Conclusions: There are critical gaps in the availability of essential diagnostics for IFIs in Africa, particularly Aspergillus antigen testing and modern medical imaging modalities. Early diagnosis and commencement of targeted therapy of IFIs are critical for optimal outcomes from complex cancer therapies