Profile of Infections in Intensive Care Unit (Icu) in a Central Nigeria Tertiary Hospital

Background: Intensive Care Units (ICUs) accommodate the most seriously ill patients in a relatively confined environment. Increased duration of stay, increased number of indwelling and invasive devices and prolonged or inappropriate use of antibiotics are common features of ICUs, with consequent or associated increase in selection of multi-resistant  pathogens, morbidity and mortality.Objectives: To determine the identity and antimicrobial resistance pattern of organisms commonly associated with infections in the ICU of the hospital.Method: A retrospective study of Intensive Care Units (ICU) infections in NHA over a three-year period January 1st, 2010 to December 31st, 2012 was conducted through review and analysis of laboratory data.Results: Data for 79specimens were fully analysed; 35(44%) from urine, 17 (22%) from blood, 6 (8%) from tracheal specimens and 8 (10%) from wound. Forty-one (52%)of the specimens yielded growth;16 (20%) from urine, 8 (10%) from wound, 6 (8%) from tracheal specimens,3(4%) from blood and others 8(10%). 14(34%) out of the 41 isolates were Escherichia coli, 8 (20%) Pseudomonas aeruginosa, 6 (15%) were Staphylococcus aureus and 6 (15%) Klebsiella pneumoniae. Three (4%) of the specimensyielded mixed growths while another 3 (4%) yielded Candida species. Sensitivity of E. coli to third generation cephalosporins ranged from 62-72%and 90% to imipenem. For Klebsiella pneumoniae it was 67-75% to third generation cephalosporins and 100% to imipenem. Pseudomonas aeruginosa was 71% and 83% sensitive to ceftazidime and imipenem respectively. Staphylococcus aureus was 67% and 83% sensitive to amoxicillin-clavulanate and imipenem respectively. Susceptibility of allthese isolates to fluoroquinolones and aminoglycosides remained poor.Conclusion: The isolates from the ICU were same as common in clinical specimens. There was wide variability in resistance with a tendency to increase over time. This trend needs to be monitored while antibiotic stewardship should be emphasised.Key words: Intensive care units (ICU), nosocomial Infections, antibiotic susceptibility

Laboratory information management in a central Nigerian hospital: non-collected or undelivered reports as quality indicator

Background: Reporting laboratory reports to the requesting physician is one vital component of the clinical laboratory testing process. Poor management of information generated in the laboratory, such as non collection/non-delivery of test reports, can adversely affect patient care and safety.Aim: To determine the proportion and financial impact of some laboratory test reports not collected or delivered to the requesting physician.Methods: A review of laboratory records of requests and collected reports of malaria parasite, urine microscopy, culture and sensitivity, and blood culture from June 2014 to December 2014 was carried out, and data analyzed.Results: A total of 5321 laboratory requests comprising 4506 malaria parasites (MP), 414 urine microscopy, culture and sensitivity (urine m/c/s), and 410 blood culture were made, processed and reports generated. Of these, 1040 (19.6%) were not collected or delivered to the requesting physician. Urine m/c/s with 37.9% (157/414) accounted for the highest test-specific non-collected reports, closely followed by blood culture with 37.7% (151/401) and MP with 16% (732/4506). ICU with 54.6% (18/33) and A&E with 21% (149/710) accounted for the highest department-specific non-collected or undelivered reports. The cost of all non-collected or delivered reports was N1, 442,560 or 29.3% of the cost of the total requests during the study period.Conclusion: The proportion of non-collected or undelivered test reports as seen in this study is huge, and indicates a poor laboratory information management system. There is therefore, need to institute and implement appropriate laboratory quality management system to improve patient care and reduce wastage of resources.Keywords: Information management, Laboratory Report, Central Nigeri

Antibiogram of bacterial agents of lower respiratory tract infections in a central Nigerian hospital

BACKGROUND: Lower respiratory tract infections (LRTIs) are one of the major public health concerns in Nigeria. They are associated with significant morbidity and mortality in children and adults.AIM: To identify bacterial causative agents of lower respiratory tract infections and to determine their antibiotic susceptibility profile to locally available antibiotics.METHODS: This was a retrospective study conducted at National Hospital Abuja (NHA). Laboratory data of processed sputum samples of patients with suspected lower respiratory tract infection at National Hospital Abuja were extracted, reviewed and analyzed from 1st January 2016- 1st December 2016. RESULT: Out of the six hundred and thirteen cases, 89 (14.5%) had an established bacterial cause. The prevalence of LRTIs was higher in males (56.1%) than females. Age group 21-40 (25.8%) had the highest cases of LRTIs followed by those aged 41- 60 (20.2%). Klebsiellapneumoniae (52.8%) was the most predominant isolates, followed by Pseudomonas aeruginosa (15.7%), Staphylococcus aureus (13.5%), Escherichia coli (7.9%), Enterococcus spp (5.6%) and Proteus spp (4.5%). The predominant bacterial pathogens were generally highly susceptible to fluoroquinolones, aminoglycosides and carbapenems.CONCLUSION: Klebsiellapneumoniae was the most common bacterial causative agent of LRTIs in Abuja. Fluroquinolones, aminoglycosides and carbapenemsare antibiotics of good choice for empiric management of this infection in this locality. Regular monitoring of trends of this aetiologic agent and its antimicrobial susceptibility profile is important in effective management of these infections.KEY WORDS: Antibiogram, Bacterial Isolates, LRTIs, National Hospital Abuja, Nigeri

Urinary tract infections in a Tertiary Hospital in Abuja, Nigeria

Background: Urinary tract infections (UTIs) are among the most common bacterial infections. In uncomplicated cases the infection is easily treated with a course of antibiotic, but there is increased resistance to many of these antibiotics.Objective: To determine the profile of UTI among patients using National Hospital Abuja and the antibiotic susceptibility profile of isolated uropathogens.Methods: This prospective study was carried out at the department of Medical Microbiology of National Hospital, Abuja over a period of three years (January 2010 – December 2012). A total of 6763 urine samples were analyzed for age, gender, distribution, yield and antibiotics sensitivity.Results: Of 6763 urine samples, 885 (13.1%) yielded uropathogens, with the highest percentage yield in the below one year and above 57 years age groups. The mean age was 33.9 years and modal group was 25 -32 years. The most common isolates were Escherichia coli 323 (37%) and Klebsiella spp 202 (25%). Although more infections occurred in outpatients than inpatients, the rate was more with inpatients (36% vs 11%). 97% of Klebsiella spp, 89% of E coli and 83% of P.aeruginosa were sensitive to imipenem, while their respective sensitivities to amikacin were 65%, 98% and 96% Most isolates showed high levels of resistance to many other antibiotics tested.Conclusion: High levels of resistance exist among uropathogens in our study area. This calls for regular surveillance and improved antibiotic stewardship.Keywords : Urinary tract infection, National Hospital Abuja, antibioti

Neonatal infections caused by Escherichia coli at the National Hospital, Abuja: a three-year retrospective study

Background: Escherichia coli (E.coli) has been implicated as a common cause of both early and late onset neonatal infections. The emergence of different strains of E.coli that are multiply resistant to commonly used antibiotics has made continuous antibiotics surveillance relevant. Knowledge about common infections caused by E.coli as well as its antibiotics susceptibility pattern will guide paediatricians in choosing appropriate antibiotics for empirical treatment of neonatal infections.Methods: A retrospective study of E.coli neonatal infections in NHA was conduct for the period 1st January 2010 to 31st December 2012. The records of all specimens submitted to the Medical Microbiology laboratory within the neonatal period (first 28 days of life) were examined and data about E.coli isolates and their antibiotics susceptibility pattern were retrieved and evaluated.Results: 251(33.2%) bacteria were isolated out of a total of 757 specimen submitted for analysis within the period under review. 17(6.8%) were E.coli; 16 were from soft tissue specimen and one from blood. There was no isolate of E.coli from CSF. Most of the isolates were resistant to commonly used antibiotics for treatment of neonatal infections. Three isolates were resistance to amoxicillin-clavulanate and ceftriaxone. One isolate was resistance to amoxicillin-clavulanate, ceftriaxone and imipenem. 100% and 80% of the strains tested were susceptible to amikacin and imipenem respectively.Conclusion: E.coli is third among the gram negative bacteria isolated within the period under review. Most of them were resistant to commonly used antibiotics for treating neonatal infections but, susceptible to amikacin and imipenem. There is need for regular antibiotics resistance surveillance and stewardship.Keywords: Neonates, E.coli Infections, Antibiotics Resistance, Abuja

A profile of wound infections in National Hospital Abuja

Background: Wound Infections cause prolonged hospital stay, increased costs and also can result in increased patient morbidity and mortality.The current spread of multi -drug resistant bacteria has further heightened the need for regular bacteriological review of infected wounds and regular antibiotics surveillance studies so as to avoid the unguided empirical treatment of wound infections which is quite common in this environmentAim: To determine the distribution of the isolates from wound specimens submitted to the medical microbiology laboratory of National Hospital Abuja for processing.Method: A review and analysis of 380 woundspecimens results from various wards in the hospital over a period of 10 months (1st Marto Dec 31st 2010) was conducted.Result: A total of 314 isolates were recovered from the 380 wound specimens giving a yield of 83%. 240(76%) yielded single isolates of various pathogens, while 74(24%) were poly-microbial. Gram negative bacilli constituted 66% of all the pathogens with Pseudomonas aeruginosa (19%) and Proteus species (18%) as the most frequent, while gram positive isolates made up 33% with S aureus (27%) as most predominant and most frequently isolated bacteria from all the wound specimens. Two candida species comprised about 1% of the isolates. Frequency of infection was highest in surgical wards (27%), gynaecology ward (14%) and accident and emergency unit (12%). The fluoroquinolones, aminoglycosides, and Beta-lactam antibiotics were the most effective drugs for most of the isolates. Staphylococcus aureus was most sensitive to amikacin (83%) and erythromycin (79%); Pseudomonas aeruginosa to imipenem (96%) and amikacin (83%) and Proteus species to amikacin (100%) and imipenem (78%).Conclusion: S aureus, Pseudomonas aeruginosa and Proteus species were the predominant bacteria from wounds, with surgery and gynaecology wards having the highest prevalence. Resistance to commonly used antibiotics is high. There is need to institute antibiotic stewardship and effective and efficient infection control measures in the hospitalKeywords: Wound infections, National Hospital , Abuj

Urine culture contamination: a one-year retrospective study at the national hospital, abuja

Background: Urine culture contamination is a significant cause of delay in treatment of patients being investigated for urinary tractinfection. Though contamination is not completely avoidable, several measures have been proven to decrease contamination rates.There are few studies detailing urine contamination rates in laboratories in Nigeria.Aim: To determine the frequency and factors associated with urine culture contamination in samples submitted to the MedicalMicrobiology Laboratory in National Hospital Abuja (NHA).Method: Retrospective study of urine culture contamination in which data from Medical Microbiology Laboratory from January 1 toDecember 31 2012 at National Hospital Abuja were reviewed. Patients’ age, gender, location and urine culture result were assessed.Contamination rates for different genders, age groups and departments were assessed and results presented in simple averages andpercentages.Results: Overall contamination rate was 13.1%. Females had a contamination rate of 16.9%, which was significantly higher than thecontamination rate of 6.8% in males. The Gynaecology and Antenatal clinics had the highest contamination rates amongst departmentswith 22.5% and 21.3% respectively. Lowest contamination rates were in Emergency Paediatric Unit (EPU) and intensive Care Unit (ICU)with rates of 5.9%and 9.5% respectively. The female gender was found to be the most significant predictor of higher contamination rate.Conclusion: Contamination rate of urine cultures in this study is unacceptably high. Appropriate interventions need to be instituted toreduce the current urine culture contamination rate in National Hospital Abuja.Key Words: Urine, Contamination, National Hospital, Abuja

Predictors of positive blood culture and deaths among neonates with suspected neonatal sepsis in a tertiary hospital, Mwanza- Tanzania

Neonatal sepsis is a significant cause of morbidity and mortality in neonates. Appropriate clinical diagnosis and empirical treatment in a given setting is crucial as pathogens of bacterial sepsis and antibiotic sensitivity pattern can considerably vary in different settings. This study was conducted at Bugando Medical Centre (BMC), Tanzania to determine the prevalence of neonatal sepsis, predictors of positive blood culture, deaths and antimicrobial susceptibility, thus providing essential information to formulate a policy for management of neonatal sepsis. This was a prospective cross sectional study involving 300 neonates admitted at BMC neonatal unit between March and November 2009. Standard data collection form was used to collect all demographic data and clinical characteristics of neonates. Blood culture was done on Brain Heart Infusion broth followed by identification of isolates using conventional methods and testing for their susceptibility to antimicrobial agents using the disc diffusion method. Among 770 neonates admitted during the study period; 300 (38.9%) neonates were diagnosed to have neonatal sepsis by WHO criteria. Of 300 neonates with clinical neonatal sepsis 121(40%) and 179(60%) had early and late onset sepsis respectively. Positive blood culture was found in 57 (47.1%) and 92 (51.4%) among neonates with early and late onset neonatal sepsis respectively (p = 0.466). Predictors of positive blood culture in both early and late onset neonatal sepsis were inability to feed, lethargy, cyanosis, meconium stained liquor, premature rupture of the membrane and convulsion. About 49% of gram negatives isolates were resistant to third generation cephalosporins and 28% of Staphylococcus aureus were found to be Methicillin resistant Staphylococcus aureus (MRSA). Deaths occurred in 57 (19%) of neonates. Factors that predicted deaths were positive blood culture (p = 0.0001), gram negative sepsis (p = 0.0001) and infection with ESBL (p = 0.008) or MRSA (p = 0.008) isolates. Our findings suggest that lethargy, convulsion, inability to feed, cyanosis, PROM and meconium stained liquor are significantly associated with positive blood culture in both early and late onset disease. Mortality and morbidity on neonatal sepsis is high at our setting and is significantly contributed by positive blood culture with multi-resistant gram negative bacteria

Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries:results of an internet-based global point prevalence survey

Summary: Background: The Global Point Prevalence Survey (Global-PPS) established an international network of hospitals to measure antimicrobial prescribing and resistance worldwide. We aimed to assess antimicrobial prescribing and resistance in hospital inpatients. Methods: We used a standardised surveillance method to collect detailed data about antimicrobial prescribing and resistance from hospitals worldwide, which were grouped by UN region. The internet-based survey included all inpatients (adults, children, and neonates) receiving an antimicrobial who were on the ward at 0800 h on one specific day between January and September, 2015. Hospitals were classified as primary, secondary, tertiary (including infectious diseases hospitals), and paediatric hospitals. Five main ward types were defined: medical wards, surgical wards, intensive-care units, haematology oncology wards, and medical transplantation (bone marrow or solid transplants) wards. Data recorded included patient characteristics, antimicrobials received, diagnosis, therapeutic indication according to predefined lists, and markers of prescribing quality (eg, whether a stop or review date were recorded, and whether local prescribing guidelines existed and were adhered to). We report findings for adult inpatients. Findings: The Global-PPS for 2015 included adult data from 303 hospitals in 53 countries, including eight lower-middle-income and 17 upper-middle-income countries. 86 776 inpatients were admitted to 3315 adult wards, of whom 29 891 (34·4%) received at least one antimicrobial. 41 213 antimicrobial prescriptions were issued, of which 36 792 (89·3%) were antibacterial agents for systemic use. The top three antibiotics prescribed worldwide were penicillins with β-lactamase inhibitors, third-generation cephalosporins, and fluoroquinolones. Carbapenems were most frequently prescribed in Latin America and west and central Asia. Of patients who received at least one antimicrobial, 5926 (19·8%) received a targeted antibacterial treatment for systemic use, and 1769 (5·9%) received a treatment targeting at least one multidrug-resistant organism. The frequency of health-care-associated infections was highest in Latin America (1518 [11·9%]) and east and south Asia (5363 [10·1%]). Overall, the reason for treatment was recorded in 31 694 (76·9%) of antimicrobial prescriptions, and a stop or review date in 15 778 (38·3%). Local antibiotic guidelines were missing for 7050 (19·2%) of the 36 792 antibiotic prescriptions, and guideline compliance was 77·4%. Interpretation: The Global-PPS showed that worldwide surveillance can be accomplished with voluntary participation. It provided quantifiable measures to assess and compare the quantity and quality of antibiotic prescribing and resistance in hospital patients worldwide. These data will help to improve the quality of antibiotic prescribing through education and practice changes, particularly in low-income and middle-income countries that have no tools to monitor antibiotic prescribing in hospitals. Funding: bioMérieux