Prevalence and Susceptibility Patterns of Clinical Isolates of Escherichia coli to Various Antimicrobials in A Clinical Microbiology Laboratory in South-South Nigeria

The purpose of this study is to determine the prevalence of Escherichia coli as an aetiologic agent in bacterial infections and its antimicrobial susceptibility patterns to ciprofloxacin, ofloxacin, norfloxacin, perfloxacin, gentamycin and cotrimoxazole as a guide for empiric therapy. A retrospective study was carried out using a clinical microbiology laboratory in Nigeria. Data retrieved include number of E. coli isolates, sources of the isolates and their antimicrobial susceptibility to various fluoroquinolones, gentamycin and cotrimoxazole between 2005 and 2009. Statistical analysis was carried out using SPSS version 14, Chicago IL. Out of a total of 906 bacterial isolates, E. coli accounted for 23 % (211) of the isolates. Thirty-eight percent (38.39 %) was isolated from urine samples, 27.96 % from high vaginal swab samples, 24.17 % from stool samples, 0.95% from urethra swabs, 1.9% from wound swabs and 6.6% from semen samples. There was poor level of susceptibility to norfloxacin (2.2%) and cotrimoxazole (23.7%), susceptibility to ofloxacin, ciprofloxacin and pefloxacin were 51.1%, 54.7% and 52.5% respectively, that of gentamycin was 51.8%. The trends across the years showed a significant increase in susceptibility to ciprofloxacin, pefloxacin and ofloxacin in 2007 after which it started reducing, while norfloxacin’s susceptibility was low across the five years with maximum susceptibility at 9.1% in 2006. There was an increase in susceptibility to gentamycin as the susceptibility levels of the  fluoroquinolones were reducing. There should be continuous surveillance of antimicrobial susceptibility patterns and empiric treatment with fluoroquinolones discouraged, especially for non urinary tract infections.KEYWORDS: Antimicrobial susceptibility, Nigeria, Escherichia coli, fluoroquinolones, gentamyci

Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study: a 7-day prospective observational cohort study.

BACKGROUND: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. METHODS: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. FINDINGS: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100 000 population (IQR 0·2-2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3-0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2-18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46-13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99-17·34]) or anaesthesia complications (11·47 (1·20-109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7-5·0). INTERPRETATION: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa. FUNDING: Medical Research Council of South Africa.Medical Research Council of South Africa