Prevalence and antibiotic susceptibility pattern of ESBL producing Klebsiellae isolated from clinical specimens in a Nigerian tertiary hospital

Background: Infection by Extended Spectrum Beta Lactamases (ESBLs) producing bacteria is a threat to man as a consequence of treatment challenges. This study evaluated the prevalence and antimicrobial susceptibility pattern of ESBL producing Klebsiellae (EPK) in clinical specimens at the University of Ilorin Teaching hospital, Ilorin (UITH), Nigeria.Methods: ESBL production was assayed using Double Discs Synergy Test (DDST). Antimicrobial susceptibility was performed by Modified Kirby- Baeur method with the organism tested against ceftazidime (30μg), cefotaxime (30μg), amoxicillin-clavulinic acid (20/10μg), cefepime (30μg), ciprofloxacin (5μg), gentamicin (10μg), trimethoprim-sulphamethoxazole (23.75/1.25μg), imipenem (10μg) and doripenem (10μg) (Oxoid, UK).Results: Fifty (26.7%) of the 187 Klebsiellae studied were EPK comprising of 37(26.8%) Klebsiella pneumoniae and 13(26.5%) Klebsiella oxytoca. EPK were mostly from wound specimens (24.0%) although Klebsiellae were mostly occurring in sputum (26.2%). The EPK were resistant to ceftazidime (100%), cefotaxime (94.0%), trimethoprim-sulphamethoxazole (92.0%), gentamicin (70.0%) and ciprofloxacin (70.0%) but 100% susceptible to both doripenem and imipenem.Conclusion: The prevalence of EPK in this study is high and they are multi-drug resistant. Carbapenems are the best antibiotic treatment option for infections arising from these organisms although a coordinated rational usage is desired along with functional antibiotic prescription policy to avoid treatment failures. Continuous surveillance for ESBL producing Klebsiellae and resistance monitoring are necessary routine to strengthen infection control policies.Keywords; ESBL, cephalosporins, Klebsiella, antibiotics susceptibility, drug resistance

Comparative in-vitro activity of Imipenem and Doripenem against ESBL producing Klebsiella isolates from a tertiary hospital in Ilorin, Nigeria

Background: Doripenem is a recent carbapenem not commercially available in Nigeria with broad spectrum antibacterial activity against various clinical infections. Carbapenems have been shown to be the last line of agents against ESBL producing organisms.Objective: To determine the in-vitro activity of Imipenem and Doripenem against ESBL producing Klebsiella spp.Design: A cross-sectional laboratory based study.Setting: The University of Ilorin Teaching Hospital, a major tertiary hospital in Ilorin, the capital of Kwara state in Nigeria.Subjects: All strains of Klebsiella spp isolated from all clinical specimens collected at the hospital laboratory non– repetitively.Result: Doripenem had a superior in-vitro activity compared to imipenem with MIC 50/90 value of 0.0125/0.023 while imipenem was found to be 0.19/0.38 which was statistically different.Conclusion: The result obtained in this study is similar to those from other studies and therefore re-affirms the superior activity of doripenem compared to imipenem and should therefore be introduced as a better alternative to imipenem against ESBL producing organisms

PREVALENCE AND ANTIBIOTIC SUSCEPTIBILITY PATTERN OF ESBL PRODUCING KLEBSIELLAE ISOLATED FROM CLINICAL SPECIMENS IN A NIGERIAN TERTIARY HOSPITAL

Background: Infection by Extended Spectrum Beta Lactamases (ESBLs) producing bacteria is a threat to man as a consequence of treatment challenges. This study evaluated the prevalence and antimicrobial susceptibility pattern of ESBL producing Klebsiellae (EPK) in clinical specimens at the University of Ilorin Teaching hospital, Ilorin (UITH), Nigeria. Methods: ESBL production was assayed using Double Discs Synergy Test (DDST). Antimicrobial susceptibility was performed by Modified Kirby-Baeur method with the organism tested against ceftazidime (30µg), cefotaxime (30µg), amoxicillin-clavulinic acid (20/10µg), cefepime (30µg), ciprofloxacin (5µg), gentamicin (10µg), trimethoprim-sulphamethoxazole (23.75/1.25µg), imipenem (10µg) and doripenem (10µg) (Oxoid, UK). Results: Fifty (26.7%) of the 187 Klebsiellae studied were EPK comprising of 37(26.8%) Klebsiella pneumoniae and 13(26.5%) Klebsiella oxytoca. There was no significant difference (p = 0.873) in ESBL production between Klebsiella pneumoniae and Klebsiella oxytoca. EPK were mostly from wound specimens (24.0%) although Klebsiellae were mostly occurring in sputum (26.2%). The EPK were resistant to ceftazidime (100%), cefotaxime (94.0%), trimethoprim-sulphamethoxazole (92.0%), gentamicin (70.0%) and ciprofloxacin (70.0%) but 100% susceptible to both doripenem and imipenem. Conclusion: The prevalence of EPK in this study is high and they are multi-drug resistant. Carbapenems are the best antibiotic treatment option for infections arising from these organisms although a coordinated rational usage is desired along with functional antibiotic prescription policy to avoid treatment failures. Continuous surveillance for ESBL producing Klebsiellae and resistance monitoring are necessary routine to strengthen infection control policies

Seroprevalence of syphilis among blood donors in Ilorin

Background: One of the greatest values of serological test for syphilis is as a surrogate marker for lifestyle known to be associated with high risk of HIV and HCV infections. This study was designed to determine the prevalence of syphilis among blood donors in Ilorin and also the relationship between seropositivity and lifestyle known to be associated with high risk for HIV and Hepatitis infection.Method: This was a hospital based cross sectional study involving 350 consenting blood donors. The socio-demographic details (e.g., age, sex, occupation, risk behavior etc) were obtained using a structured questionnaire designed for the study. Screening for syphilis was carried out using the DiaSpot Rapid Diagnostic Test kit (DS 401- Syphilis test strips; lot: SYP2070028) according to the manufacturer's (Sam Tech Diagnostics) instructions.Result: The seroprevalence of syphilis among the blood donors was 1.1%. None of the seropositive donors was a homosexual, commercial sex worker or intravenous drug user. None of them had history of blood transfusion. Only one out of the 4 seropositive donors engaged in extramarital sex.Conclusion: The seroprevalence of syphilis among blood donors in Ilorin was low and therefore the relationship between syphilis seropositivity and high risk lifestyle could not be determined. A prospective study design where cases and controls are appropriately matched to exclude confounders would be more appropriate. The relationship of syphilis seropositivity and high risk lifestyle can therefore be better studied among patients attending Sexually Transmitted Infection clinic and using seronegative patients as controls.Keywords: syphilis, blood donors, risky lifestyl

Prophylactic effect of multi-herbal extract ‘Agbo-Iba' on Malaria induced in mice

Objective: To determine the efficacy of a multi-herbal preparation extract of ‘Agbo-Iba' on rodent malaria induced in mice. Design: An experimental design in which mice were divided into four groups A,B,C,D representing control, prophylactic, chloroquine and ‘Agbo-Iba' groups respectively. Each mouse was intraperitonally inoculated with Plasmodium yoelii nigeriensis and treated with oral herbal extract or chloroquine syrup depending on group. Setting: College of Medicine of the University of Lagos Medical Microbiology and Parasitology Laboratory. Subjects: One hundred and twenty male and female albino mice aged 10-12 weeks with an average weight of 25 grams. Main Outcome measures: The herbal extract was effective, preventing the development of parasitaemia in the prophylactic group of mice. Results: After intraperitoneal inoculation of Plasmodium yoelii nigeriensis, a prepatent period of two days was observed before parasitaemia was established in all but the prophylactic group of mice. Induced infection was promptly aborted with oral chloroquine treatment in group C, while in groups A and D, infection terminated fatally. Group B mice appeared normal throughout the duration of investigation with 100% survival rate. Conclusion: ‘Agbo-Iba' extract has some prophylactic action against malaria induced in mice with no apparent significant side effects. (East African Medical Journal: 2002 79(7): 343-346

BACTERIOLOGY OF CHRONIC SINUSITIS IN ILORIN, NIGERIA

A prospective study of the bacteriology of 120 patients with chronic sinusitis and 55 control subjects seen between January 1995 and December 1998 in the Ear, Nose and Throat (ENT) Diseases Clinic of University of Ilorin Teaching Hospital, Ilorin, Nigeria was made. Whereas all cultures from the control group yielded only Staphylococcus (63.6% Coagulase positive and 36.4% Coagulase negative), cultures of patients with chronic sinusitis yielded Staphylococcus aureus (48.1%), Escherichia coli (20.4%), Klebsiella spp. (20.4%), Streptococci (7.4%) and Streptococcus pneumoniae (3.7%). The isolates were 100% sensitive to Ofloxacin, while penicillin was the least effective antimicrobial agent across board. It was concluded that because of the difficulty in differentiating pathogenic organisms from commensals, the result of nasal swabs should be interpreted with caution. However, non-otolaryngologists involved in the management of the vast majority of patients with chronic sinusitis should request a carefully obtained posterior nasal mucosal swab. (Af J Clinical & Exp Microbiology: 2003 4(2): 91-97

Prevalence Of Hepatitis B Surface Antigen Among Tertiary Health Workers in Ilorin

A total of 181 tertiary hospital staff at the University of Ilorin Teaching Hospital were screened for the presence of Hepatitis B surface antigen (HBsAg) in their Sera. They were made up of 128 nursing staff, 36 doctors, and 17 laboratory staff, with a mean length of service of 12.3+7.6 years, and who actively work in contact with patients and laboratory specimens. Screening for HBsAg was carried out using the enzyme-linked immunosorbent assay (ELIZA) method. Fourteen (7.7%) of the staff were found to be positive for HBsAg. This was significantly lower than the percentage positives of 21.7% and 16.0% obtained among the blood donors and antenatal clinic patients respectively. The positivity rate was not affected by sex, age or length of service. The possible reasons for, and inferences from our findings are discussed. Nigerian Quarterly Journal of Hospital Medicine Vol. 9, No. 2 (June 1999) pp. 95-9

Pathogenic agents of chronic suppurative otitis media in Ilorin, Nigeria

Objective: To determine the type and pattern of antibiotic susceptibility of the pathogenic micro-organisms causing chronic suppurative otitis media (CSOM) in our environment. Design: A retrospective study of ear discharges from patients presenting consecutively with chronic suppurative otitis media. Settings: University of Ilorin Teaching Hospital, a major referral centre in the Middle Belt region of Nigeria. Main outcome measures: Bacterial isolates and their sensitivity patterns. Subjects: Three hundred and seventy five patients aged between eight months and 70 years referred to the ear, nose, and throat clinic of The University of llorin Teaching Hospital were enrolled in the study. Results: About 95.5% and 4.5% of the specimens were culture positive and negative respectively. The commonest bacterial aetiologic agents were Pseudomonas aeruginosa (26.0%) and Proteus spp (21.8%). Peak prevalence of 30.5% occurred among the 0-5 years age group. Seventy five per cent of isolates were gram-negative bacteria. Ofloxacin produced 100% sensitivity in both gram positive and gram-negative organisms tested. Colistin, ceftazidime and cefuroxime were highly active ( _80%) against the gram-negative bacteria while erythromycin and cloxacillin were very effective ( _80%) against the gram-positive isolates. Conclusion: Chronic suppurative otitis media is still highly prevalent in our environment, affecting mainly children. The antibiotic susceptibility pattern of pathogenic isolates is different from those of other regions of Nigeria with increasing resistance recorded for some organisms. Hence, where possible and available, susceptibility tests should guide the management of CSOM in this environment, otherwise, ofloxacin if indicated and cloxacillin/ erythromycin may provide relief and delay emergence of resistant strains. (East African Medical Journal: 2002 79(4): 202-205