Multiple Antibiotic Resistance (MAR) indices of Pseudomonas and Klebsiella species isolates in Lagos University Teaching Hospital

Background/Objectives: Pseudomonas and Klebsiella infections are important nosocomial infections because of the attendant significant morbidity, mortality and socio-economic impact. These infections are difficult to treat due to the innate and acquired resistance mediated by the organisms’ genome and other transferable genetic elements. We determined the multiple antibiotic resistance indices of Pseudomonas spp and Klebsiella spp isolated from clinical specimens in Lagos University Teaching Hospital.Methods: 110 clinical isolates were evaluated using MicrobactTM 24E (Oxoid, UK) and Pseudomonas and Klebsiella species isolates were 34 and 21 respectively. The antimicrobial susceptibility patterns of the  Pseudomonas and Klebsiella isolates were determined by Kirby-Bauer’s disc diffusion method and results interpreted by CLSI interpretative values. Multiple Antibiotic Resistance index (MAR) were calculated.Results: MAR index of the Pseudomonas and Klebsiella samples was 0.4, as 31 (91.2%) and 14 (66.7%) of Pseudomonas spp and Klebsiella spp respectively were multi drug resistant. Isolates of Pseudomonas spp demonstrated the highest level of resistance to Ceftazidime (79.4%), Cefixime (76.5%), Cedipime (50%) and Piperacillin (44.1%); while that of Klebsiella spp were carbenicillin (76.4%), pipericillin (71.4%), cefixime (52.4%) and cefradoxil (42.9%) respectively. There was a low levelof resistance to quinolones and aminoglycosides.Conclusion: The MAR index shows increase in the rates of resistance among these organisms thus making antimicrobial susceptibility surveillance and testing more crucial in selecting empiric regimen or definitive treatment.KEY WORDS: Lagos, multiple antibiotic resistance (MAR), antimicrobial susceptibility, Pseudomonas and Klebsiella spp

Correlating Antibiotic ConsumptionWith Antimicrobial Resistance Of Uropathogens In A University Teaching Hospital In Lagos, Nigeria

This study was carried out to correlate the antibiotic consumption rates with the antibiotic resistance rates of uropathogens in Lagos University Teaching Hospital. Urine specimens obtained over 18 months (between January 2005 and June 2006) were processed for microscopy culture and sensitivity, and records of antibiotics dispensed during the same periods were reviewed. Significant bacteriuriawas performed by the standard loopmethod. Isolation and identification of organisms was by standard laboratory methods. The antibiotic consumption calculator of Monnet (ABC calc version 3) was used to classify the antibiotics into ATC classes and to calculate the numbers of daily defined doses. The 6-monthly antibiotic resistance and consumption rates were compared using Pearson\'s correlation coefficient. For analysis, the period of studywas divided into three. Except for co-trimoxazole the rates of consumption of all antibioticswere higher in the second period than the first period of the study and highest in the 3 period for ciprofloxacin, and ceftazidime. This correlated with an increase in the rates of resistance for some antibiotics during the 2 and 3 periods. While a steady increase in consumption of ciprofloxacin correlatedwith a steady increase in the resistance rates from the 1 to the 3 periods, a steady increase in consumption of ceftazidimewas associatedwith an increased resistance rate fromthe 2 to 3 periods. Increased consumption of the antibiotics tested, most noticeably, ciprofloxacin and ceftazidime correlated with increased resistance rates. There is need for urgent interventions like formulation of antibiotic policies and education of staff on the appropriate use of antibiotics to reduce the development of resistance. Keywords: Antibiotic Resistance, Antibiotic Consumption Nigerian Jouranl of Clinical Practice Vol. 11 (4) 2008: pp. 305-30

In-vitro antifungal effect of Garcinia kola and garlic (Alliums sativum) on vaginal isolates of candida

Background/Objectives:Within the last decade there has been an emergence of antifungal drug resistance. Alliums sativum and Garcinia kola seeds were tested for their anticandidal properties in comparison with fluconazole and miconazole.Methods: High Vaginal swab samples from patients with vulvovaginal candidiasis were processed and identified to the species level by germ tube method, morphology on corn meal agar and sugar fermentation reactions. Methanol and aqueous extracts of Garcinia kola and Alliums sativum, as well as fluconazole and miconazole were tested in-vitro using the agar dilution method.Results: One hundred and twenty six women with symptoms of  vulvovaginal candidiasis were sampled and Candida species were isolated from 25 of them. Candida spp. identified were C. albicans (44%), C. tropicalis (28%), C. glabrata (16%) and C. parapsilosis (12%). All species except C. glabrata were inhibited by fluconazole and miconazole, all isolates of the same species having same minimum inhibitory  concentrations (MICs). The highest MICs (25 mg/ml) with the alcoholic extracts were shown by C. albicans and C. glabrata and the lowest MICs (12.5 mg/ml) were shown by C parapsilosis and C tropicalis. All the isolates tested with Garcinia kola aqueous extract had a uniform MIC of 50 mg/ml, those tested with garlic aqueous extract had an MIC of 200 mg/ml. C. albicans and C. glabrata had MIC of 200 mg/ml of the alcoholic extract but C. tropicalis was inhibited at 25 mg/ml.Conclusion: We found that Garcinia kola and Alliums ativum have activity against the vaginal Candida species isolated thus showing promise as alternative therapy for vaginal candidiasis.Keywords: Alliums ativum, Candida spp, Garcinia kola, Minimum inhibitory concentration

Chlamydia and Vaginitis in Sexually Active Females: Classical Identification Methods for Effective Control

Laboratory diagnosis of Chlamydia and vaginitis in sexually active females has been limited by unavailability of a sequential method/rapid technique for simple diagnosis. Six hundred (600) adult females from hotel/brothel, Sexually Transmitted Infections (STIs) Clinic, Obstetrics/Gynaecology Clinic, Family Planning Clinic and Healthy controls were investigated for Chlamydia, Candida, trichomoniasis and bacterial vaginosis (BV). This was done using microscopy: wet mount, stained vaginal secretion and stained smear after culture. Results showed that there were 72% infections in the female groups. The brothel and STI group had infection in the range (70-86%). Chlamydial infection was highest in the STI group while Candida infection was highest in the healthy (control) females. Bacterial vaginosis was distributed in all groups. As p-value increased, f-value increased indicating constant co-infection of Candida and BV in Chlamydia positive females. Microscopy by direct detection from sample and stained smear after culture were in the range: 56-86%. Direct microscopy for BV was 78.5% and stained smear after culture, 57.1%. Sensitivity and specificity of the techniques showed that detection of Chlamydia was less sensitive by direct microscopy of sample but sensitivity and specificity of stained smear after culture were high. Immunoassay (32.2%) was also less sensitive. Sensitivity and specificity of wet mount microscopy for Candida, Trichomoniasis and BV were in the range 62.5 – 80% and 62.5-97.8% respectively. Wet mount has high sensitivity and specificity for detecting agents of vaginitis and may be useful for routine use and for diagnosis where disease is absent, thus, making identification more cost effective

External Ocular Surface Bacterial Isolates and their Antimicrobial Susceptibility Patterns among Pre-operative Cataract Patients at Mulago National Hospital in Kampala, Uganda.

Endophthalmitis is a severe complication of cataract surgery which leads to high ocular morbidity and visual loss even with antibiotic treatment. Bacterial ocular floras are the implicated causative agents. This study was undertaken to evaluate the external ocular surface bacterial isolates and their antimicrobial susceptibility patterns among pre-operative cataract patients at Mulago National Hospital. This cross sectional study enrolled consecutively 131 patients scheduled for routine cataract surgery in the Department of Ophthalmology at Mulago National Hospital in Kampala, Uganda. Eyelid margin and conjunctival swabs were collected and processed using standard microbiological procedures to identify bacterial isolates and their respective antimicrobial susceptibility patterns. Of 131 patients involved (mean age 63.3 ± 14.5 years), 54.2% (71/131) were females. The eyelid margin and conjunctival samples were culture positive in 59.5% (78/138) and 45.8% (60/138) respectively. The most common organisms identified were Coagulase-negative Staphylococci (CoNS) [65.9% (91/138)] and Staphylococcus aureus [21.0% (29/138)]. CoNS showed the highest resistance to tetracycline (58.2%, 53/91) and erythromycin (38.5%, 35/91), whereas in S. aureus the resistance to tetracycline and erythromycin were 55.2% (16/29) and 31.0% (9/29) respectively. Methicillin resistant CoNS (MRS) and Methicillin resistance S. aureus (MRSA) were 31.9% (29/91) and 27.6% (8/29) respectively. There were low resistance rates for CoNS, S. aureus and other bacterial isolates to ciprofloxacin (11.1%-24.2%), gentamicin (5.6-31.0%), tobramycin (17.2% -25.3%) and vancomycin (0.0%). CoNS and S. aureus are the most common bacterial isolates found on the external ocular surface of the pre-operative cataract patients. Ciprofloxacin, gentamicin, tobramycin and vancomycin showed the lowest resistance rates to all bacterial isolates, therefore may be used to reduce bacteria load in the conjunctiva sac among cataract patients prior to surgery

Candidiasis, Bacterial Vaginosis, Trichomoniasis and Other Vaginal Conditions Affecting the Vulva

info:eu-repo/semantics/publishedVersio

Resistance patterns of Streptococcus pneumoniae isolated from the upper respiratory tract of persons attending various clinics of a University Teaching Hospital in Lagos, Nigeria - a preliminary study

The upper respiratory carriage rate, serotypes and resistance patterns of Streptococcus pneumoniae in persons attending four clinics of the Lagos University Teaching Hospital (LUTH) were determined. Nasal swab specimens were collected from a total of 372 persons, 175 of whom were males and 177 were females. Their ages ranged from 14 weeks to 65 years. The upper respiratory carriage rate found in the total population of both adults and children was 9.9%, but the rate was highest in children less than 5 years (18.6%). Among the 17 isolates that were available for serotyping, there was no significant serotype, though resistant serotypes like 23F. 19F. 6A and I4 were identified. Initial oxacillin screening for penicillin resistance revealed that 12 out of 36 isolates were clearly sensitive, but combined with the result of Etest, penicillin resistance was found to be 6.8%. Susceptibility testing by disc diffusion revealed that 80.5% of isolates were sensitive to ceftriaxone and 94.4% to chloramphenicol. Sixty one percent were sensitive to erythromycin while 94.4% were resistant to co-trimoxazole and 80.5% to tetracycline. Except for amoxicillin and cefotaxime which showed high activity, sensitivity pattern by Etest was found to be similar to that of disc diffusion. The result of this study makes it possible to formulate hypothesis for a larger study. In this study. the carriage rate of S. pneumonia probably ranged from 2.6% to over 18.6% depending on the study population. If the limitations of this study are excluded in a larger study, the rate most likely will be higher. Also, penicillin resistance in carriage strains would be up to 6.8%, probably higher, but may be intermediate, so penicillin could still be useful for treatment of pneumonia and probably otitis media, but not meningitis. There is reason to watch out for increased resistance to penicillin, cephaloporin and erythromycin. Most pneumoeoccal isolates would likely be resistant to tetracycline and co-trimoxazole. African Journal of Clinical and Experimental Microbiology Vol. 7(2) 2006: 89-9

A study on the outcome of neonates with sepsis at the Lagos University Teaching Hospital

Background: Neonatal morbidity and mortality are major public health challenges in our local environment with a huge percentage of deaths in the neonatal period attributable to sepsis. Aim: The aim of the study was to assess the factors that affect patients’ outcome with respect to sepsis in neonates. Methods: This was a prospective descriptive cross sectional study. Neonates with proven and suspected sepsis were recruited into the study. Outcome was assessed based on the length of hospital stay and mortality. Clinical response to treatment was also assessed. Results: Nine factors were identified as risk factors for mortality, birth weight (< 2500g P = 0.000, OR = 7.214, CI = 2.5 – 21.0), prolonged rupture of membranes (PROM) (P = 0.014, OR = 2.470, 95% CI = 1.2 -5.1), prolonged preterm rupture of membranes (PPROM) P = (0.046. OR = 2.1, 95% CI = 0.9 -4.6) multiple gestation (P = 0.009), an infectious clinical diagnosis (P = 0.046, OR = 0.480), frequent changes in antibiotics (P = 0.013). Others were a low Apgar score (P = 0.000), presence of organisms in intravenous fluids (P = 0.042, OR = 0.2, 95% CI = 0.02 – 1.3 and the presence of organisms in the blood stream (P = 0.007). Conclusion: This study determined the mortality rate in our environment due to sepsis to be 15.7%. Risk factors for a poor outcome include low birth weight, perinatal period, and maternal illness in pregnancy and isolation of a pathogen from the blood stream.Key words: Neonatal sepsis, prolonged stay, mortality, bactec 9050, microbact 12a, risk factor

Prevalence of fungal infections in immunosuppressed patients in Lagos University Teaching Hospital - a preliminary report

No abstract Nigerian Quarterly Journal of Hospital Medicine Vol. 13(1-2): 48-5

Knowledge, attitude and practice of the trainee seafarers to HIV/AIDS and STIs at Apapa Seaport, Lagos

The epidemic of human immunodeficiency virus (HIV) in Nigeria is being fuelled by ignorance and other Sexually Transmitted Infections (STIs). Little is known about HIV-risk related sexual behavior of the Nigerian sailors. This study describes the baseline knowledge, attitude and practice of the trainee sailors to HIV. Ninety four (83.2%) of the 113 trainee interviewed consented to participate in voluntary counseling and confidential testing (VCT) programme. Each trainee completed an anonymous self- administered questionnaire and was tested for syphilis, trichomoniasis and HIV. Seventy one (75.5%) of the respondents were between ages 21-25 years. Twenty three (25%) did not believe that having sex with commercial sex workers puts them at high risk of HIV while eighteen (19.1%) did not believe that condoms were protective. Only ten (10.6%) practiced abstinence while three were homosexual. Despite all these, sixty three (67%) believed that they were at little or no risk of HIV, prevalence of which was found to be 5.3% among them. Seventy one (75.5%), fifteen (16%), twenty (21%) and (20.2% of respondents believed that genital ulcers, gonorrhea, syphilis and HIV respectively were not sexually transmitted. Trichomoniasis and syphilis were found in two (2.1%) and one (1.1%) respondents respectively. Female sex (P=0.002) and trichomoniasis (P=0.017) were found to significantly influence HIV infection. There was a high level of ignorance about HIV and STIs among respondents. This was further highlighted by the high rate of high-risk behaviors. Therefore, sustained educational programs and promotion of condoms are recommended to address this problem. African Journal of Clinical Experimental Microbiology Vol. 8 (2) 2007: pp. 94-10