The susceptibility of multidrug resistant and biofilm forming Klebsiella pneumoniae and Escherichia coli to antiseptic agents used for preoperative skin preparations at zonal referral hospital in Mwanza, Tanzania

Background Non-susceptibility of bacteria to antiseptic agents used for preoperative skin preparations threaten the effectiveness of prevention of surgical site infections. Data concerning susceptibility of multidrug resistant bacteria strains to antiseptic agents was limited at our setting. This study presents the susceptibility of extended spectrum β-lactamases producing Klebsiella pneumoniae and Escherichia coli (with and without biofilm formation) to antiseptic agents used for preoperative skin preparations at zonal referral hospital in Mwanza, Tanzania.Methods This cross-sectional descriptive study was conducted through July 2020. Presumptive extended spectrum beta-lactamase producing Klebsiella pneumoniae and Escherichia coli were recovered for this study. Disc combination method was used to confirm production of ESBL while tube method was used to detect biofilms formation. Then, isolates were tested for susceptibility towards 10% povidone iodine, 70% methylated spirit, 50% hydrogen peroxide (6% of industrial H2O2 diluted in equal volume with sterile distilled water) and 2% chlorhexidine. STATA software version 13.0 was used for data analysis. Results A total of 31 presumptive ESBL producers were recovered and phenotypically confirmed, whereas 54.8% (n=17) were K. pneumoniaeand 45.2% (n=14) were E. coli. Five (35.7%) E. coli and seven (41.2%) K. pneumoniae had positive biofilms test results. Four (12.9%) bacteria were non-susceptible to antiseptic agents used for preoperative skin preparations. However, none exhibited resistance towards 10% PVP-I. Conclusion In this study we highlight the existence of multidrug resistant Gram-negative bacteria with resistance to antiseptic agents used for preoperative skin preparation at a zonal referral hospital in Mwanza, Tanzania

Knowledge, Attitude and Practices of Hand Hygiene among Students and Nurses Staff in Mwanza Tanzania: A Cross-Sectional Hospital-Based Study during Global COVID-19 Pandemic

Background: Hand hygiene (HH) is a critical component of infection prevention and control (IPC) which aims at preventing microbial transmission during patient care hence reducing the burden of healthcare associated infections (HCAIs). Information on the level of HH knowledge, attitudes and practices among healthcare workers (HCWs) from low- and middle-income countries is scarce. This study determined knowledge, attitude and practices of HH among students and staff nurses in Mwanza, Tanzania.Methods: This cross-sectional hospital-based study was conducted between August and October 2020 among student and staff nurses from 2health centres, 2district hospitals, 1regional referral hospital and 1zonal referral hospital. Self-administered pretested structured questionnaires were used for data collection. All data was transferred to Microsoft excel spreadsheet for cleaning and coding, then to STATA software version 13.0 for analysis.Results: A total of 726 nurses aged 18 to 59 years with median (IQR) age of 29(24-38) years were enrolled. About 3 quarters 76.4% (555/726) of nurses had good level of knowledge on HH as most of them 88.3% (641/726) had received rigorous IPC trainings during COVID-19 pandemic. About 42.0% (305/726) of the participants reported that, the action of HH was effortless. Majority of the participants, 81.1% (589/726) practiced hand washing more than hand rubbing routinely. Being a student nurse [OR: 0.30, 95%CI: 0.21-1.44, p<.001], working in inpatient department [OR: 0.38, 95%CI: 0.27-0.55, p<.001], high level of education i.e., degree and above [OR: 1.74, 95%CI: 1.36-2.24, p<.001] and having working experience of 5 years and above [OR: 2.41, 95%CI: 1.52-3.82, p<.001] was associated with being knowledgeable of HH.Conclusion: Majority of the participants had good level of knowledge on HH because they had received rigorous training on IPC, notably HH during the global COVID-19 pandemic

Etiology and antimicrobial susceptibility patterns of bacteria causing pneumonia among adult patients with signs and symptoms of lower respiratory tract infections during the COVID-19 pandemic in Mwanza, Tanzania : a cross-sectional study

Funding: This study was supported by the HATUA/CARE (MR/V036157/1): COVID-19 and Antimicrobial Resistance in East Africa—impact and response funded by UK Research and Innovation (Medical Research Council) and the Department of Health and Social Care (National Institute for Health Research).Background   Bacterial pneumonia is among the leading causes of morbidity and mortality worldwide. The extensive misuse and overuse of antibiotics observed during the Corona Virus Disease 2019 (COVID-19) pandemic may have changed the patterns of pathogens causing bacterial pneumonia and their antibiotic susceptibility profiles. This study was designed to establish the prevalence of culture-confirmed bacterial pneumonia and describe their antimicrobial susceptibility profile in adult patients who presented with signs and symptoms of lower respiratory tract infections (LRTIs) during the COVID-19 pandemic. Methodology  This hospital-based cross-sectional study was conducted from July 2021 to July 2022 at a zonal referral hospital and two district hospitals in Mwanza, Tanzania. Demographic and clinical data were collected using a standardized questionnaire. Sputum samples were processed by conventional culture followed by the identification of isolates and antibiotic susceptibility testing. Descriptive data analysis was performed using STATA version 15.0. Results   A total of 286 patients with a median age of 40 (IQR 29-60) years were enrolled in the study. More than half of the patients enrolled were females (52.4%, n = 150). The overall prevalence of bacterial pneumonia was 34.3% (n = 98). The majority of the bacterial pathogens isolated were Gram-negative bacteria (GNB) (61.2%, 60/98), with a predominance of Klebsiella spp., 38.8% (38/98), followed by Streptococcus pyogenes (21.4%, 21/98). Multi drug resistant (MDR) bacteria were detected in 72/98 (73.5%) of the isolates. The proportions of GNB-resistant strains were 60.0% (36/60) for ciprofloxacin, 60% (36/60) for amoxicillin, 60% (36/60) for amoxicillin, 68.3% (41/60) for trimethoprim-sulfamethoxazole and 58.3% (35/60) for ceftriaxone. Conclusion   One-third of the patients with signs and symptoms of LRTIs had laboratory-confirmed bacterial pneumonia with a predominance of Gram negative MDR bacteria. This calls for continuous antimicrobial resistance (AMR) surveillance and antimicrobial stewardship programs in the study setting and other settings in developing countries as important strategies for tackling AMR.Peer reviewe

Patterns and outcomes of health-care associated infections in the medical wards at Bugando medical centre: a longitudinal cohort study

Abstract Background The burden of healthcare associated infections (HCAIs) in low- and middle-income countries (LMICs) remains underestimated due to diagnostic complexity and lack of quality surveillance systems. We designed this study to determine clinical diagnosis, laboratory-confirmed, associated factors and risks of HCAIs. Methods This hospital-based longitudinal cohort study was conducted between March and June 2022 among adults (≥ 18 years) admitted in medical wards at BMC in Mwanza, Tanzania. Patients who were negative for HCAIs by clinical evaluations and laboratory investigations during admission were enrolled and followed-up until discharge or death. Clinical samples were collected from patients with clinical diagnosis of HCAIs for conventional culture and antimicrobial sensitivity testing. Results A total of 350 adult patients with a median [IQR] age of 54 [38–68] years were enrolled in the study. Males accounted for 54.6% (n = 191). The prevalence of clinically diagnosed HCAIs was 8.6% (30/350) of which 26.7% (8/30) had laboratory-confirmed HCAIs by a positive culture. Central-line-associated bloodstream infection (43.3%; 13/30) and catheter-associated urinary tract infection (36.7%; 11/30) were the most common HCAIs. Older age was the only factor associated with development of HCAIs [mean (± SD); [95%CI]: 58.9(± 12.5); [54.2–63.5] vs. 51.5(± 19.1); [49.4–53.6] years; p = 0.0391) and HCAIs increased the length of hospital stay [mean (± SD); [95%CI]: 13.8 (± 3.4); [12.5–15.1] vs. 4.5 (± 1.7); [4.3–4.7] days; p < 0.0001]. Conclusion We observed a low prevalence of HCAIs among adult patients admitted to medical wards in our setting. Central-line-associated bloodstream infections and catheter-associated urinary tract infections are common HCAIs. Significantly, older patients are at higher risk of acquiring HCAIs as well as patients with HCAIs had long duration of hospital stays

Efficacy of disinfectants on control and clinical bacteria strains at a zonal referral hospital in Mwanza, Tanzania: a cross sectional hospital-based study

Abstract Contaminated-hospital surfaces are an important source of pathogenic bacteria causing health-care associated infection (HCAIs). Monitoring the performance of disinfectants that are routinely used to clean hospital surfaces is critical for prevention and control of HCAIs. Nevertheless, the evaluation of the performance of disinfectants and their efficacy are not routinely practiced in most resource-limited countries. This study was designed to determine the efficacy of sodium dichloroisocyanurate (NaDCC) and chloroxylenol against American Type Culture Collection (ATCC) and their respective multidrug resistant (MDR) strains causing neonatal sepsis at a zonal referral hospital in Mwanza, Tanzania. Four ATCC (n = 4) and their respective MDR strains of Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa were used. The suspension test was used with contact time of 1, 5 and 10 min with starting concentration of 105 bacterial colony forming unit per milliliters (CFU/mL). The log10 reduction value at specified bacteria-disinfectant contact time was used to assess the efficacy of 0.5%NaDCC and 4.8% chloroxylenol in-use and freshly prepared solutions. In-use 0.5%NaDCC demonstrated poor log reduction (˂ 5log) against MDR-clinical isolates. Freshly laboratory prepared 0.5% NaDCC had 100% microbial reduction at 1, 5 and 10 min of both ATCC and MDR strains up to 48 h after preparation when compared with freshly prepared 4.8% chloroxylenol (˂ 5log). Freshly, prepared 0.5% NaDCC should be used in health-care facilities for effective disinfection practices

Predominance of Other Pathogenic Bacteria among Presumptive Tuberculosis Cases Attending Tuberculosis Clinics in Mwanza, Tanzania: A Cross-Sectional Laboratory-Based Study

This study was designed to determine the prevalence and co-infection of Mycobacterium tuberculosis and other pathogenic bacteria among presumptive cases of tuberculosis (TB) at selected hospitals in Mwanza, Tanzania. GeneXpert and conventional bacteriological culture and sensitivity were used for the detection of TB and other pathogenic bacteria, respectively. STATA version 13.0 was used for data analysis. The median (IQR) age of participants was 33 (19–51) years with males forming more than half (i.e., 59% (158/264)) of the participants. Microscopically, 29.5% (78/264) of the patients had polymorphonuclear leucocytes in the sputum samples. Approximately 7.2% (19/264), 16.3% (43/264), and 1.1% (3/264) of participants had TB, other pathogenic bacteria, and co-infections, respectively. One sample had growth of two other bacteria, resulting in a total of 44 isolated bacteria with the predominance of Gram-negative bacteria at 75.0% (33/44). The predominant species isolated was the Klebsiella pneumoniae complex at 52.3% (23/44). Overall, 27.3% (9/33) of GNB were resistant to third-generation cephalosporins, while Gram-positive bacteria were more resistant to erythromycin at 63.6% (7/11). Good quality sputa had a significantly higher yield of pathogenic bacteria than poor quality sputa (37.2% vs. 7.5%, p M. tuberculosis. Therefore, other pathogenic bacteria should be considered when attending presumptive TB cases to ensure favorable treatment outcomes