Antibiotic resistance in patients with clinical features of healthcare-associated infections in an urban tertiary hospital in Sierra Leone: a cross-sectional study

Abstract

Background: Available data on antibiotic resistance in sub-Saharan Africa is limited despite its increasing threat to global public health. As there is no previous study on antibiotic resistance in patients with clinical features of healthcare-associated infections (HAIs) in Sierra Leone, research is needed to inform public health policies. Our study aimed to assess antibiotic resistance rates from isolates in the urine and sputum samples of patients with clinical features of HAIs.Methodology: We conducted a cross-sectional study of adult inpatients aged ≥18 years at Connaught Hospital, an urban tertiary care hospital in Freetown between February and June 2018. Results: Over the course of the study, we enrolled 164 patients. Risk factors for HAIs were previous antibiotic use (93.3%), comorbidities (58.5%) and age (≥65 years) (23.9%). Of the 164 samples, 89.6% were urine. Bacterial growth was recorded in 58.8% of cultured specimens; the type of specimen was an independent predictor of bacterial growth (p < 0.021). The most common isolates were Escherichia coli and Klebsiella pneumoniae; 29.2% and 19.0% in urine samples and 18.8% and 31.3% in sputum samples, respectively. The overall resistance rates were 58% for all extended-spectrum beta-lactamase (ESBL)-producing organisms, 13.4% for carbapenem-resistant non-lactose fermenting gram-negative bacilli, 8.7% for carbapenem-resistant Acinetobacter baumannii (CRAB) and 1.3% for carbapenem-resistant Enterobacteriaceae (CRE). There were no carbapenem-resistant P. aeruginosa (CRPA) isolates but all Staphylococcus aureus isolates were methicillin-resistant S. aureus. Conclusion:We demonstrated a high prevalence rate of ESBL-producing organisms which are a significant burden at the main tertiary hospital in Sierra Leone. Urgent action is needed to strengthen microbiological diagnostic infrastructure, initiate surveillance on antibiotic resistance and develop and implement policy framework on antibiotic stewardship.

Incidence and risk factors of surgical site infections and related antibiotic resistance in Freetown, Sierra Leone: a prospective cohort study

“…Moreover, the prevalence rate of the extended-spectrum beta-lactamase-producing Enterobacteriaceae is slightly higher than previously reported in Sierra Leone (59.8% vs. 58.0%) [ 27 ] and the African continent as a whole (59.2% vs. 28.0%) [ 28 ]. As the prevalence of carbapenem-resistant Enterobacteriaceae (CRE) had also increased from 1.3% in 2018 [ 27 ] to 8.4% in the present study, urgent actions are needed to set up and operationalize robust hospital-based antimicrobial stewardship programs and strengthen infection prevention and control practices.…”

Prevalence and Characterization of Carbapenem-Hydrolyzing Class D β-Lactamase-Producing Acinetobacter Isolates From Ghana

“…However, carbapenem resistance was less prevalent (5.6%), in our study (primarily conducted in the Western region of Ghana) compared with a prior study conducted in the country's capital, Accra, in which seven out of nine A. baumannii isolates from burn wounds were resistant to meropenem (Forson et al, 2017). Higher carbapenem resistance, 51.5 and 10%, have been reported in the West African countries of Nigeria and Sierra Leone, respectively (Nsofor and Chekwube, 2017;Lakoh et al, 2020). Such discrepancy suggests that CRA dissemination varies by region, and may be attributed to the variability in antibiotic choice, infection control, and prevention practices.…”

Using essential oils to overcome bacterial biofilm formation and their antimicrobial resistance

“…Acquired mechanisms include enzymes to modify drugs and plasmid-encoded efflux ( Peterson and Kaur, 2018 ). Alternative metabolic pathways can also be used by bacteria ( Tenover, 2006 , Lakoh et al, 2020 ) to modify the drugs target and prevent binding ( Tenover, 2006 ), or the target enzyme is over-expressed to reduce the impact of the antibiotic’s inhibtion ( Palmer and Kishony, 2014 ). The various mechanisms of bacterial antibiotic resistance are illustrated in Fig.…”

“…Biofilm formation starts with planktonic bacterial cell forming a reversible polar attachment and aligning flat to the surface to resist removal ( Armbruster and Parsek, 2018 ). In flagellated bacteria, flagellum detachment mediated by cyclic diguanylate start after attachment as the aggregation of cells begin ( Guttenplan and Kearns, 2013 , Lakoh et al, 2020 ). Robust cell-to-cell organization is required for irreversible cell attachment, involving binding proteins, enzymic hydrolyzation of adhesion molecules, and the adsorption of protein ( Pavithra and Doble, 2008 ).…”

“…Increasingly, microorganisms are evading control by antimicrobials, resulting in poor ineffective management, persistence, and a spread of infection ( Tanwar et al, 2014 ). Annually in USA, there are >63,000 hospital-acquired bacterial infections resulting in deaths ( Aminov, 2010 , Lakoh et al, 2020 ). Within the European Union, MDR infections cause ~ 25,000 patient deaths annually ( DOH, 2016 ).…”