Colonization of Extended-spectrum β-lactamase producing Enterobacterales and meticillin-resistant S. aureus in the intensive care unit at a tertiary hospital in Tanzania: Implications for Infection control and prevention

Manyahi, Joel; Majigo, Mtebe; Kibwana, Upendo; Kamori, Doreen; Lyamuya, Eligius

doi:10.1016/j.infpip.2022.100212

Cited by 6 publications

(2 citation statements)

References 39 publications

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“…Furthermore, studies from Sub-Saharan Africa have reported a similar trend in the use of antibiotics with extensive use of ceftriaxone [ 8 , 9 , 19 , 22 , 23 ], the notion of ceftriaxone being broad-spectrum and easy to use as a single dose per day remains a reason for its increased usage. Increasing resistance to ceftriaxone in Gram-negative patients has been reported at the same health facility [ 5 , 24 , 25 ], and extended-spectrum beta-lactamase-producing Gram-negatives have been reported in up to 50% of isolates in Tanzania [ 26 – 28 ]. Therefore, the effectiveness of ceftriaxone as a first-choice empiric antibiotic needs to be revisited at this facility, as this antibiotic has a relatively high risk of selection for bacterial resistance.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic use at a tertiary hospital in Tanzania: findings from a point prevalence survey

Katyali,

Kawau,

Blomberg

et al. 2023

Antimicrob Resist Infect Control

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Background In Tanzania, data on antibiotic use at the patient level is scarce, and intervention measures to optimize antibiotic use and reduce antimicrobial resistance are rarely performed. Objectives To describe antibiotic use at Muhimbili National Hospital. Methods This was a point prevalence survey on antibiotic use conducted at Muhimbili National Hospital in August-September 2022. The World Health Organization point prevalence survey data collection tool was used to collect patients’ information from the files. All patients admitted to the wards on the day of the survey were included. Results Overall, 47% (185/397) of admitted patients were on at least one antibiotic during the survey. All antibiotics prescribed were for empirical treatment and guideline compliance was low, at 45%. Of 185 patients who received antibiotics, the most common indication was community acquired infection (55%) and 36% had no documentation of the reasons for prescribing antibiotics. Almost 75% of the antibiotics were administered parenterally, with only 2% switching to oral route. Microbiological tests were performed in only 9 (5%) patients out of 185 and results were available for only one patient. Of all participants, 52% received two or more antibiotic in combination, with the combination ceftriaxone-metronidazole being most frequently prescribed, followed by the combination of ampicillin, cloxacillin, and gentamicin. For individual antibiotics, ceftriaxone was the most frequently prescribed antibiotic accounting for 28% (79/283), followed by metronidazole (24%) and amoxicillin-clavulanic acid (11%). Conclusion The findings of a high prevalence of antibiotic use, inadequate use of bacterial culture, and frequent empiric antibiotic treatment suggests the need for strengthening diagnostic and antimicrobial stewardship programs. Furthermore, this study has identified areas for quality improvement, including education programs focusing on prescription practice.

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Section: Discussionmentioning

confidence: 99%

Antibiotic use at a tertiary hospital in Tanzania: findings from a point prevalence survey

Katyali,

Kawau,

Blomberg

et al. 2023

Antimicrob Resist Infect Control

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“…Sampling was consecutive sampling by choosing the rst 172 patients admitted on the trauma orthopedic wards upon tting in the inclusion criteria. A questionnaire was developed after reviewing different literature on factors associated with colonization with ESBL-PE (11)(12)(13)(14)(15)(16). A pretested questionnaire was used to collect information on demographic characteristics, history of admission, history of antibiotic use, travel and care of animals, hygiene practices and antibiotics used in the hospital, demographics, history of antibiotic use, history of admission, travel and care of animals were measured as independent variables whereas EBLs, AmpC and Carbapemase resistance were considered as dependent variables.…”

Section: Data Collectionmentioning

confidence: 99%

Colonization of Patients Hospitalized at Orthopedic Department of Tertiary Hospital in Uganda with Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae

Bizimana

Ndayisenga

Kajumbura

et al. 2022

Preprint

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Background Beta-lactamase production remains the most contributing factor to beta-lactam resistance. Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae (ESBL-PE) are associated with risk factors both in hospital and community settings. Objectives To assess the incidence and risk factors for intestinal carriage of extended spectrum beta lactamase producing Enterobacteriaceae among patients admitted to orthopedic ward of Mulago National Referral Hospital, and to analyze the acquisition of ESBL-PE during hospital stay and associated factors. Methods We screened 172 patients aged 18 years old and above who got admitted to the orthopedic ward of Mulago National Referral Hospital between May to July 2017. Stool samples or rectal swabs were collected at admission, every 3 days until fourteen days and screened for ESBL-PE. Data on demographic status, antibiotic use, admission and travel, length of hospital stay, hygiene practices and drinking boiled water were analyzed by logistic regression and cox regression model. Results At admission, 61% of patients showed intestinal ESBL-PE carriage. Co- resistance was common but no Carbapenem resistance was detected. Of the ESBL-PE negative, 49 % were colonized during hospitalization. On admission, prior antibiotic use was significantly associated with carriage, but none was associated with acquisition during hospitalization at p-value < 0.05. Conclusion Carriage of ESBL-PE on admissions and acquisition at orthopedic ward of Mulago Hospital were high, and dissemination into the community are of substantial concern. We suggested refinement of empirical treatment based on risk stratification, and enhanced infection control measures that target health care workers, patients and attendants.

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Predominance of Multidrug-Resistant Gram-Negative Bacteria on Contaminated Surfaces at a Tertiary Hospital in Tanzania: A Call to Strengthening Environmental Infection Prevention and Control Measures

et al. 2023

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Colonization of Extended-spectrum β-lactamase producing Enterobacterales and meticillin-resistant S. aureus in the intensive care unit at a tertiary hospital in Tanzania: Implications for Infection control and prevention

Cited by 6 publications

References 39 publications

Antibiotic use at a tertiary hospital in Tanzania: findings from a point prevalence survey

Antibiotic use at a tertiary hospital in Tanzania: findings from a point prevalence survey

Colonization of Patients Hospitalized at Orthopedic Department of Tertiary Hospital in Uganda with Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae

Predominance of Multidrug-Resistant Gram-Negative Bacteria on Contaminated Surfaces at a Tertiary Hospital in Tanzania: A Call to Strengthening Environmental Infection Prevention and Control Measures

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