Increasing Antimicrobial Resistance in Surgical Wards at Mulago National Referral Hospital, Uganda, from 2014 to 2018—Cause for Concern?

Abstract

Antimicrobial Resistance (AMR) and Healthcare Associated Infections (HAIs) are major global public health challenges in our time. This study provides a broader and updated overview of AMR trends in surgical wards of Mulago National Referral Hospital (MNRH) between 2014 and 2018. Laboratory data on the antimicrobial susceptibility profiles of bacterial isolates from 428 patient samples were available. The most common samples were as follows: tracheal aspirates (36.5%), pus swabs (28.0%), and blood (20.6%). Klebsiella (21.7%), Acinetobacter (17.5%), and Staphylococcus species (12.4%) were the most common isolates. The resistance patterns for different antimicrobials were: penicillins (40–100%), cephalosporins (30–100%), β-lactamase inhibitor combinations (70–100%), carbapenems (10–100%), polymyxin E (0–7%), aminoglycosides (50–100%), sulphonamides (80–100%), fluoroquinolones (40–70%), macrolides (40–100%), lincosamides (10–45%), phenicols (40–70%), nitrofurans (0–25%), and glycopeptide (0–20%). This study demonstrated a sustained increase in resistance among the most commonly used antibiotics in Uganda over the five-year study period. It implies ongoing hospital-based monitoring and surveillance of AMR patterns are needed to inform antibiotic prescribing, and to contribute to national and global AMR profiles. It also suggests continued emphasis on infection prevention and control practices (IPC), including antibiotic stewardship. Ultimately, laboratory capacity for timely bacteriological culture and sensitivity testing will provide a rational choice of antibiotics for HAI.

The need to improve antimicrobial susceptibility testing capacity in Ugandan health facilities: insights from a surveillance primer

“…This study found a high prevalence of E. coli, P. aeruginosa , and S. aureus . These findings are similar to those of many short-term researcher-driven studies earlier done at MH, which stated a high prevalence of the same species [ 9 – 15 ]. These species continue to cause the commonest community- and hospital-acquired bacterial infections [ 9 – 15 ].…”

“…These findings are similar to those of many short-term researcher-driven studies earlier done at MH, which stated a high prevalence of the same species [ 9 – 15 ]. These species continue to cause the commonest community- and hospital-acquired bacterial infections [ 9 – 15 ]. But, these species could be used as surveillance markers for AMR in this setting as has been shown [ 16 ].…”

“…Broadly, our ASPs of the different bacterial species were similar to ASPs reported for the same species in many studies earlier done at MH [ 9 – 15 ]. Lab-based surveillance of AMR hinges on the availability of reliable ASP data [ 6 ].…”

“…The lack of complete ASP data is not unique to this study. It has also been reported in some studies earlier done at MH [ 9 , 15 ]. The lack of complete ASP data could be attributed to the fact that testing for some antimicrobials was never done due to their unavailability, testing was never done at all, and possible loss of data during its manual management.…”

Implementation of the World Health Organization Global Antimicrobial Resistance Surveillance System in Uganda, 2015-2020: Mixed-Methods Study Using National Surveillance Data

“…The success of establishing the national AMR surveillance program in Uganda highlights the feasibility of implementing the WHO GLASS program in LMICs. AMR surveillance programs are fundamental in Sub-Saharan African countries such as Uganda for generating antibiograms that can inform the development of treatment guidelines and antibiotic procurement plans and contribute toward standardized reporting [25,26]. Clinicians at surveillance sites can also access bacterial ID and AST results to inform patient care because of the availability of strengthened quality microbiology services.…”