<p>The Existence of High Bacterial Resistance to Some Reserved Antibiotics in Tertiary Hospitals in Tanzania: A Call to Revisit Their Use</p>

Abstract

Background: Antibiotic resistance poses burden to the community and health-care services. Efforts are being made at local, national and global level to combat the rise of antibiotic resistance including antibiotic stewardship. Surveillance to antibiotic resistance is of importance to aid in planning and implementing infection prevention and control measures. The study was conducted to assess the resistance pattern to cefepime, clindamycin and meropenem, which are reserved antibiotics for use at tertiary hospitals in Tanzania. Methods: A hospital-based antibiotic resistance surveillance was conducted between July and November 2019 at Muhimbili National Hospital and Bugando Medical Center, Tanzania. All organisms isolated were identified based on colony morphology, Gram staining and relevant biochemical tests. Antibiotic susceptibility testing was performed on Muller-Hinton agar using Kirby-Bauer disc diffusion method. Antibiotic susceptibility was performed according to the protocol by National Committee for Clinical Laboratory Standards. Results: A total of 201 clinical samples were tested in this study. Urine (39.8%, n=80) and blood (35.3%, n=71) accounted for most of the collected samples followed by pus (16.9%, n=34). The bacterial resistance to clindamycin, cefepime and meropenem was 68.9%, 73.2% and 8.5%, respectively. About 68.4% Staphylococcus aureus isolates were resistant to clindamycin whereby 56.3%, 75.6%, 93.8% and 100% of the tested Escherichia coli, Klebsiella spp, Pseudomonas aeruginosa and Enterobacter cloacae, respectively, were cefepime resistant. About 8.5% of isolated Klebsiella spp were resistant and 6.4% had intermediate susceptibility to meropenem. Also, Pseudomonas aeruginosa was resistant by 31.2% and 25% had intermediate susceptibility to meropenem. Conclusion: The bacterial resistance to clindamycin and cefepime is high and low in meropenem. Henceforth, culture and susceptibility results should be used to guide the use of these antibiotics. Antibiotics with low resistance rate should be introduced to the reserve category and continuous antibiotic surveillance is warranted.

Antibiotic Susceptibility Patterns of Bacterial Isolates from Routine Clinical Specimens from Referral Hospitals in Tanzania: A Prospective Hospital-Based Observational Study

“…Of the isolates tested, (66.7%) were resistant to Cefoxitin and classified as MRSA infection. This observation corroborates with that recently reported at Muhimbili National Hospital and Bugando Medical Centre (61%), 18 and those from other sub-Saharan Africa countries; Kenya (53.5%), 31 Rwanda (82%) 32 ) and Eretria (72%). 32 S. aureus isolates also exhibited resistance to Erythromycin, Tetracycline, and Notes: Three P. aeruginosa isolates were tested for CAZ, 1 (33.3%) isolate was resistant (results not shown in this Table).…”

“…The majority of P. aeruginosa isolates were recovered from wound pus and ear pus and the pathogen was highly resistant to Ampicillin, Amoxicillin-Clavulanic Acid, Gentamicin, Ceftriaxone, Tetracycline, Nalidixic Acid, and Meropenem but more susceptibility to Ciprofloxacin. Resistance to Meropenem was 66.7%, relatively higher than the 55.2% reported by Mikomangwa et al (2020) 18 and 19% in a study conducted at Bugando Medical Centre using isolates collected between 2012 and 2017. 29 This suggests that P. aeruginosa is increasingly becoming resistant to antibiotics.…”

“…Gram-negative bacteria constituted the majority of the isolates, this corroborates with previous studies in Tanzania. 16,17 [16][17][18] and other parts of Africa. 19 Ear pus, urine, wound pus, stool, and blood specimens were the most frequent clinical specimens analyzed.…”

“…were prevalent, similar to earlier studies conducted in Tanzania. [16][17][18] E. coli, and Klebsiella spp. were frequently found in urine specimens; the two are cited as the leading etiologies of urinary tract infections (UTI) especially among pregnant women.…”

Biofilm Genes among Drug Resistant Pseudomonas Aeruginosa

“…Similar results were revealed by Saderi and Owlia . [27]who reported that (55.7%) of P. aeruginosa isolates were susceptible to imipenem.…”