Predominance of multi-resistant gram-negative bacteria colonizing chronic lower limb ulcers (CLLUs) at Bugando Medical Center

Abstract

BackgroundInfections, trauma, malignances and poorly controlled diabetes are common causes of chronic lower limb ulcerations in developing countries. Infected wound with multi-drug resistant bacteria usually are associated with increased morbidity and mortality. We report the distribution of bacteria pathogens colonizing the chronic lower limb ulcers and their drug susceptibility pattern from Bugando Medical Centre (BMC) a tertiary hospital in Tanzania.FindingsThree hundred non-repetitive wound swabs were aseptically collected from 300 patients with chronic lower limb ulcers using sterile swabs and processed following standard operative procedures. Isolates were identified using in house biochemical testing and in case of ambiguous confirmation was done using API 20NE and API 20E. Susceptibility was determined using disc diffusion test following clinical laboratory standard Institute guidelines (CLSI). Of 300 swabs from patients with chronic lower limbs ulcers, 201 (67.7%) had positive aerobic culture within 48 hours of incubation. Of 201 isolates, 180(89.6%) were gram-negative bacteria. Out of 180 gram negative bacteria, resistance was detected for ampicillin (95%, n = 171), amoxicillin/clavulanate (83.9%, n = 151), trimethoprim-sulphamethoxazole (78.9%, n = 142), ceftriaxone (46.7%, n = 84), ceftazidime (45.6%, n = 82), gentamicin (39.4%, n = 71), ciprofloxacin (17.8%, n = 32) and meropenem 28(15.6%, n = 25). A total of 41 (35%) of enterobacteriaceae were found to be extended spectrum beta-lactamases (ESBL) producers while of 18 Staphylococcus aureus, 8(44.4%) were found to be methicillin resistant Staphylococcus aureus (MRSA).ConclusionThere is high prevalence of ESBL and MRSA isolates in surgical wards at BMC. We recommend infection control and antibiotic stewardship programs in these wards to minimize spread of multi-resistant organisms.

Antimicrobial resistance pattern: a report of microbiological cultures at a tertiary hospital in Tanzania

“…The general proportion of MRSA in this study was found to be in agreement with MRSA proportion observed in other studies done in the same setting in 2010 and 2014 [12, 14]. However, during the observation period a significant decrease was observed in 2015, this could be explained by the ongoing hand washing campaigns and improvement of IPC programs in various BMC wards coupled by increased awareness of the emergence of multidrug-resistant strains among healthcare workers.…”

“…As in previous study [14], most of the Pseudomonas aeruginosa isolates in this study were recovered from wound swabs and more than 50% were resistant to third generation cephalosporins. The majority of Pseudomonas aeruginosa isolates in this study were sensitive to amikacin, as previously observed [32].…”

“…In Africa there are limited surveillance data irrespective of an upsurge of HCAIs and AMR clones circulating both in hospitals and communities [9–11]. At the BMC hospital in Tanzania the rate of extended spectrum beta-lactamases (ESBL) producing Escherichia coli increased from 25 to 50%, and that of MRSA increased from 16 to 44% between 2009 and 2014 [12–14]. Preliminary findings show significant variation of the epidemiology and evolution of these strains as evidenced by multiple clones of Escherichia coli carrying bla CTX-M-15 [15], causing sepsis among neonates and a new ST1797 MRSA causing wound infections [16].…”

The effect of early versus delayed surgical debridement on the outcome of open long bone fractures at Bugando Medical Centre, Mwanza, Tanzania

“…Similarly other studies have shown the predominance of Gram negative bacteria [37–39] and of recent Pseudomonas aeruginosa is reported at BMC as the commonest bacteria colonizing patients with chronic lower limb ulcers [40]; connoting the possibility of nosocomial transmission if stringent infection control and prevention are not adhered in this setting. Similar to another study done in Uganda, the majority of isolates showed high sensitivities to less used antimicrobial agents (gentamicin, ciprofloxacin, cefepine and meropenem) as opposed to commonly used agents (ampicillin, trimethoprim sulphamethoxazole and ceftriaxone) exemplifying the need to have laboratory guided antimicrobial therapy in this setting [38].…”

Predominance of CTX-M-15 among ESBL Producers from Environment and Fish Gut from the Shores of Lake Victoria in Mwanza, Tanzania

“…Such high AMR rates detected in the isolates from gut contents of wild fish are of concern and indicate strong anthropogenic environmental contamination of the Lake Victoria. The presence of ESBL isolates in the environmental samples suggests that the Lake Victoria is being contaminated by sewage from the hospitals and from animals (Mshana et al, 2009; Kayange et al, 2010; Moremi et al, 2014; Seni et al, 2016). Farming activities that use of animal manure together with agricultural waste from the community generate steady contaminated effluents along the borders of Lake Victoria.…”