Nationally-devised standard treatment guidelines (STGs) for nosocomial infections were evaluated in the context of antibiotic resistance within the public health care system in Kwazulu-Natal. A multi-centre surveillance study instituted in 3 hospitals at 3 progressive levels of health care (district, regional and tertiary) collected consecutive, non-repetitive isolates commonly implicated in nosocomial infections as cited by the STGs, viz.,Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa andAcinetobacter spp. Isolates were subjected to susceptibility testing against antibiotics recommended in the treatment guidelines as empirical treatment for nosocomial infections using the Kirby Bauer disc diffusion method advocated by the CLSI. Percentage susceptibility across (1) bacterial species, (2) antibiotics and (3) hospital levels was compared. Susceptibility to antibiotics recommended in the treatment guidelines and hence potentially successful empiric therapy ranged from 5 to 95% with multi-resistance evident in all isolates. Statistically significant differences in overall susceptibility were observed (1) across bacterial species, (2) within 2 of the 3 bacterial species for different antibiotics and; (3) across hospital levels for 2 antibiotics with p values <0.001 for across bacterial species, (1), ranging from 0.003 to <0.001 for within 2 of the 3 bacterial species for different antibiotics (2) and ranging from 0.001 to <0.001 for across hospital levels for 2 antibiotics (3). This study showed that the success of empiric therapy as dictated by treatment guidelines would vary depending upon the bacterial species, the antibiotic used and the hospital, thus making a strong case for institution-specific guidelines based on evidence from well-executed surveillance. Key words: Treatment guidelines, nosocomial infections, antibiotic resistance.
Abstract ‘Antimicrobial resistance is a global health security threat that requires concerted cross-sectional action by governments and society as a whole,’ according to a report published by the WHO in April 2014[1]. On 24–25 June 2014, the Global Respiratory Infection Partnership (GRIP) met in London, UK, together with delegates from 18 different countries to discuss practical steps that can be taken at a local level to address this global problem in an aligned approach. This was the second annual summit of GRIP. The group, formed in 2012, includes primary care and hospital physicians, microbiologists, researchers, and pharmacists from nine core countries. GRIP aims to unite healthcare professionals (HCPs) around the world to take action against inappropriate antibiotic use, focussing on one of the most prevalent therapy areas where antibiotics are inappropriately prescribed – upper respiratory tract infections (URTIs). Chaired by GRIP member, Professor John Oxford (UK), the 2014 summit included engaging presentations by guest speakers examining the latest science regarding the impact of inappropriate antibiotic use.
Background: Methicillin-resistant Staphylococcus aureus (MRSA) are a major cause of hospital- and community-acquired infection. They can colonize humans and cause a wide range of infections including pneumonia, endocarditis and bacteraemia. We investigated the molecular mechanism of resistance and virulence of MRSA isolates from a teaching hospital in Ghana.Methodology: A total of 91 S. aureus isolates constituted the initial bacterial sample. Identification of S. aureus was confirmed by the VITEK 2 system. The cefoxitin screen test was used to detect MRSA and antibiotic susceptibility was determined using the VITEK 2 system. The resistance (mecA, blaZ, aac-aph, ermC, and tetK) and virulence (lukS/F-PV, hla, hld and eta) genes were amplified by polymerase chain reaction (PCR) and positive samples subjected to DNA sequencing. Pulsed field gel electrophoresis (PFGE) was used to ascertain the relatedness of the isolates.Results: Fifty-eight of 91 (63.7%) isolates were putatively methicillin resistant by the phenotypic cefoxitin screen test and oxacillin MICs. However, 43 (47%) of the isolates were genotypically confirmed as MRSA based on PCR detection of the mecA gene. Furthermore, 37.9% of isolates displayed resistance to tetracycline, 19% to trimethoprim-sulphamethoxazole, 15.5% to clindamycin, 12.1% to gentamicin, 13.8% to ciprofloxacin and erythromycin, 6.9% to moxifloxacin and 7.0% to rifampicin. None of the isolates was positive for inducible clindamycin resistance. The prevalence of resistance (mecA, blaZ, aac(6')-aph(2''), tetK, and ermC) and virulence (hla and lukS/F-PV) genes respectively were 74%, 33%, 22%, 19%, 3%, 5% and 3%, with isolates organized in two highly related clades.Conclusion: Results indicate a fairly high occurrence of MRSA, which can complicate the effective therapy of S. aureus infections, necessitating surveillance and stringent infection control programmes to forestall its spread.Keywords: MRSA, mecA, blaZ, hla, lukS/F-PV
Introduction: Plasmid-mediated resistance to β-lactam and fluoroquinolone antibiotics was investigated in Enterobacteriaceae isolated from retailed frozen chickens from Brazil, South Africa and Mozambique.
Methodology: Carcass swabs and the liquid thaw of 33 chickens from each of the three countries constituted the total sample size of 198. Isolates were identified by biochemical tests, antibiotic susceptibility was ascertained by the disc diffusion assay and β-lactamases were detected using the double-disk synergy test. PCR was used to detect the presence of blaCTX-M, blaSHV, blaTEM, blaCMY, blaMOX, blaFOX, blaDHA, qnrB, qnrD, qnrS and qepA genes. A random selection of CTX-M genes was sequenced.
Results: The 198 samples yielded 27 (13.6%) putative extended-spectrum β-lactamase (ESBL)-positive isolates, 15 from carcass swabs and 12 from the liquid thaw from 22 chickens with 19, 5 and 3 isolates from South African, Mozambican and Brazilian chicken, respectively. Isolates exhibited the following resistance: ampicillin 100%, ceftriaxone 89%, trimethoprim-sulfamethoxazole 78%, cefotaxime 74%, ciprofloxacin 70%, ceftazidime 67%, cefoxitin 22% and gentamicin 8%. The predominant putative ESBL gene was blaSHV (85%), followed by blaCTX-M (62.9%) and blaTEM (44.4%) whilst blaMOX and blaDHA were the most common pAmpC genes at 33.3%. The predominant plasmid-mediated fluoroquinolone-resistance gene was qepA (22.2%). DNA sequencing identified blaCTX-M-55/-79/-101/-164. ERIC–PCR profiles did not show strong evidence of clonality.
Conclusion: The Mozambican population is exposed to a reservoir of plasmid-mediated, and hence mobile β-lactam and quinolone resistance genes via imported, and to a lesser extent, locally produced poultry. This presents a food safety concern.
Patients already colonized with multidrug-resistant (MDR) Gram-negative bacteria (GNB) on admission to critical care units may be an important source of transmission of these bacteria in hospitals. We sought to determine the prevalence of MDR GNB colonization in patients, staff and the ward environment and to assess the risk factors for colonization of patients in wards.The study was conducted from April 2021 to July 2021 in a teaching hospital in Ghana. MDR GNB were isolated from rectal, and hand swabs were taken from patients on admission and after 48 h. Swabs from HCW's hands and the ward environment were also taken. Risk factors for colonization with MDR GNB were assessed using univariate and multivariate analysis.MDR GNB rectal colonization rate among patients was 50.62% on admission and 44.44% after 48 h. MDR GNB were isolated from 6 (5.26%) and 24 (11.54%) of HCW's hand swabs and environmental swabs, respectively. Previous hospitalization (p-value = 0.021, OR, 95% CI= 7.170 (1.345-38.214) was significantly associated with colonization by MDR GNB after 48 h of admission. Age (21-30 years) (p-value = 0.022, OR, 95% CI = 0.103 (0.015-0.716) was significantly identified as a protective factor associated with a reduced risk of rectal MDR GNB colonization.The high colonization of MDR GNB in patients, the carriage of MDR GNB on HCW's hands, and the contamination of hospital environments highlights the need for patient screening and stringent infection prevention and control practices to prevent the spread of MDR GNB in hospitals.
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