Prevalence, Distribution, and Antibiotic Susceptibilities of Nosocomial Infections at a Tertiary Hospital in Port Harcourt, Nigeria

Background: Many infections could previously be treated effectively based on the clinicians past clinical experience. The development of resistance to essentially all of the antimicrobial agents currently in use in clinical practice has made this scenario more of the exception than the norm. Selecting an appropriate antimicrobial agent has become increasingly more challenging as the clinician has to navigate through the variety of available agents in the face of increasing antimicrobial resistance. The diagnostic laboratory plays very important role in clinical practice.   To ensure safe and effective empirical treatment, a surveillance study of the susceptibility pattern of common pathogens and appropriate use of antibiotics is imperative. This current study reports on the prevalence, distribution and antibiotic susceptibility patterns of nosocomial pathogens isolated at the University of Port Harcourt Teaching Hospital (UPTH) and the effectiveness of the antibiotics commonly prescribed at the hospital in treating these infections. Methods: A retrospective cross-sectional study of specimens received at the Microbiology Laboratory was conducted over a six-month period, from October 2015 to March 2016 using urine, blood and semen specimens respectively. A total of 5,160 samples received and analyzed at the laboratory within the study period were assessed. Results: Out of the 5160 specimens analyzed, 881(17.07%) were positive for bacteria out of which 691(78.43%), 86(9.76%), 104 (11. 81%) were from urine, blood and semen respectively. Escherichia coli (35.74%), Klebsiella pneumoniae (52.33%) and Staphylococcus aureus (65.4%) were the most frequently isolated pathogens from urine, blood and semen respectively. Wide spread multiple-drug resistance was observed among the organisms. Klebsiella pneumoniae, S. aureus, and E. coli isolated from urine were resistant to amoxicillin/clavulanate, cefuroxime, ceftazidime, ciprofloxacin, ampicillin, gentamycin and ceftriaxone. A review of the pattern of prescribing antibiotics revealed that in the Accidents and Emergency unit, ceftriaxone (34.09%) and metronidazole (30.09%) were most frequently prescribed while in the General Out-Patient Department, metronidazole (19.09%), amoxicillin (16.61%), amoxicillin/clavulanate (9.39%) and ofloxacin (9.39%) were often prescribed. S. aureus was susceptible to only ceftriaxone while K. pneumoniae and E. coli were susceptible only to ofloxacin. Conclusion: Most of the isolated pathogens were not susceptible to the frequently prescribed antibiotics. Empirical prescribing of antibiotics without current epidemiological data of pathogens in the hospital can only further exacerbate the problem of antimicrobial resistance. The need for epidemiological surveillance and rational use of antibiotics in the Hospital is therefore strongly recommended.