Predominance of multi-drug resistant bacterial pathogens causing surgical site infections in Muhimbili National Hospital, Tanzania.
Predominance of multi-drug resistant bacterial pathogens causing surgical site infections in Muhimbili National Hospital, Tanzania.
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DOI：
10.1186/1756-0500-7-500
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发表时间：
2014-08-07
影响因子：
1.8
通讯作者：
Lyamuya, Eligius F
中科院分区：
文献类型：
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作者：
Manyahi, Joel;Matee, Mecky I;Lyamuya, Eligius F
背景技术背景：手术部位感染（SSI）仍然是一个常见和广泛的问题，导致显著的发病率和死亡率，部分原因是病原体中抗菌药物耐药性的增加。这项研究是为了确定频谱的细菌分离株和它们的敏感性模式，导致SSIs在Muhimbili国家医院，Tanzani.METHODS：这个描述性的横断面研究，2011年9月和2012年2月之间进行。将脓液拭子或脓液在血琼脂（Oxoid，UK）和麦康凯琼脂（Oxoid，UK）上培养，并在37°C下有氧孵育18-24小时。采用API 20 E和VITEK进行细菌鉴定，采用Kirby Bauer纸片扩散法测定药物敏感性。结果：在100例患者中，收集的伤口拭子中，90例（90%）有阳性需氧菌生长。共分离出147株病原菌，其中革兰阴性菌114株（77.5%），革兰阳性菌33株（22.5%）。铜绿假单胞菌（16.3%）、金黄色葡萄球菌（12.2%）和肺炎克雷伯菌（10.8%）是最常见的细菌。在18 S。金黄色葡萄球菌（MRSA）8例（44%），其中3例（17%）同时携带MRSA和诱导性克林霉素耐药（ICR）。29株肠杆菌科细菌中有23株（79.3%）产超广谱β-内酰胺酶（ESBL）。大肠埃希菌12株（92.3%）;产ESBL菌株11株（69%）。多重耐药（MDR）占63%（93/147），其中革兰阳性菌和革兰阴性菌的MDR分别为60.6%（20/33）和61.4%（73/114）。E. coli、A.鲍曼不动杆菌和斯氏不动杆菌感染率均为100%。革兰阴性菌对4类以上抗生素耐药率最高（97%）。结论：该三级医院分离的SSIs菌株耐药率较高（63%），其中耐药率最高（90%）。鉴于这些发现，该国立医院需要对抗生素处方政策进行紧急和重大的改变。
BACKGROUND: Surgical site infections (SSIs) remain a common and widespread problem contributing to a significant morbidity and mortality, attributed partly by the increase in antimicrobial resistance among the etiological agents. This study was done to determine the spectrum of bacterial isolates and their susceptibility patterns causing SSIs at Muhimbili National Hospital, Tanzania.METHODS: This descriptive cross sectional study was conducted between September, 2011 and February, 2012. Pus swabs or pus were cultured on blood agar (Oxoid, UK) and MacConkey agar (Oxoid, UK) and incubated aerobically at 37°C for 18-24 hours. Bacterial identification was done using API 20E and VITEK and antimicrobial susceptibility was determined by Kirby Bauer disc diffusion.RESULTS: Of the 100 patients, from whom wound swabs were collected, 90 (90%) had positive aerobic bacterial growth. A total of 147 pathogenic bacteria were isolated, including 114 (77.5%) gram negative and 33(22.5%) gram positive organisms. The most prevalent bacterial species were Pseudomonas aeruginosa (16.3%), followed by Staphylococcus aureus (12.2%) and Klebsiella pneumoniae (10.8%). Of the 18S. aureus , 8 (44%) were methicillin resistant Staphylococcus aureus (MRSA) and three of them (17%) were carrying both MRSA and induced clindamycin resistance (ICR). Extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae were observed in 23 (79.3%) of the 29 isolates tested. Majority of Escherichia coli 12 (92.3%) and K. pneumoniae 11 (69%) isolates were ESBL producers. About 63% (93/147) were multiple-drug resistance (MDR) isolates, and the overall MDR among Gram positive and Gram negative bacteria was 60.6% (20/33) and 61.4%, (73/114), respectively. The prevalence of MDR for E. coli, A. baumannii and P. stuartii was 100% each. Majority (97%) of the Gram negative bacteria were resistant to more than four categories (classes) of antibiotics.CONCLUSION: A high proportion (63%) of the isolates causing SSIs in this tertiary hospital were MDR, of which (90%) were resistant to more than four classes of antibiotics. In the light of these findings, an urgent and significant change in antibiotic prescription policy is required at this National hospital.