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Background: Antimicrobial resistance threatens adequate healthcare provision against infectious diseases. Antibiograms, combined with patient clinical history, enable clinicians and pharmacists to select the best empirical treatments prior to culture results. Objectives: To develop a local antibiogram for the Ho Teaching Hospital. Methods: This was a retrospective cross-sectional study, using data collected on bacterial isolates from January-December 2021. Samples from urine, stool, sputum, blood, and cerebrospinal fluid (CSF) were considered as well as, aspirates and swabs from wound, ears and vagina of patients. Bacteria were cultured on both enrichment and selective media including blood agar supplemented with 5% sheep blood and MacConkey agar, and identified by both the VITEK 2 system and routine biochemical tests. Data on routine culture and sensitivity tests performed on bacterial isolates from patient samples were retrieved from the hospital's health information system. Data were then entered into and analysed using WHONET. Results: In all, 891 pathogenic microorganisms were isolated from 835 patients who had positive culture tests. Gram-negative isolates accounted for about 77% of the total bacterial species. Escherichia coli (246), Pseudomonas spp. (180), Klebsiella spp. (168), Citrobacter spp. (101) and Staphylococcus spp. (78) were the five most isolated pathogens. Most of the bacterial isolates showed high resistance (>70%) to ampicillin, piperacillin, ceftazidime, ceftriaxone, cefotaxime, penicillin G, amoxicillin, amoxicillin/clavulanic acid, ticarcillin/clavulanic acid and trimethoprim/sulfamethoxazole. Conclusions: The isolates from the various samples were not susceptible to most of the antibiotics used in the study. The study reveals the resistance patterns of E. coli and Klebsiella spp. to some antibiotics on the WHO 'Watch' and 'Reserve' lists. Using antibiograms as part of antimicrobial stewardship programmes would optimize antibiotic use and preserve their efficacy.
RESUMO
Public Health Emergency Operations Centres (PHEOCs) provide a platform for multisectoral coordination and collaboration, to enhance the efficiency of outbreak response activities and enable the control of disease outbreaks. Over the last decade, PHEOCs have been introduced to address the gaps in outbreak response coordination. With its tropical climate, high population density and poor socioeconomic indicators, Nigeria experiences large outbreaks of infectious diseases annually. These outbreaks have led to mortality and negative economic impact as a result of large disparities in healthcare and poor coordination systems. Nigeria is a federal republic with a presidential system of government and a separation of powers among the three tiers of government which are the federal, state and local governments. There are 36 states in Nigeria, and as with other countries with a federal system of governance, each state in Nigeria has its budgets, priorities and constitutional authority for health sector interventions including the response to disease outbreaks. Following the establishment of a National PHEOC in 2017 to improve the coordination of public health emergencies, the Nigeria Centre for Disease Control began the establishment of State PHEOCs. Using a defined process, the establishment of State PHEOCs has led to improved coordination, coherence of thoughts among public health officials, government ownership, commitment and collaboration. This paper aims to share the experience and importance of establishing PHEOCs at national and subnational levels in Nigeria and the lessons learnt which can be used by other countries considering the use of PHEOCs in managing complex emergencies.