Antimicrobial resistance in pathogenic aerobic bacteria causing surgical site infections in Mbarara regional referral hospital, Southwestern Uganda.

Surgical site infections (SSI) remain a common postoperative complication despite use of prophylactic antibiotics and other preventive measures, mainly due to increasing antimicrobial resistance. Here, we present antimicrobial resistance rate of bacteria isolated in clinical cases of SSI. A hospital based descriptive cross sectional study was conducted on 83 consented postoperative patients with clinical SSI. Data on patients was obtained using structured data collection form. Two swabs were collected aseptically from each patient. Bacteriological culture examination and identification was done following standard microbiological techniques. Antibiotic susceptibility test was done by Kirby-Bauer disc diffusion method. Gram negative bacteria (GNB) were predominant (65.59%) with the dominant being Klebsiella species (29.03%). Overall 86% of aerobic bacteria isolated were multidrug resistant (MDR) where 65.63% and 96.72% of Gram positive and Gram negative isolates were MDR respectively. All the isolates with exception of Enterococci species were resistant to ampicillin. GNB showed high resistance to ceftriaxone, sulfamethoxazole/trimethoprim and gentamicin. All the isolated Klebsiella spp were MDR. S. aureus were all resistant to oxacillin. The isolation rate was higher in emergency, males and dirty wounds in relation to nature of surgery, gender and class of surgical wound respectively. These findings necessitate judicious antibiotic use and calls for surveillance of SSIs periodically as well as strict adherence to good sanitation practice to reduce spread of drug-resistant pathogens.

Older age and higher parity are associated with nonuse of the partograph at Mbarara Regional Referral Hospital, Uganda.

OBJECTIVE: To determine the frequency of partograph use, the proportion of mothers with partographs completed to standard, the completeness of recorded parameters, and factors associated with nonuse at Mbarara Regional Referral Hospital (MRRH), Uganda. METHODS: A retrospective review of medical records from mothers admitted to MRRH's postnatal ward between October 2016 and March 2017. Partograph use and whether it had been completed to standard were analyzed. RESULTS: Of 527 study participants, 409 (77.6%) records contained a partograph, of which only 17 (4.2%) had been completed to standard. Parameters most commonly completed to standard were monitoring of cervical dilatation (n=41, 10%), fetal heart rate (n=21, 5.1%), and uterine contractions (n=18, 4.4%). Age older than 30 years (prevalence ratio 1.73; 95% CI, 1.14-2.64) and parity greater than or equal to five (prevalence ratio 1.88; 95% CI, 1.19-2.98) were associated with nonuse of the partograph. Birth outcome was recorded in 98.8% (n=404) of partographs. CONCLUSION: Appropriate use of the partograph to monitor mothers in labor was extremely low; most common use was to record birth outcomes. Older mothers and those with higher parity were less likely to have their labor monitored using a partograph and should be targeted for partograph interventions.

Association between Prior Chlamydia trachomatis Infection and Ectopic Pregnancy at a Tertiary Care Hospital in South Western Uganda.

BACKGROUND: Increase in the number of ectopic pregnancy is attributed to increase in the incidence of pelvic infections. Chlamydia trachomatis is responsible for most of the sexually transmitted bacterial infections. If undetected and untreated, the infection can ascend to the upper genital tract and cause pelvic inflammatory disease (PID) and related sequelae (ectopic pregnancy and tubal factor infertility). OBJECTIVE: To determine the association between prior Chlamydia trachomatis infection and ectopic pregnancy at Mbarara Regional Referral Hospital (MRRH). METHODS: This was an unmatched case-control study carried out at MRRH involving 25 cases and 76 controls. Serological evidence of prior chlamydial infection was determined by testing for the presence of Chlamydia immunoglobulin G antibodies in their blood. Logistic regression was used to determine the association between prior Chlamydia trachomatis infection and also the factors associated with ectopic pregnancy. The significant level of <0.05 was used. Results. Chlamydia antibodies were found in 60% of patients with ectopic pregnancy and 26.3% of the controls (p=0.002). The presence of Chlamydia antibodies was associated with a fourfold risk of ectopic pregnancy. CONCLUSION: There was a strong association between prior Chlamydia trachomatis infection and ectopic pregnancy.