Aerobic bacterial nosocomial infections in paediatric surgical patients at a tertiary health institution in Lagos, Nigeria.

This study was undertaken to determine nosocomial bacterial infections (NI) in surgical patients in a developing country using the detailed option of the Center for Disease Control (CDC) surgical patient surveillance technique. From 1994 - 1995. Paediatrics surgical patients at the Lagos University Teaching Hospital (LUTH) were prospectively monitored for NI at all body sites. Standard definitions of NI were used, and NI sites were categorised by type of operation. A total of 304 NI occurred in 245 out of 664 surgical patients investigated. SSI (77.3 %) and urinary tract infections (19.1%) were in preponderance. Seventy three per cent of SSI were superficial incisions, 20.5% organ/space and 6.8% deep incisions. The overall wound infection rate was 30.9%. The SSI rate for emergency surgery was 35.6% and 26.5% for elective procedures. Rates within each wound class were 20.2, 23.8, 51.9 and 52.8% respectively and 17, 37.6, 43.4 and 47. 1% for patients with ASA scores of I II III and IV in that order. The SSI rates for patients with scores of 0, 1, 2 and 3 were 20.4; 43.5, 57.1 and 75% respectively. Mean infection rates in the various wound classes were highly correlated with the number of risk factors present. Klebsiella pneumoniae (38. 7%), Escherichia coli (22.7%), Pseudomonas aeruginosa (16.8%) and Staphylococcus aureus (10. 7%) were the most common pathogens.

Prevalence of methicillin-resistant Staphylococcus aureus in eight African hospitals and Malta.

Methicillin-resistant Staphylococcus aureus (MRSA) poses a serious therapeutic problem worldwide, and its frequency in most African countries has not been reported. This study was aimed at determining the prevalence and antibiotic susceptibility patterns of MRSA in eight large hospitals (>500 beds) in Africa and Malta, from 1996 to 1997. Susceptibility to methicillin (oxacillin) and to other drugs was determined by E test (AB Biodisk, Solna, Sweden) on a total of 1440 clinical isolates of S. aureus. Methicillin resistance was detected in 213 (15%) of the 1440 isolates tested. The rate of MRSA was relatively high in Nigeria, Kenya, and Cameroon (21-30%), and below 10% in Tunisia, Malta, and Algeria. All MRSA isolates were sensitive to vancomycin, with MICs 60%) of MRSA strains were multiresistant. There is a need to maintain surveillance and control of MRSA infections in Africa.

Beta-lactamase detection in nosocomial bacterial pathogens in Lagos, Nigeria.

Beta-lactamase production was investigated in 1033 bacterial pathogens--262 gram-positive bacteria, 482 Enterobacteriaceae, 289 non-fermenting bacilli. These were isolated from nosocomial infections in paediatric patients. Beta-lactamase was detected using chromogenic cephalosporin and starch paper methods. More than 80% of the isolates produced the enzyme, which was not detected in enterococci and streptococci. There was no appreciable difference ([symbol: see text] 2 = 5.31, P > 0.05) in the number of Beta-lactamase producers obtained using the two methods. Great caution must be exercised in the therapeutic use of Beta-lactam drugs for nosocomial bacterial infections.

Bacteria causing septicaemia in neonates with tetanus.

105 consecutively admitted neonates with tetanus were screened for sepsis to determine the prevalence of sepsis in neonatal Tetanus (NNT) patients and identify the bacterial pathogens causing septicaemia in them. The presence of omphalitis, poor colour, hypothermia and hyperthermia were found to be sensitive predictors of septicaemia in NNT patients. 50 bacterial pathogens were isolated from 50 babies. Klebsiella pneumoniae (20.7%), and Enterobacter cloacae (19.0%) were the leading gram negatives, while staphylococcus aureus (19.2%) was the prevalent gram positive organism isolated. Antimicrobial susceptibility profile heavily favours ofloxacin but a combination of cloxacillin and gentamicin is recommended as first line. Ceftazidime with about 60% susceptibility across board is the favoured cephalosporin.

Bacterial eye infection in neonates, a prospective study in a neonatal unit.

One hundred and fifty five neonates with conjunctivitis admitted into the neonatal unit at the Lagos University Teaching Hospital were microbiologically investigated. This was to determine the bacterial aetiologic agent(s) in neonatal eye infection and highlight some risk factors. Antimicrobial susceptibility testing was done on the pathogens isolated using the diskagar diffusion method. The incidence of conjuctivitis in the newborn was 18 per 1000 live births. Predisposing factor noted were vaginal delivery, asphyxia neonatorum and prolonged rupture of membrane. Pathogens predominantly isolated were Staphylococcus aureus (37.4%), Coagilase negative Staphylococci (12.3%), Klebsiella pneumoniae (12.9%) and Pseudomonas aeruginosa (8.2%). Antimicrobial suscepibility results revealed varied degrees of susceptibility to ofloxacin (75%), Cloxacillin, erythromycin, Gentamicin and augumentin (30%) by the gram positive bacteria while most of the gram negative were susceptible to colistin and ofloxacin (above 90%). The high incidence of bacterial eye infection should be minimized by the elimination of the risk factors and adoption of stringent aseptic measures in the care of the neonate.

Prevalence, antimicrobial properties and beta-lactamase production of haemolytic enterobacteria in patients with diarrhoea and urinary tract infections in Legos, Nigeria.

OBJECTIVE: To determine the prevalence, antimicrobial properties and beta-lactamase production of haemolytic enterobacteria in patients with diarrhoea and urinary tract infections in Lagos, Nigeria. DESIGN: Hospital based prospective study. SUBJECTS: Total of 324 patients comprising 194 diarrhoeal and 130 urinary tract infection (UTI) cases. MAIN OUTCOME MEASURES: Production of haemolysms. beta-lactamase and antibiograms of isolates. RESULTS: 186 (57.41 pc) of the 324 clinical specimens screened were positive for enterobacteria, out of which 29 (15.59 pc) were haemolytic. Proteus vulgaris (2.78 pc) Klebsiella spp. (1.85pc). Escherichia coli (1.23 pc). Pseudomonas spp. (0.93 pc). Yersinia enterocolitics and Morganella morganii (0.62 pc). Salmonella spp. Vibrio cholerae and Proteus mirabilis (0.31pc) were the haemolytic enterobacteria Isolated. The susceptibilities of haemolytic bacteria to eight antibotics determined by disc-agar diffusion technique revealed that all 29 (100 pc) haemolytic isolates were sensitive to gentamycin and streptomycin but showed varied susceptibilities to the other drugs. Eleven (37.9 pc) of the 29 isolates produced beta-lactamase. CONCLUSION: We conclude that gentamycin and streptomycin are effective drugs against haemolytic isolates from diarrhoea and UTI cases.