Transmission Dynamics of Antimicrobial Resistance at a National Referral Hospital in Uganda.

Reliable data on antimicrobial resistance (AMR) transmission dynamics in Uganda remains scarce; hence, we studied this area. Eighty-six index patients and "others" were recruited. Index patients were those who had been admitted to the orthopedic ward of Mulago National Referral Hospital during the study period; "others" included medical and non-medical caretakers of the index patients, and index patients' immediate admitted hospital neighbors. Others were recruited only when index patients became positive for carrying antimicrobial-resistant bacteria (ARB) during their hospital stay. A total of 149 samples, including those from the inanimate environment, were analyzed microbiologically for ARB, and ARB were analyzed for their antimicrobial susceptibility profiles and mechanisms underlying observed resistances. We describe the diagnostic accuracy of the extended-spectrum ß-lactamase (ESBL) production screening method, and AMR acquisition and transmission dynamics. Index patients were mostly carriers of ESBL-producing Enterobacteriaceae (PE) on admission, whereas non-ESBL-PE carriers on admission (61%) became carriers after 48 hours of admission (9%). The majority of ESBL-PE carriers on admission (56%) were referrals or transfers from other health-care facilities. Only 1 of 46 samples from the environment isolated an ESBL-PE. Marked resistance (> 90%) to ß-lactams and folate-pathway inhibitors were observed. The ESBL screening method's sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 50%, 90%, and 100%, respectively. AMR acquisition and transmission occurs via human-human interfaces within and outside of health-care facilities compared with human-inanimate environment interfaces. However, this remains subject to further research.

Phenotypic prevalence of extended spectrum beta-lactamases among enterobacteriaceae isolated at Mulago National Referral Hospital: Uganda.

OBJECTIVE: Enterobacteriaceae, common causes of health care associated and community acquired infections are mainly treated with beta-lactam agents. Our study objective was to determine the prevalence and common enterobacteriaceae pathogen producing extended spectrum beta lactamases (ESBLs). The isolates were recovered from various clinical specimens. This was cross sectional study conducted between July 2016 and September 2016 at Mulago National Referral Hospital, Uganda. We used ChromID™ ESBL agar (Biomerieux SA, Lyon, France) and Vitek2 compact system GN83 card (BioMerieux Inc, Hazelwood, Missouri, USA) to detect and confirm presence of phenotypic extended spectrum beta lactamases producing pathogens respectively. RESULTS: Of the 261 tested clinical isolates, 35 (13.4%) were identified as ESBLs producing bacteria. Escherichia coli predominated in the samples [18 (51.4%)], presenting the highest frequency of ESBLs producing, followed by Klebsiella pneumonia [10 (28.5%)], Proteus mirabilis [4 (11.4%)], Enterobacter sp. [2 (5.7%)] and least among Acinetobacter baumanii [1 (2.8%)].

Epidemiology of Antimicrobial Resistance in pathogens Isolated in Mulago Hospital in 1998 and 2000

This study analysed the antimicrobial resistance distribution of Staphylococcus; Enterobacteria; Haemophillus and Pseudomonas isolated from the common service departments in Mulago Hospital; over periods of 1998 and 2000. The Standard Errors (se) of two proportions (resistance) and 95Confidence Interval (CI) for the difference between two proportions were used as statistical tests for determining whether there were changes being experienced over the study period. The analysed agents such as Methicillin; Etythromycine and Ceftazidime did not change in resistance point prevalence mechanisms that do not modify or attack them. While Augumentin; Sodium Cefuroxime; Chloramphenicol; Ciprofoxacin; Gentamicin; Tetracycline and Nitrofurantoin showed icnreased resistance prevalence (P0.05 possibly because of being overused or modified by many resistance mechanisms; high rates of resistance were seen in Enterobacteria (67); Staphylococcus (62) and haemophilus (50). Antipseudomonal agents did not show change in resistance prevalence (P0.05). Departmental/ward distribution of resistant isolates did not also change; except in Emergency and Outpatient departments since bacterial ecology tends to keep constant unless contronted by high level of infection control practice

Staphylococcus Aureus Antibiotypes at Mulago Hospital

We investigated the levels of Staphylococcus aureaus antibiotypes in Mualgo Hospital; toward effective control antibiotic drug resistance in the country. One hundred and elven (n=111) strains of Staph. aureus were tested to fourteen (n=14) antibiotics using stokes method. The obtained resistance profiles were analyzed by WHOBET5 computer software. forty-six (n=46) different antibiotypes were detected. These were further subdivided into three major categories:- 1. Methicilin Resistant - methicilin Suscpetible Staphylococcus aureus (MSSA); 2. Methicillin Resistant Staphylococcus aureus (MR-MSSA) and 3. Methicillin Resistant Staphylocossus aureus (MRSA). These categories were associated with 4; 28 and 14 antibiotypes respectively. One of the antibiotypes did not show any resistance to the tested drugs; while others expressed resistance mechanisms. We noted that MSSA; MR-MSSA and MRSA antibiotypes did not show any resistance to the tested drugs; while others expressed resistance to one or more (up to 11) antibiotics. This result reflects large number of resistance mechanisms. We noted that MSSA; MR-MSSA and MRSA antibiotypes expressed 0-1; 2-7 and 4-11 resistance mechanisms respectively. Of significance; the medical wards were source of 24of the MR-MSSA and MRSA strains. The predominating antibiotypes showed resistance to many common well established drugs (Trimethoprim; Tetracycline; Chloramphenicol; Erythromycin; Gentamicin and Methicillin) as well newer drugs Sodium Cefuroxime and Ciprofloxacin. The increased number of Staph. aureus resistant antibiotypes reflected uncontrolled antibiotic usage. This problem call for increased vigilance and proper use of bacterial antibiotics. In this connection; the last - line drugs methicillin; Telcoplanin and Vocomycin should be properly administered in order to prolong and maintain their use