Application of the research electronic data capture (REDCap) system in a low- and middle income country- experiences, lessons, and challenges.

The challenges of reliably collecting, storing, organizing, and analyzing research data are critical in low- and middle-income countries (LMICs), particularly in Sub-Saharan Africa where several healthcare and biomedical research organizations have limited data infrastructure. The Research Electronic Data Capture (REDCap) System has been widely used by many institutions and hospitals in the USA for data collection, entry, and management and could help solve this problem. This study reports on the experiences, challenges, and lessons learned from establishing and applying REDCap for a large US-Nigeria research partnership that includes two sites in Nigeria, (the College of Medicine of the University of Lagos (CMUL) and Jos University Teaching Hospital (JUTH)) and Northwestern University (NU) in Chicago, Illinois in the United States. The largest challenges to this implementation were significant technical obstacles: the lack of REDCap-trained personnel, transient electrical power supply, and slow/intermittent internet connectivity. However, asynchronous communication and on-site hands-on collaboration between the Nigerian sites and NU led to the successful installation and configuration of REDCap to meet the needs of the Nigerian sites. An example of one lesson learned is the use of Virtual Private Network (VPN) as a solution to poor internet connectivity at one of the sites, and its adoption is underway at the other. Virtual Private Servers (VPS) or shared online hosting were also evaluated and offer alternative solutions. Installing and using REDCap in LMIC institutions for research data management is feasible; however, planning for trained personnel and addressing electrical and internet infrastructural requirements are essential to optimize its use. Building this fundamental research capacity within LMICs across Africa could substantially enhance the potential for more cross-institutional and cross-country collaboration in future research endeavors.

Chronic pulmonary aspergillosis as a cause of smear-negative TB and/or TB treatment failure in Nigerians.

OBJECTIVE: To evaluate chronic pulmonary aspergillosis (CPA) as an alternative diagnosis of smear-negative tuberculosis (TB) and treatment failure in TB patients in Nigeria. METHODS: We conducted a cross-sectional multicentre survey in human immunodeficiency virus (HIV) positive and negative adult patients at the end of their TB treatment in clinics in Lagos and Ilorin states. All were assessed using clinical examination, chest X-ray (CXR) and aspergillus immunoglobulin G (IgG) serology, and some for sputum fungal culture. CPA was defined as a positive Aspergillus fumigatus IgG titre with compatible CXR or a positive sputum culture of Aspergillus with a visible fungal ball on CXR with symptoms of underlying lung disease. RESULTS: Of 208 patients recruited between June 2014 and May 2015, 153 (73.6%) were HIV-positive. The mean age was 39.8 years, 124 (59.6%) were female and 39 (18.8%) were unable to work. The median CD4 count was 169.5 cells/ml (range 4-593) in HIV-infected patients with positive Aspergillus IgG. Overall, 109 (52.4%) had documented TB, 140 (67.3%) had a productive cough and 50 had haemoptysis. CPA prevalence was 8.7%; 10 (6.5%) had HIV infection and 8 (14.5%) were HIV-negative (Fisher's exact P = 0.092). CONCLUSION: CPA is a neglected disease in Nigeria, and most cases match the World Health Organization diagnostic criteria for smear-negative TB.

EFFECT OF TRIMETHOPRIM-SULFAMETHOXAZOLE PROPHYLAXIS ON FEACAL CARRIAGE RATES OF RESISTANT ISOLATES OF ESCHERICHIA COLI IN HIV-INFECTED ADULT PATIENTS IN LAGOS.

BACKGROUND: The daily use of Trimethoprim-Sulfamethoxazole (TMP-SMX) prophylaxis reduces morbidity and mortality among patients infected with human immunodeficiency virus (HIV) but its impact on increasing antimicrobial resistance rates has been of public health concern, globally. This study investigated the effect of daily TMP-SMX prophylaxis on feacal carriage rates of resistant isolates of Escherichia coli in HIV-infected adult patients in Lagos. METHODS: A total of 550 HIV-infected patients with CD4-cell counts of less than 350 cells/mm3 who were eligible for TMP-SMX prophylaxis and attending Lagos University Teaching Hospital, Lagos, Nigeria, were recruited for this study. Stool/rectal swab samples were aseptically collected from the patients and processed using standard methods for culture and sensitivity. RESULTS: There was a baseline Trimethoprim-Sulfamethoxazole resistance rate of 54% which increased to 77.9% in first 3 months, rising to 96.1% by 6 months and all isolates were resistant by the 9th month. There was also evidence of cross-resistance to other antibiotics with significance in association with TMP-SMX resistance (p<0.0001). The Escherichia coli isolates showed a progressive increase in resistance to the tested antibiotics over the 12-month period. The resistance was in the following order: Ampicillin (74% to 82.6% in the first 3 months; 98.3% by the 6th month and 99.4% by the 9th month; all isolates were resistant by the 12th month), Augmentin (32.5% to 47.7% in first 3 months; 76.1% by the 6th month; 86.3% by the 9th month; all isolates were resistant by 12 months), Ceftriaxone (2.0% to 10.8% in first 3 months; 20.6% by the 6th month; 24.2% by the 9th month; 54.3% by the 12 months). CONCLUSIONS: The carriage rate of feacal E. coli resistant to TMP-SMX is common before TMP-SMX prophylaxis. Initiation of TMP-SMX leads to further increase in resistance to TMP-SMX and cross-resistance to other antimicrobials.

EFFECT OF TRIMETHOPRIM-SULFAMETHOXAZOLE PROPHYLAXIS ON FAECAL CARRIAGE RATES OF RESISTANT ISOLATES OF ESCHERICHIA COLI IN HIV-INFECTED ADULT PATIENTS IN LAGOS.

BACKGROUND: The daily use of Trimethoprim-Sulfamethoxazole (TMP-SMX) prophylaxis reduces morbidity and mortality among patients infected with Human Immunodeficiency Virus (HIV) but its impact on increasing antimicrobial resistance rates has been of public concern globally. This study investigated the effect of daily TMP-SMX prophylaxis on faecal carriage rates of resistant isolates of Escherichia coli in HIV-infected adult patients in Lagos. METHODS: A total of 550 HIV-infected patients with CD4-cell count of less than 350 cell/mm3 and were eligible for TMP-SMX prophylaxis attending Lagos University Teaching Hospital, Lagos, Nigeria, were recruited. Stool/rectal swab samples were aseptically collected from the patients and processed using standard methods for culture and sensitivity. RESULTS: There was a baseline Trimethoprim-Sulfamethoxazole resistance rate of 54% which increased to 77.9% in first 3 months, rising to 96.1% by 6 months and all isolates were resistant by the 9th month. There was also evidence of cross-resistance to other antibiotics with significant association with TMP-SMX resistance (p<0.0001). The Escherichia coli isolates showed a progressive increase in resistance to the tested antibiotics over the 12-month period. The resistance was in the following order: Ampicillin (74% to 82.6% in the first 3 months; 98.3% by the 6th month and 99.4% by the 9th month; all isolates were resistant by the 12th month). Augmentin (32.5% to 47.7% in first 3 months; 76.1% by the 6th month; 86.3% by the 9th month; all isolates were resistant by 12 months). Ceftriaxone (2.0% to 10.8% in first 3 months; 20.6% by the 6th month; 24.2% by the 9th month; 54.3% by the 12 months). CONCLUSION: The carriage rate of faecal E. coli resistant to TMP-SMX is common before TMP-SMX prophylaxis. Initiation of TMP-SMX leads to further increase in resistance to TMP-SMX and cross-resistance to other antimicrobials.

Aetiology and Risk Factors for Neonatal Sepsis at the Lagos University Teaching Hospital; Idi-Araba; Lagos; Nigeria

Background. Neonatal sepsis is a significant cause of morbidity and mortality in developing countries; accounting for a large proportion of neonatal deaths annually. Every year; 4 million neonates die; and one-third of these deaths is attributed directly to neonatal sepsis.Objectives. To determine the prevalence of neonatal sepsis; characterise and identify causative organisms and identify possible risk factors. Specific objectives were to determine the aetiological agents responsible for neonatal sepsis at Lagos University Teaching Hospital and also to identify the risk factors responsible for the development of neonatal sepsis.Methods. Venous blood pairs were collected from clinically septic admitted neonates and inoculated into BACTEC Peds Plus (BD; USA) bottles aerobically in the BACTEC 9050 system. Organisms were identified using the Microbact 12A/E system and biochemicals. A structured questionnaire was used to collect data for risk factors; which were analysed with the SPSS version 17. Results. Of 250 neonates who were sampled; 85 (34%) had pathogens recovered from their bloodstream; with Klebsiella pneumoniae the predominant organism. Risk factors for sepsis were being delivered outside the hospital (p=0.01); and by frequent changes in antibiotics (p=0.00). Conclusion. The burden of neonatal sepsis is still high in our environment as evidenced by our isolation rate of 34%. A concerted effort needs to be made to reduce this

Immunological and Virological Outcomes of Patients Switched from LPV/r to ATV/r-Containing Second- Line Regimens.

BACKGROUND: Atazanavir/ritonavir (ATV/r) recently became the preferred protease inhibitor (PI) for use in Nigeria since it is dosed once daily, which may improve treatment adherence and has fewer side effects than lopinavir/ritonavir (LPV/r)--the most widely available PI in resource-limited settings. We, therefore, aimed to evaluate the immunologic and virologic effects of switching patients to an ATV/r-containing regimen. METHODS: In a large antiretroviral treatment programme at the Lagos University Teaching Hospital in Nigeria, 400 patients were switched to ATV/r-based second-line ART. We conducted a retrospective evaluation of immunologic and virologic outcomes following 24 months on the ATV/r regimens. RESULTS: Of the 400 patients switched to an ATV/r containing regimen, 255 were virologically suppressed on LPV/r prior to switch, 107 were switched due to failure on a first-line regimen, 28 were on saquinavir/ritonavir (SQV/r)-based regimen, while 10 were unintentionally switched while non-suppressed on a LPV/r-based regimen. Demonstrable and sustained immunological responses were documented as the median (IQR) CD4+ cell count increased steadily from 466 (323) cells/mm3 at the time of switch to 490 (346) cells/mm3 at 6 months, and 504 (360) cells/mm3 at 24 months. Of 99 patients evaluated 12 months after ATV/r switch, 2 (2%) had detectable viral load (VL). None of the 26 (0%) in this group evaluated at 24 months had detectable viral load. In a comparison group of 576 patients who were maintained on LPV/r-based second line regimens, 359 (62.3%) had undetectable viral loads. Of 318 patients with VL data 24 months later, 25 (7.9%) had detectable VL. There was no significant difference between the proportion of patients maintained on LPV/r (7.9%) and those switched to ATV/r (0%) in the development of virologic failure after 24 months of follow-up. CONCLUSION: Among patients that were switched to ATV/r-containing regimens, we found improvements in immunological responses and no increase in risk of virologic failure.

Characterization of Clostridium Species from Food Commodities and Faecal Specimens in Lagos State, Nigeria.

BACKGROUND: Food-borne pathogens are a major public health challenge worldwide. These organisms' cause illnesses leading to time loss in the work place and reduced productivity.Clostridium species cause infections through the production of powerful toxins which are responsible for diarrhoea and cramping. Diarrhoeal diseases due to Clostridia are one of the commonest worldwide but have hardly been reported in Nigeria. OBJECTIVE: This study characterized Clostridium species from food commodities and human faeces in Lagos State MATERIALS AND METHODS: Four hundred and twenty samples comprising food (220) and faecal (200) specimens in Lagos state were included in this study. Isolates obtained were identified using API 20-A and confirmed by Polymerase Chain Reaction assay and 16S rRNA sequencing. The food samples included meat and meat products, ready to drink traditionally prepared milk products, fresh vegetables, canned foods and local honey. RESULTS: Seventy (16.7%) Clostridium species were identified, 50 from food and 20 from faeces. Majority of the isolates were obtained from vegetables (56%) and meat products (34%). Of the 70 Clostridial species, 38 (54.3%) were C. perfringens, 5 (7.1%) were C. difficile and 2 (2.9%) were C. botulinum. All 38 (100%) strains of C. perfringens possessed alpha (cpa) toxin gene. CONCLUSION: Clostridium species are present in our environment and contaminate food products posing potential risks to consumers. There is therefore a need for these traditionally made street vended foods to be monitored because they are potential sources of food borne pathogens.

Isolation and molecular identification of Fusobacterium nucleatum from Nigerian patients with oro-facial infections.

BACKGROUND: Fusobacterium nucleatum is one of the most common anaerobic bacteria present in the oral cavity and is often isolated from infections involving other body sites. OBJECTIVE: To characterise F. nucleatum strains from patients attending a teaching hospital in Nigeria in order to provide information on the methods for accurate identification of anaerobes in clinical specimen. METHODS: Fusobacterium nucleatum specie from 50 patients presenting with oro-facial infections were studied by culture on Fusobacterium selective agar and fastidious anaerobe agar. The isolates were characterised based on colonial morphology, microscopy, lipase production, susceptibility to kanamycin and colistin and resistance to vancomycin. Biochemical tests were performed using a commercial test kit. The identity of the isolates was confirmed based on molecular characterization performed using polymerase chain reaction (PCR) analysis. RESULTS: Forty-eight (96%) F. nucleatum isolates were obtained from the 50 patients by culture and all the isolates were identified by colonial appearance and microscopy based on their unique spindle shape with tapered ends. Only 26 (54.2%) of the 48 isolates were identified by commercial API 20A test kit while PCR confirmed the identity of all the isolates. CONCLUSION: Anaerobes are involved in human infections and their study is quite cumbersome due to tedious nature and high cost of the techniques involved. Cultural method is reliable in the isolation and identification of F. nucleatum species. PCR is a rapid and simple method that can complement the phenotypic identification of anaerobes and would assist in their full identification.

Detecting Nosocomial Intrinsic Infections through Relating Bacterial Pathogens of Incision

Surgical procedures often lead to both intrinsic and extrinsic infections. In order to improve on recovery of patients; investigations were carried out on samples collected from patients during and after surgery. Laboratory analysis was performed on wound swabs from incision; colon segments; scrapes; tissues; pus and catheter specimen urine. The samples were cultured on MacConkey and Blood agar and incubated aerobically at 370C for 16-24 hours. Thereafter; isolates were identified using standard microbiological methods. Results showed that isolates from wound were also found on endogenous indicators of surgery. Klebsiella species from incision was 15 (18.75) while those from colon segment was 30(37.6); scrapes 8(16) and pus 3(7.5). Acinetobacter species found on incision was 15(7.5) and pus 7(2.3). Pseudomonas species was distributed on incision 5(2.5); colon segment 4(5); tissue 3(1.6); scrapes 5(10) and pus was 5(12.5). Staphylococcus aureus which was isolated from incision was 2(1); while scrapes and pus were 5(10) and 7(17.5) respectively. Catheter associated urinary tract infections yielded significant bacteriuria (64.7); almost twice the rate of non-significant bacteriuria (35.3); indicating the need to remove all catheters as soon as possible. Antibiogram of isolates of Klebsiella pneumoniae with resistance pattern: ApGnNaNt; Escherichia coli (ApCtNaTtCm) and S. aureus (ApChCxErPn) with plasmid sizes in the range (30.2-52.51Kb) were common to both indicators and wound; showing that the pathogens were the same clusters. This study demonstrated surgical procedures as precursory to intrinsic infections and that bacterial pathogens found on wounds and endogenous indicators of surgery are links to intrinsic infection. The study therefore emphasizes the need to culture wounds promptly to effect speedy recovery of patients who have undergone surgery

Aetiology of bacteraemia among adult AIDS patients attending Lagos University Teaching Hospital (LUTH), Lagos, Nigeria.

BACKGROUND: Bacteraemia is a relatively common event in HIV-infected patients, especially in late infection. Studies in Africa have shown that more than 23% of AIDS patients have bacteraemia but there is paucity of data from Nigeria. METHODS: Blood samples from 67 consecutive patients with AIDS attending the Lagos University Teaching Hospital between April and August 2000 were cultured. Temperature, ESR, Full blood count, and where possible CD4 counts were obtained. Socio-demographic details were also recorded. Thirty apparently healthy people were randomly selected from a low-risk population to act as non-AIDS controls. The Oxoid Signal Blood Culture System was used to investigate bacteraemia. Antibiotic sensitivity tests were carried out on all isolates. RESULTS: Twenty-two (33%) of the 67 AIDS patients were culture positive. Non-typhoidal Salmonella spp (45.5%), coagulase-negative staphylococci (22.7%) and Staphylococcus aureus (18.2%) were most commonly isolated. One isolate each of Klebsiella pneumoniae, Pseudomonas aeruginosa and Bacillus spp were identified. All bacteraemic patients had temperatures above 38 degrees C and white blood cell counts ranged between 2,700-13,500/mm(3). There was a high rate of antibiotic resistance particularly to chloramphenicol, tetracyclines, cotrimoxazole and beta-lactam antibiotics. However, most isolates were still susceptible to gentamicin and the fluoroquinolones. There was no significant difference in the socio-demographics of the bacteraemic AIDS and non-bacteraemic AIDS patients. CONCLUSION: Salmonella spp. were the most common aetiological agent of bacteraemia among AIDS patients seen at the Lagos University Teaching Hospital (LUTH), Nigeria. A high temperature was a pointer to the presence of bactaeraemia while total white blood cell counts were not useful. It is recommended that blood culture should be done for AIDS patients with elevated temperature irrespective of the total white blood cell count.

Comparison of four methods of hand washing in situations of inadequate water supply.

BACKGROUND: Hand washing is the single most important means of preventing hospital acquired infections, but requires for effectiveness, a constant supply of running water and proper facilities. Most developing countries do not have constant running water facilities, so alternate methods have been developed and used in clinics and hospitals. OBJECTIVE: To compare and validate alternate methods of hand washing developed for use in Nigeria. METHODS: The hands of 12 volunteers were pre-contaminated with known isolates of Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa. The volunteers washed their hands as described by Ayliffe. The hands and equipment were cultured pre- and post-contamination and post-hand washing. The water used for the hand wash was also cultured pre-hand washing to control for water-based contamination. Each method was evaluated three times and various parts of the equipment were cultured to determine the areas contaminated by the hands during the hand wash. RESULTS: "Elbow-way" was shown to be the best and the gold standard Sink and Tap for promoting an effective hand washing, as there was no evidence of post-contamination. The worst was the single-bowl method in which the hands of all the 12 (100%) volunteers were contaminated from the bowl, followed by the two-bowl initiative 10 (83%) and the bucket and bowl 9 (75%). CONCLUSION: The bucket and bowl as well as the single-bowl methods most commonly used in hospitals result in gross contamination of the bowls and bucket and are therefore unsafe and should be discouraged. The elbow way on the other hand appears to be an easy and safe alternative in situations where there is no running water.

Susceptibility of cariogenic Streptococcus mutans to extracts of Garcinia kola, Hibiscus sabdariffa, and Solanum americanum.

BACKGROUND: The elimination of cariogenic bacteria from the oral cavity using antibacterial agents is one of the primary strategies for the prevention of dental caries. Avariety of plants with potent activity are known to be used in indigenous communities for dental hygiene worldwide. OBJECTIVE: To determine if Hibiscus sabdariffa, Solanum americanum and Garcinia kola can inhibit the growth of cariogenic bacteria in the mouth. METHODS: Methanol and aqueous extracts obtained from three plants, Hibiscus sabdariffa, Solanum americanum and Garcinia kola were studied for their antibacterial activity against cariogenic Streptococcus mutans obtained from patients with clinically identified carious lesions, using the agar dilution method. The sources of extracts for Garcinia, Hibiscus and Solanum were respectively fruits and leaves for the latter two. RESULTS: The extracts (both methanol and aqueous) from Garcinia kola showed the most intensive activity and completely inhibited the growth of the primary cariogenic Streptococcus mutans at 1.25 mg/ml. Hibiscus sabdariffa was also active at a minimum inhibitory concentration (MIC) of 2.5mg/ml while Solanum americanum did not show any direct effect on S. mutans. CONCLUSION: The result of this study showed that G. kola and H. sabdariffa have direct antibacterial effect on Streptococcus mutans.

Bacterial flora of commonly used soaps in three hospitals in Nigeria.

OBJECTIVES: To obtain general information on soap use and soap bacterial flora, and to assess the risk of transmission of organisms from contaminated soap to patients. DESIGN: Descriptive study. SETTING: Three hospitals in an urban area of Lagos, Nigeria. A teaching (761 bed) hospital, a general hospital (a 51 bed secondary healthcare facility) and a private hospital (a 30 bed private community with a surgical specialty). RESULTS: Bar soaps were much more commonly used than liquid soaps. Out of the thirty six bar soaps and their receptacles studied, 19 (52.8%) were found wet, nine (25%) dry, five (13.9%) very dry, and three (8.3%) in a pool of water. A total of 39% soaps and 75% of receptacles were contaminated. Thirty three percent of the dry soaps and 68.4% of the wet soaps were contaminated. None of the very dry soaps and all in a pool of water were contaminated. The bacteria isolated from soaps included Pseudomonas aeruginosa (89.5%) and Klebsiella pneumoniae (10.5%), while Pseudomonas aeruginosa (70.6%), Klebsiella pneumoniae (14.7%), Staphylococcus aureus (11.8%) and Serratia marcescens (2.9%) were isolated from the receptacles. The antibiogram showed that the Pseudomonas aeruginosa isolated from the soaps and their containers (sinks) were distinct from those obtained from colonised or infected wounds. The soap contamination rates correlated with the conditions in which the soaps were kept. CONCLUSION: The type of soap containers in particular, played a vital role in keeping the soap dry or wet. In all the hospitals studied, the policies on soap use, if any, were not in agreement with the recommended guidelines. The healthcare workers need to be re-educated on these guidelines.

Laboratory Survey of Significant Bacteriuria in a Family Practice Clinic - Is the Spectrum of Causative Agents Changing?

Urinary tract infection correlates with significant bacteriuria. Empiric and definitive therapy depends on the sensitivity pattern of the causative agents; so it is essential to keep abreast of changes in the causative organisms. This study was carried out to determine the causative agents of significant bacteriuria and their antibiotic sensitivity pattern. Mid stream urine specimens were collected from all patients attending the Family Medicine Clinic of the Lagos State University Teaching Hospital; Ikeja Lagos in July and August of 2005. The urine specimens were transported on ice to the Medical Microbiology and Parasitology Department of the College of Medicine; Idi-Araba. Significant bacteriuria was determined by the standard loop method. Culture was performed on MacConkey agar (oxoid) and blood agar base (Oxoid) and Isolates were identified by standard laboratory methods. Antibiotic sensitivity was by disc diffusion method. Four hundred and fifty urine specimens surveyed for bacteria were from 251 females (55.8) and 199 males (44.2) with age range 13 to 89 years. Ninety four patients (20.9) had significant bacteriuria and 14 were symptomatic; making the prevalence rate of symptomatic bacteriuria 3.1. Out of 91 patients who had been on antibiotics; a significantly higher proportion (52) had bacteriuria while only 13.4 of those who had not been on antibiotics had bacteriuria. Klebsiella and Enterobacter species were more commonly isolated than E. coli. Most of the isolates were resistant to cotrimoxazole (89); tetracycline (69.1) and amoxicillin (88.1) and amoxicillin (88.1). Sensitivity rates to the urinary antiseptics ranged from 54.2 to 55.9. Many of the bacteria were sensitive to ofloxacin (92.9)); ciprofloxacin (84.7); cefotaxime(72.9); ceftriaxone(86.4) and ceftazidime( 88.1). Sensitivity to the aminoglycosides ranged from 57.7 to 59.3

Bacterial pathogens associated with secondary peritonitis in Lagos University Teaching Hospital (LUTH).

Secondary peritonitis is a common and serious form of intra-abdominal infection, often associated with high morbidity and mortality. The overall patient outcome has not markedly improved in spite of advances in patient management. There is therefore need to study the pattern of bacterial pathogens associated with secondary peritonitis in Lagos University Teaching Hospital (LUTH) and the antibiotic susceptibility pattern as that would help in formulation of empiric antibiotic policy on peritonitis and improve the outcome/prognosis of the patients. A prospective study of 35 patients with suspected peritonitis at LUTH between February, 2002 and June 2003 was done. Peritoneal fluids of these patients were collected intra-operatively under aseptic conditions. The specimens were subjected to aerobic and anaerobic studies. Twenty-seven isolates were identified aerobically with Escherichia coli being the most predominant organism 11 (31.4%) followed by Staphylococcus aureus 6 (17.1%) then Klebsiella spp 4 (11.4%). Anaerobic culture showed Prevotella species as the most predominant 14 (40%) followed by Bacteroides fragilis group 8 (22.9%). Overall, Prevotella species were the most predominant organisms isolated in LUTH patients with secondary peritonitis.

Aetiology of catheter-associated bacteriuria in Lagos University Teaching Hospital.

A prospective study to determine the causative agents of catheter-related bacteriuria was carried out on 99 patients with median age of 55 years, on admission in the Oncology, Paediatric Surgery and Obstetric and Gynaecology wards of the Lagos University Teaching Hospital. There was significant bacteriuria in seventy-one (72%) of the 99 urine samples. All catheter urine samples were contaminated by day 5 Gram-negative bacilli were predominant (89.3%) of which Pseudomonas aeruginosa (26.2%) was the most common, while Escherichia coli and Enterobacter aerogenes accounted for 15.5% each, closely followed by Proteus mirabilis (14.3%) and Klebsiella pneumoniae (9.5%). The Gram positive isolates Enterococcus faecalis (8.3%) and Staphylococcus saprophyticus (2.4%) made up only 10.7% of isolates. Most of the isolates from catheterised patients were resistant to the common antibiotics such as ampicillin, cotrimoxazole, gentamicin and ceftriaxone with high susceptibility to ofloxacin and ceftazidime though the isolates of Enterococcus faecalis was also resistant to ofloxacin. However, isolates of S. saprophyticus were still susceptible to the penicillins and tetracycline.

Comparative evaluation of direct stool smear and formol-ether concentration methods in the identification of Cryptosporidium species

Cryptosporidium is a common cause of diarrhoea in patients with Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS). Unfortunately this pathogen is not often checked for in Microbiology laboratories because the formol-ether stool concentration method for identification of Cryptosporidium is cumbersome and may not be routinely undertaken in very busy laboratories and in laboratories with inadequate personnel. This study was therefore carried out to compare the outcome of direct stool examination and formol-ether concentration method with the aim of finding a non-cumbersome method of examining for Cryptosporidiumspecies routinely in stools when it is indicated. Fresh stool specimens of 193 HIV positive and 200 HIV negative patients (control) attending clinic at the Lagos University Teaching Hospital (LUTH) were processed within two hours of collection using direct stool smear and formol-ether concentration methods. Permanently stained slides were prepared using Kinyoun acid-fast stains. Cryptosporidium oocysts were found in 35 (18.1) of HIV seropositive patients using direct stool smear method and in 36 (18.7) using formol-ether concentration method. There was no statistical difference between the two methods (p 0.05; xz = 0.012; df = 1 at 95 confidence limit critical ratio = 3.841). No Cryptosporidiumwas identified in the control (HIV negative) patients using either method. Cryptosporidium oocysts can be routinely checked for in the Microbiology laboratories using either direct stool smear or formol-ether concentration stool method with comparable sensitivity

Extended-spectrum beta-lactamase enzymes in clinical isolates of Enterobacter species from Lagos, Nigeria.

Over a 9-month period, 8 of 40 nonduplicate isolates of Enterobacter spp. producing extended-spectrum beta-lactamase (ESBL) were detected for the first time from two hospitals in Lagos, Nigeria. Microbiologic and molecular analysis confirmed the presence of ESBL. Only four isolates transferred ESBL resistance as determined by the conjugation test, and pulsed-field gel electrophoresis showed genetically unrelated isolates.

Susceptibility profile of Enterococcus faecalis isolated at the Lagos University Teaching Hospital, Nigeria.

Enterococcus faecalis is the most common of the Enterococcus genus causing infection, particularly urinary tract infections, worldwide. It is also a common cause of nosocomial infections and resistance to various antibiotics is on the increase worldwide. Thirty-five strains of E. Faecalis isolated from various clinical specimens (blood, wound swabs endocervical swabs but mostly urine) were screened for high-level aminoglycoside resistance. Their susceptibility nine antibiotics (ampicillin, gentamicin, streptomycin, vancomycin, tetracycline cotrimoxazole and chloramphenicol, ciprofloxacin and erthromycin) was also determined. All isolates were susceptible to Ampicillin and Vancomycin with MIC90 of 4microg/ml but resistant to Nalidixic acid with an MIC90>256microg/ml. Four (11%) of the isolates showed high-level resistance to Gentamicin while 11(32%) exhibited high-level resistance streptomycin after 24 hours incubation. It will appear that Ampicillin in combination with gentamicin but not streptomycin, can still be used empirically for the treatment of Enterococcal infections.

Infections caused by Acinetobacter species and their susceptibility to 14 antibiotics in Lagos University Teaching Hospital, Lagos.

Acinetobacter spp are well recognised as causes of nosocomial infections particularly in patients with immature or defective body defence system. Information concerning these organisms are lacking in this environment. For this reason the pattern of infection and the antimicrobial susceptibility profiles of these organisms isolated over a one-year period were studied. A total of 58 (3%) of the 2001 isolates from all clinical specimens received in the laboratory during the year were Acinetobacter spp. The 58 Acinetobacter spp constituted 5.5% of all the 1051 NLF-GNB isolated, and caused 4.6% of all the 1261 nosocomial infections. Thirty-seven (63%) and 17 (30%) of the Acinetobacter isolates were from wound infections and UTI respectively. All the infections were nosocomially acquired and were associated with compromised host immunity, defective body defence, surgery or urinary catheterization; with Acinetobacter baumannii being the predominant species. There was an apparent male predominance over females by a ratio of 1. 9:1 in the infections, particularly from 45 years and above. One hundred percent and 96.6% of the isolates were susceptible to cefoperazone-sulbactam and travofloxacin respectively. Forty-five (77.6%) were susceptible to cefotaxime, 49 (84.5%) to ampicillin-sulbactam, 34 (58.6%) to ceftazidime, 38 (65.6%) to ticarcillin-clavulanic acid and 41 (70.7%) to ciprofloxacin. Generally the Acinetobacter spp showed multiple resistance to the range of antibiotics tested. All the isolates produced beta-lactamase.