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Antibiotic resistance in patients with clinical features of healthcare-associated infections in an urban tertiary hospital in Sierra Leone: a cross-sectional study

BACKGROUND: Available data on antibiotic resistance in sub-Saharan Africa is limited despite its increasing threat to global public health. As there is no previous study on antibiotic resistance in patients with clinical features of healthcare-associated infections (HAIs) in Sierra Leone, research i...

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Autores principales: Lakoh, Sulaiman, Li, Letian, Sevalie, Stephen, Guo, Xuejun, Adekanmbi, Olukemi, Yang, Guang, Adebayo, Oladimeji, Yi, Le, Coker, Joshua M., Wang, Shuchao, Wang, Tiecheng, Sun, Weiyang, Habib, Abdulrazaq G., Klein, Eili Y.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036224/
https://www.ncbi.nlm.nih.gov/pubmed/32087751
http://dx.doi.org/10.1186/s13756-020-0701-5
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author Lakoh, Sulaiman
Li, Letian
Sevalie, Stephen
Guo, Xuejun
Adekanmbi, Olukemi
Yang, Guang
Adebayo, Oladimeji
Yi, Le
Coker, Joshua M.
Wang, Shuchao
Wang, Tiecheng
Sun, Weiyang
Habib, Abdulrazaq G.
Klein, Eili Y.
author_facet Lakoh, Sulaiman
Li, Letian
Sevalie, Stephen
Guo, Xuejun
Adekanmbi, Olukemi
Yang, Guang
Adebayo, Oladimeji
Yi, Le
Coker, Joshua M.
Wang, Shuchao
Wang, Tiecheng
Sun, Weiyang
Habib, Abdulrazaq G.
Klein, Eili Y.
author_sort Lakoh, Sulaiman
collection PubMed
description BACKGROUND: Available data on antibiotic resistance in sub-Saharan Africa is limited despite its increasing threat to global public health. As there is no previous study on antibiotic resistance in patients with clinical features of healthcare-associated infections (HAIs) in Sierra Leone, research is needed to inform public health policies. Our study aimed to assess antibiotic resistance rates from isolates in the urine and sputum samples of patients with clinical features of HAIs. METHODOLOGY: We conducted a cross-sectional study of adult inpatients aged ≥18 years at Connaught Hospital, an urban tertiary care hospital in Freetown between February and June 2018. RESULTS: Over the course of the study, we enrolled 164 patients. Risk factors for HAIs were previous antibiotic use (93.3%), comorbidities (58.5%) and age (≥65 years) (23.9%). Of the 164 samples, 89.6% were urine. Bacterial growth was recorded in 58.8% of cultured specimens; the type of specimen was an independent predictor of bacterial growth (p < 0.021). The most common isolates were Escherichia coli and Klebsiella pneumoniae; 29.2% and 19.0% in urine samples and 18.8% and 31.3% in sputum samples, respectively. The overall resistance rates were 58% for all extended-spectrum beta-lactamase (ESBL)-producing organisms, 13.4% for carbapenem-resistant non-lactose fermenting gram-negative bacilli, 8.7% for carbapenem-resistant Acinetobacter baumannii (CRAB) and 1.3% for carbapenem-resistant Enterobacteriaceae (CRE). There were no carbapenem-resistant P. aeruginosa (CRPA) isolates but all Staphylococcus aureus isolates were methicillin-resistant S. aureus. CONCLUSION: We demonstrated a high prevalence rate of ESBL-producing organisms which are a significant burden at the main tertiary hospital in Sierra Leone. Urgent action is needed to strengthen microbiological diagnostic infrastructure, initiate surveillance on antibiotic resistance and develop and implement policy framework on antibiotic stewardship.
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spelling pubmed-70362242020-03-02 Antibiotic resistance in patients with clinical features of healthcare-associated infections in an urban tertiary hospital in Sierra Leone: a cross-sectional study Lakoh, Sulaiman Li, Letian Sevalie, Stephen Guo, Xuejun Adekanmbi, Olukemi Yang, Guang Adebayo, Oladimeji Yi, Le Coker, Joshua M. Wang, Shuchao Wang, Tiecheng Sun, Weiyang Habib, Abdulrazaq G. Klein, Eili Y. Antimicrob Resist Infect Control Research BACKGROUND: Available data on antibiotic resistance in sub-Saharan Africa is limited despite its increasing threat to global public health. As there is no previous study on antibiotic resistance in patients with clinical features of healthcare-associated infections (HAIs) in Sierra Leone, research is needed to inform public health policies. Our study aimed to assess antibiotic resistance rates from isolates in the urine and sputum samples of patients with clinical features of HAIs. METHODOLOGY: We conducted a cross-sectional study of adult inpatients aged ≥18 years at Connaught Hospital, an urban tertiary care hospital in Freetown between February and June 2018. RESULTS: Over the course of the study, we enrolled 164 patients. Risk factors for HAIs were previous antibiotic use (93.3%), comorbidities (58.5%) and age (≥65 years) (23.9%). Of the 164 samples, 89.6% were urine. Bacterial growth was recorded in 58.8% of cultured specimens; the type of specimen was an independent predictor of bacterial growth (p < 0.021). The most common isolates were Escherichia coli and Klebsiella pneumoniae; 29.2% and 19.0% in urine samples and 18.8% and 31.3% in sputum samples, respectively. The overall resistance rates were 58% for all extended-spectrum beta-lactamase (ESBL)-producing organisms, 13.4% for carbapenem-resistant non-lactose fermenting gram-negative bacilli, 8.7% for carbapenem-resistant Acinetobacter baumannii (CRAB) and 1.3% for carbapenem-resistant Enterobacteriaceae (CRE). There were no carbapenem-resistant P. aeruginosa (CRPA) isolates but all Staphylococcus aureus isolates were methicillin-resistant S. aureus. CONCLUSION: We demonstrated a high prevalence rate of ESBL-producing organisms which are a significant burden at the main tertiary hospital in Sierra Leone. Urgent action is needed to strengthen microbiological diagnostic infrastructure, initiate surveillance on antibiotic resistance and develop and implement policy framework on antibiotic stewardship. BioMed Central 2020-02-22 /pmc/articles/PMC7036224/ /pubmed/32087751 http://dx.doi.org/10.1186/s13756-020-0701-5 Text en © The Author(s). 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Lakoh, Sulaiman
Li, Letian
Sevalie, Stephen
Guo, Xuejun
Adekanmbi, Olukemi
Yang, Guang
Adebayo, Oladimeji
Yi, Le
Coker, Joshua M.
Wang, Shuchao
Wang, Tiecheng
Sun, Weiyang
Habib, Abdulrazaq G.
Klein, Eili Y.
Antibiotic resistance in patients with clinical features of healthcare-associated infections in an urban tertiary hospital in Sierra Leone: a cross-sectional study
title Antibiotic resistance in patients with clinical features of healthcare-associated infections in an urban tertiary hospital in Sierra Leone: a cross-sectional study
title_full Antibiotic resistance in patients with clinical features of healthcare-associated infections in an urban tertiary hospital in Sierra Leone: a cross-sectional study
title_fullStr Antibiotic resistance in patients with clinical features of healthcare-associated infections in an urban tertiary hospital in Sierra Leone: a cross-sectional study
title_full_unstemmed Antibiotic resistance in patients with clinical features of healthcare-associated infections in an urban tertiary hospital in Sierra Leone: a cross-sectional study
title_short Antibiotic resistance in patients with clinical features of healthcare-associated infections in an urban tertiary hospital in Sierra Leone: a cross-sectional study
title_sort antibiotic resistance in patients with clinical features of healthcare-associated infections in an urban tertiary hospital in sierra leone: a cross-sectional study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036224/
https://www.ncbi.nlm.nih.gov/pubmed/32087751
http://dx.doi.org/10.1186/s13756-020-0701-5
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