| dc.description.abstract | Hospital acquired infections are a serious public health problem worldwide affecting hundreds of millions of people every year and are difficult to treat due to the problem of antibiotic resistance. The problem has been compounded by lack of sufficient data to help understand the antimicrobial pattern and spectrum, which impedes has the fight against antimicrobial resistance. This study aimed at determining the common pathotypes causing nosocomial infection in various categories of patients including age, sex and the type of wards in which they were admitted and then determining antimicrobial resistance in the common isolates in JOOTRH. A descriptive cross- sectional study design involving bacteriological analysis of clinical samples including urine, blood, pus swab, stool, cerebrospinal fluid, and effusion was used to purposively select 111 study participants from August to December 2021. Specimens were cultured and the bacterial isolates were tested against different antibiotics by disk diffusion technique following clinical laboratory standards institute (CLSI) guidelines. Data obtained were analyzed using SPSS version 20. P values ≤ 0.05 were considered statistically significant. Tables and bar graphs were used to summarize data in percentages. More than half of the study participants 59(53.2%) were females while 52(46.8%) were males. A third, (31%) were aged less than one year while 4% were aged between six and twelve years. In total, 51(45.9%) of samples yielded bacterial growth out of which, 37(33.3%) were gram negative while 14(12.6%) were gram positive. Generally, Klebsiella pneumoniae was the predominant bacterial pathogen isolated from samples followed by Escherichia coli and Staphylococcus aureus; Pseudomonas aeruginosa, Proteus spp., Enterococci and Acinetobacter baumannii at 16(31.4%), 13(25.5%), 12(23.5%), 4(7.8%), 3(5.9%), 2(3.9%) and
1(2%) respectively. The newborn unit had 1(7.7%) accounting for the least number of pathogens isolated. 27(52%) of the isolates were from surgical ward. Staphylococcus aureus was the predominant pathogen responsible for surgical site infection. This study found an association between age and the risk of hospital acquired bacterial infection (χ2, p=0.012) however, gender (p=0.338) and ward category (p=0.774) were not significantly associated with acquiring bacterial infection during hospitalization period. High prevalence of multidrug resistant bacteria was noted with many pathogens showing resistance to more than three antibiotic classes. Included in this category were ampicillin, imipenem and ceftazidime at 17(100%), 33(97.1%), and
35(92.1%) respectively. Piperacillin and penicillin G showed 27(87.1%) and
5(83.3%) resistance respectively, while sulphamethoxazole-trimethoprim resistance was at 64.7%(n=11). Low resistance was however, noted against amikacin, gentamycin and meropenem at 7.3% (n=3), 22.2% (N=8) and 24.1% (N=7) respectively. This study reported high hospital infections in surgical wards with gram- negative bacteria being most common and Klebsiella spp., predominating among Enterobacteriaceae and Staphylococcus aureus among gram positive pathogens. Most bacteria isolated were resistant to multiple antibiotics. While this study recommends the use of amikacin, gentamycin and meropenem for empiric treatment particularly in resource limited areas where culture facilities are not available it is envisaged that this information will be used in clinical practice to manage patients as antibiotics are being researched on while continuously monitoring new antimicrobial threats that may emerge against them. On the other hand, the study also recommended a review on the continued use of sulphamethoxazole-rimethoprim, ampicillin, ceftazidime, piperacillin and penicillin G due to high resistance showed against them by the bacterial pathogens. | en |
