PREVALENCE OF NOSOCOMIAL INFECTIONS AND ANTIBIOTICS SUSCEPTIBILITY PROFILE OF BACTERIA ISOLATES IN SOME HOSPITALS IN ILORIN, NIGERIA
PREVALENCE OF NOSOCOMIAL INFECTIONS AND ANTIBIOTICS SUSCEPTIBILITY PROFILE OF BACTERIA ISOLATES IN SOME HOSPITALS IN ILORIN, NIGERIA
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Date
2008-08
Authors
ATATA, RAZAQ FUNSHO
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Abstract
Prevalence of nosocomial infections and antibiotics susceptibility profiles of bacterial
isolates in six private hospitals and University of Ilorin Teaching Hospital (UITH) in
Ilorin town Kwara State, Nigeria were investigated. . A 1-year retrospective study of the
private hospitals and 3-years retrospective analysis of the university of Ilorin teaching
hospital were carried out. A 2-year prospective study surgical site nosocomial infection in
the teaching hospital was also carried out.
Patients’ folders and Microbiology laboratory records were used for the determination of
prevalence of nosocomial infections in retrospective study. Bacteriological analysis of
Floor and air of theater and surgical wards of the private hospitals and swabs of surgical
wounds, floors and air of theater and surgical wards of the teaching hospital were done,
using diagnostic media and biochemical tests.
Antibiotic susceptibility profiles of the bacterial isolates were determined using tube
dilution and agar diffusion methods as described in official monographs. Multi Antibiotic
Resistant (MAR) isolates were screened for β-lactamase production by iodometric method.
Presence of plasmids in the MAR isolates was determined using the agar gel
electrophoresis technique. Plasmid curing, to determine if antibiotic resistance was due to
plasmids was also carried out by treating the isolates with acridine orange and redetermining
of their MIC values. Susceptibility of the isolates to some commonly used
hospital disinfectants were determined by the broth- dilution technique, for two years. Insitu
efficacies of some hospital disinfectants indicated reduction level of microbial count
of the floors and airs of theater and surgical wards.
Result of the retrospective study of the six private hospitals showed that nosocomial
infections are common in the hospitals, with a prevalence rate of 15.23%. Analysis of
incidence of nosocomial infection rates showed that Surgical site infection ranked the
highest with prevalence rate of 26.1%, followed by infection of the blood stream, urinary
tract and respiratory tract in descending order. In the university teaching hospital the
average rate of nosocomial infection in the wards for the 3 years was 1.27%. With highest
rate of prevalence of 67.42% also occurring in surgical site followed distantly by UTI,
Blood stream and Respiratory tract infections in descending order.
Comparative analysis of results of retrospective study on leading causative agents of
nosocomial infection in both private and the teaching hospitals showed that S. aureus, Ps.
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aeruginosa, S. epidermidis and E. coli are the leading causative pathogens nosocomial
infections in decreased order of frequencies. Isolates from both private and Teaching
hospital environments equally incriminated S. aureus, S. epidermidis and Ps. aeruginosa
as the leading causative agents.
The results of susceptibility tests showed that all the isolated bacterial species from both
the private hospital and university teaching hospital environments were multiple
antibiotics resistant (MAR). The MAR indices ranged from 0.4-0.8. Bacteriological study
of surgical site infections at UITH showed nosocomial infection prevalence rate of 30-
45.7% with appendicectomy having the highest figure of 46.7%. Other commonly infected
surgical sites were laparatomy, mastectomy, thyroidectomy, and herniorrhaphy.
A total of ten (10) different bacterial species were isolated from the surgical sites, with S.
aureu, S. epidermidis, Ps. aeruginosa, E. coli, Kl. pneumonia, and Pr. mirabilis
constituting 89% of the isolates. Most of the isolates from the surgical sites were multiantibiotic
resistant, with MAR indices ranging from 0.6-0.8. Only the quinolones and
aminoglycosides showed good inhibitory activities against most of the isolates.
Sixty- four percent (90 out of 149) of the bacteria isolated from the surgical sites were β-
lactamase producers with Staphylococci constituted 90% of the β-lactamase producers.
Results of plasmid curing analysis showed that 61.2% of the multiple antibiotic resistant
isolates, which also produced β-lactamase, harboured plasmids. After plasmid curing
61.2% of these isolates became sensitive to some of the antibiotics which they were
initially resistant to. The result of electrophoresis analysis of the resistant isolates showed
different plasmid numbers and sizes, with some isolates having the same number of
plasmid bands and sizes confirming that resistance observed with the isolates were
plasmid- mediated and the likely origin of the these isolates. There was decrease in
efficacies of the disinfectants from 2004 to 2005 which resulted in high bacterial counts in
most of the wards in the hospital.
Generally, surgical site infection was the leading nosocomial infection in the investigated
hospitals in Ilorin. S. aureus, S. epidermidis, Ps. aeruginosa, E. coli and Kl. pneumoniae.
Which were the causative pathogens They were resistant to commonly prescribed
antibiotics. Antibiotic resistance in the isolates was largely due to production of β-
lactamases and transfer of resistance plasmid among the isolates. Ineffective disinfection
of the clinical environment was mostly responsible for the high number of the bacteria
contaminants in the hospital wards.
Description
A THESIS SUBMITTED TO THE POSTGRADUATE SCHOOL, AHMADU BELLO
UNIVERSITY, ZARIA, IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR
THE AWARD OF DOCTOR OF PHILOSOPHY IN PHARMACEUTICAL
MICROBIOLOGY.
DEPARTMENT OF PHARMACEUTICS AND PHARMACEUTICAL
MICROBIOLOGY, FACULTY OF PHARMACEUTICAL SCIENCES, AHMADU
BELLO UNIVERSITY, ZARIA, NIGERIA
AUGUST, 2008
Keywords
PREVALENCE,, NOSOCOMIAL,, INFECTIONS,, ANTIBIOTICS,, SUSCEPTIBILITY,, PROFILE,, BACTERIA,, ISOLATES,, HOSPITALS,, ILORIN,, NIGERIA.