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Title: Hospital Acquired Surgical Site and Catheter Related Urinary Tract Infections among Patients Admitted in Mekelle Hospital, Mekelle, Tigray, Ethiopia
Authors: Zeamanuel, Tesfahunegne
Advisors: Daniel Asrat, MD, M.Sc, PhD
Keywords: Nosocomial infections, UTI, SSI, Ethiopia.
Copyright: 2007
Date Added: 23-Apr-2008
Abstract: ABSTRACT Nosocomial infections are widespread. They are important contributors to morbidity and mortality. They will become even more important as public health problem with increasing economic and human impact because of increasing numbers and crowding of people, more frequent impaired immunity (age, illness and treatments), new microorganisms and increasing bacterial resistance to antibiotics. Epidemiologic studies are useful in revealing the prevalence of hospital-acquired infections. Thus, a cross sectional prevalence study of hospital acquired surgical site (SSI) and urinary tract (UTI) infections was conducted between November 2005 and April 2006, in Mekele Hospital, Tigray region, Northern Ethiopia. The study population comprised of a total of 246 informed and consented adult patients hospitalized for surgical (n=212) and Gynecology and Obstetrics cases (n=34). 134 (54.5%) were males and 112 (45.5%) females with overall male to female ratio of 1.2: 1. The average age of the patients was 35.5 years. Of the 212 surgical cases, genitourinary tract problems accounted for 25.4%, followed by goiter 14.2%, fracture of bones 10.3%, cholelithiasis 7.1%, soft tissue infections 6.6%, gastrointestinal problems and soft tissue tumors accounted for 6.1% each and others 24.1%. Of the 34 obstetrics and gynecological cases, caesarian section accounted for 29.4%, followed by myoma 20.6%, ovarian tumor and fallopian tube blockage accounted for 17.6% each and for others 14.8%. Most admitted patients (41%) stayed in the hospital 10-20 days. Wound specimens and midstream urine were collected twice (pre and post catheter insertion) from every admitted patient, where catheterization was mandatory for the operative procedure, for culture and sensitivity. A total of 68/246 (27.6%) admitted patients developed nosocomial infections (SSI and/or nosocomial UTI) based on the clinical evaluations, and positive wound and urine culture results. Out of the 68 patients who developed nosocomial infections, 49/212 (23.1%) and 19/34 (55.8%) were from patients admitted for surgical and Gynecology and Obstetrics cases, respectively (p>0.05). Among catheterized patients, 38/96 (39.5%) developed nosocomial UTI (pre-catheterization urine negative and post-catheterization urine culture positive). Twelve patients out of the 96 who were catheterized (12.5%) developed community-acquired UTI (pre-catheterization urine culture positive). Surgical site infection (SSI) was observed in 30/68 (44.1%) of the patients who developed nosocomial infection. Of the 246 admitted patients, 202 (82.2%) received antibiotic/s on the day of operation and their treatment continued for 7 to 15 days. Among these patients, 64/202 (31.6%) developed nosocomial infections (37 UTI and 27 SSI). In this study gram negative bacteria were predominantly isolated with a rate of 53% and 83% from SSI and UTI respectively. A total of 75 bacterial pathogens were isolated from SSI and nosocomial UTI. E. coli (20%), Klebsella spp. (18.7%) were the commonest bacterial pathogens isolated, followed by Coagulase negative Staphylococci (14.6%), Enterococcus and Proteus spp. each 10.6% , S. marcescens (6.6 %), Enterobacter spp and S. aureus each 5.3%, and C. freundii (4%). P. aeruginosa was isolated only from SSI. More than one bacterial etiologic agent was isolated from 8/68 (11.7%) of the patients with nosocomial infections. Our results have demonstrated that in general most of the isolates from UTI have high rates of resistance (>80%) to the commonly used antibiotics such as ampicillin, amoxicillin, chloramphenicol, gentamicin, streptomycin, and trimethoprim-sulphamethoxazole; and in isolates from SSI to amoxicillin and trimethoprim-sulphamethoxazole. But in both cases low level of resistance (< 60%) was observed against ceftriaxone, norfloxacin, nitrofurantoin and nalidixic acid. All gram positive bacteria isolated from nosocomial UTI showed high level of resistance to vancomycin, erythromycin and methicillin, while those from SSI showed low level of resistance to erythromycin and vancomycin, and intermediate level to methicillin. In conclusion, the present prevalence survey gives a brief overview of the burden and distribution of nosocomial infections in Mekele Hospital, Tigray region, North Ethiopia. The results showed that the prevalence of HAIs (SSI and nosocomial UTI) in the Hospital is high when compared to previous Ethiopian and other studies. Despite the practice of high usage of antibiotic prophylaxis in the hospital, the majority of the patients developed HAIs. Most of the isolates were gram negative bacteria showing high level of resistance to the commonly used antimicrobial agents. The findings underscore the need for an infection control system and surveillance program in the Hospital. Key words: Nosocomial infections, UTI, SSI, Ethiopia.
Description: A Thesis Presented to the School of Graduate Studies, Addis Ababa University in Partial Fulfillment of the Requirements for the Degree of Master of Science in Medical Microbiology
URI: http://hdl.handle.net/123456789/912
Appears in:Thesis - Medical Microbiology

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