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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 |
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
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|
|Appears in:||Thesis - Medical Microbiology|
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