Bacterial Nosocomial Infections and Their Antimicrobial Susceptibility Patterns in Surgical Wards and Surgical Intensive Care Unit (SICU) Of Tikur Anbessa University Hospital Addis Ababa, Ethiopia
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2008-08
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Addis Ababa University
Abstract
Background: Nosocomial infections are defined as infections which are not present or not incubating when the patient is hospitalized and are acquired during hospital stay. Sign and symptoms of the infection may be evident during hospitalization or after discharge related to the length of the incubation period. It is usually defined as an infection that is identified at least 48-72 hours following admission to health institution. Infections acquired in hospital
are likely to complicate illness, cause anxiety and discomfort, and can lead to death. Nosocomial infection is a global problem with multi facet out comes. The problem is well pronounced in developing countries. Epidemiological and etiological characteristics of nosocomial infections show variations among countries and even among different hospitals in the same country. Many of these infections are associated with micro-organisms that are resistant to multiple antibiotics and can easily spread on the hands of personnel. The most frequent types of nosocomial infections are urinary-tract infection, surgical-wound infection, pneumonia, and bloodstream infection. At present, the emergence of resistance to antimicrobial agents is a global public health problem, particularly in pathogens causing nosocomial infections. Antimicrobial resistance results in increased morbidity, mortality and health-care costs.
Objective: To determine the prevalence, etiological agents and drug susceptibility pattern of nosocomial infections at Tikur Anbessa University Hospital.
Methods: A cross-sectional study was conducted from June 2007 to April 2008 at Tikur Anbessa University Hospital, Addis Ababa, Ethiopia. During the study, all adult patients admitted to surgical wards and SICU with suspected of nosocomial infection were included. Among 854 patients admitted to surgical wards and SICU, 215 patients selected based on their clinical ground, after a careful clinical examination. Clinical samples were collected from the study subject and analyzed accordingly.
Results: Eight hundred fifty four patients admitted to surgical ward and SICU between June 2007 and April 2008 to Tikur Anbessa University Hospital in Addis Ababa were studied for prevalence of nosocomial infections. A total of 215(25.2%) patients, were selected based on their clinical grounds from surgical wards (n=161) and SICU (n=54). The mean hospital stay from the date of admission until sample collection was 16.72 days with a range of 3 to 66 days. Of the 215 patients, 130(60.5%) were males and 85 (39.5%) were females. A total of nine percent (77/854) patients were confirmed to have nosocomial infections. Of the 77 patients, 51(66.2%) were males and 26(33.8%) females. The distribution of nosocomial infections among positive cases was surgical site infection 38(49.4%), urinary tract infections 23(29.8%) and blood stream infection 16(20.8%). The Gram-positive and negative bacteria accounted for 23/84(23.4%) and 61/84(72.6%) respectively. A total of 84 bacterial pathogens (strains) were isolated, E. coli accounted for 19.0% of the total isolates followed by S. aureus and Klebseiella spp. More than one bacteria etiologic agent was isolated from 7/77(9.1%) of the patients with nosocomial infection. Gram positive bacteria showed 100% resistance to penicillin, ampicillin, tetracycline, chloramphenicol, and trimethoprim sulphamethoxazole; while gram negative bacteria showed 100% resistance to
amoxicillin, Tetracycline and Trimethoprim-sulphamethoxazole.
Conclusion: The prevalence of nosocomial infection at Tikur Anbessa University Hospitals decreased from the previous study (16.4% and 13%) in the same hospital. Gram-positive bacteria isolated from nosocomial infection were 100% resistance to Ampicillin, Tetracycline, Trimethoprim-sulphamethoxazole and Chloramphenicol. In addition, gramnegative
bacterial isolates were 100% resistance to Amoxicillin, Tetracycline and
Trimethoprim-sulphamethoxazole. Due to the presence of high level drug resistance bacteria, empirical treatment to nosocomial infections may not be effective. Therefore, treatment should be based on the result of culture and sensitivity.
Keywords: Nosocomial infection, Surgical Site Infection, Blood Stream Infection, Urinary Tract Infection, Intensive Care Unit
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Keywords
Nosocomial infection, Surgical Site Infection, Blood Stream Infection, Urinary Tract Infection, Intensive Care Unit