African Journal of Clinical and Experimental Microbiology

Draft metagenome-assembled genomes of Pseudomonas putida isolated from human gut microbiome in Nasarawa State, Nigeria

Oluchukwu Ogechukwu Anunobi — Tue, 02 Jul 2024 00:00:00 +0000

The metagenome-assembled genome (MAG) sequences of Pseudomonas putida PP14A and PP20A were obtained by metagenomic sequencing from the gut microbiomes of a female and a male patient both 24 years old from the same household presenting to a health outreach laboratory with complaint of headache, and occasional diarrhoea in Mararaba, Nasarawa State, Nigeria. The phylogenetic relationship observed between the two PP MAGs with other Pseudomonas spp MAGs from human, points to the global spread of Pseudomonas putida through human activity and migration.

Prevalence of high-risk HPV types 16 and 18 in relation to immune status and cervical cytological profile of HIV-infected women on antiretroviral therapy in northcentral Nigeria

A. Y. Ajang, E. E. Ella, A. O. Oguntayo, E. Innocent, M. Aminu — Tue, 02 Jul 2024 00:00:00 +0000

Background: Human papillomavirus (HPV) is a well-established causal agent of cervical cancer, and the first group of viruses to have been acknowledged to prompt carcinogenesis. They are linked with cancers of the uterine cervix, anogenital tumours, and head and neck malignancies. Cervical cancer is by far the most common HPVrelated disease, with about 99% of cervical cancer cases caused by persistent genital high-risk (HR) HPVs, especially types 16 and 18.
Methodology: A hospital-based descriptive analytical study of 300 consenting HIV-infected women on antiretroviral therapy (ART), selected from the three senatorial districts of Plateau State, Nigeria, was conducted over a period of 24 months (November 2018 to November 2020). Blood and cervical specimens were collected from each participant. HIV status was confirmed by standard rapid test on serum sample, CD4⁺ cell count was determined by flow cytometry and HIV viral load estimation was done by GeneXpert nucleic acid amplification technique. Cervical cytology was performed by Papanicolaou (Pap) smear on the cervical specimen and reported according to the 2004 Bethesda system classification. HPV antigen was first detected on the cervical specimen using ELISA, and samples positive for HPV antigen were then subjected to multiplex PCR amplification of E6 and E7 genes to detect HR-HPV (16 and 18) and other HPV types. Standard questionnaires were administered to obtain information on biodata, risk factors and clinical presentations. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 26.0, and significance level was determined at p<0.05.
Results: Of the 300 participants, 84 were positive for HPV of any type, giving an overall prevalence of HPV infection of 28.0%. The prevalence of HPV-16 and HPV-18 types were 5.0% (15/300) and 5.3% (16/300) respectively. Cytological analysis showed that 36.3% (109/300) of the participants had cervical abnormalities ranging from low-grade to high grade squamous intraepithelial lesions and cervical intraepithelial neoplasia. HPV prevalence of 46.8% (51/109) in women with cervical abnormalities was significantly higher than 17.3% (33/191) in women with normal cervical cytology (OR 4.2, p<0.0001). HPV prevalence was higher in women with AG-US (100.0%), ASC-US (78.8%), AC-US (66.7%), ASC-H (33.3%), HSIL (33.3%), HSIL (23.8%), and LSIL (41.2%) compared with women with normal cervical cytology (p<0.001). Aside educational level (p=0.03), none of the analyzed sociodemographic characteristics or risk factors for cervical cancer was significantly associated with HPV infection in the study (p>0.05).
Conclusion: This study showed high prevalence of HPV infections among HIV-infected patients on ART in Plateau State, north-central Nigeria including detection of high-risk HPV types 16 and 18, which are major risk factors for progression of cervical intraepithelial neoplasia to cervical cancer.

Phenotypic detection of extended-spectrum β-lactamase Enterobacterales isolated from people living with HIV/AIDS in Kinshasa, Democratic Republic of the Congo

Tue, 02 Jul 2024 00:00:00 +0000

Background: People living with HIV/AIDS (PLWHA) are prone to opportunistic bacterial infections caused by multidrug-resistant organisms. The aim of this study was to determine the susceptibility of Enterobacterales isolated from urine and stool samples of PLWA attending the BOYAMBI Hospital Center, Kinshasa, Democratic Republic of the Congo to commonly used antibiotics and to detect extended-spectrum β-lactamases (ESBLs) producers among the isolates.
Methodology: A total of 163 HIV-infected patients attending the BOYAMBI Hospital, Kinshasa, DRC, were randomly selected for this study. Urine samples were collected from 108 patients, while stool samples were collected from 55 of them. Samples were cultured in MacConkey agar and identified using conventional microbiological methods. Antibiotic susceptibility on each isolate to selected antibiotics was performed by the disc diffusion method. Phenotypic detection of ESBL was done by the double-disc synergy test.
Results: A total of 120 Enterobacterales were isolated from the samples of the 163 HIV-infected patients with 65 of 108 (60.2%) urine and 55 of 55 (100.0%) stool samples. Escherichia coli was the most frequent bacterial species from both urine and stool with 84 (70.0%), followed by Klebsiella species with 23 (19.2%). Other bacterial pathogens were Citrobacter (n=6, 5.0%), Enterobacter (n=4, 3.3%), Proteus (n=2, 1.7%) and Morganella (n=1, 0.8%) species. Escherichia coli isolates were resistant to amoxicillin (90.5%), sulfamethoxazole-trimethoprim (81.0%), ciprofloxacin (77.4%), ceftriaxone (77.4%), ceftazidime (73.8%), amoxicillin–clavulanic acid (61.9%), imipenem (60.7%), and cefotaxime (50.0%). Klebsiella pneumoniae isolates were resistant to ceftazidime (95.7%), ceftriaxone (91.3%), imipenem (91.3%), ciprofloxacin (87%), sulfamethoxazole-trimethoprim (78.3%), cefotaxime (56.5%), and amoxicillin–clavulanic acid (52.2%). Citrobacter, Enterobacter, Morganella and Proteus species were resistant to majority of the antibiotics. The rate of ESBL production was 23.0% (28/120) with Citrobacter spp being the most frequent ESBL-producer, followed Klebsiella spp, Enterobacter spp and E. coli.
Conclusion: The results obtained showed a high rate of ESBL-producing Enterobacterales isolates which were multi-drug resistant. Nitrofurantoin, gentamicin, chloramphenicol, cefixime and nalidixic acid were the most active antibiotics against the isolates.

Vaginal carriage of Streptococcus agalactiae among pregnant women in Ouagadougou, Burkina Faso

A. Ky/Ba, A. Ouattara, T. Issa, A. Y. Ky , C. Ki , M. Sanou, I. Sanou — Tue, 02 Jul 2024 00:00:00 +0000

Background: Group B Streptococcus (GBS) is one of the main bacteria responsible of serious neonatal infections. Neonatal transmission is very high at the end of pregnancy between the 34th and 38th week of gestation, and the systematic screening of GBS is strongly recommended in Burkina Faso. The objective of this study was to assess the prevalence of GBS carriage among pregnant women in Ouagadougou, Burkina Faso.
Methodology: This was a cross-sectional study of 300 pregnant women in their third trimester of pregnancy, conducted between July and November 2020. Vaginal sample was collected from each of the pregnant women during prenatal consultations. The samples were cultured on blood agar and the isolated pathogens were identified using the BD Phoenix M50 automated system. Antibiotic sensitivity test was performed on each isolate according to the recommendations of the CA-SFM-EUCAST 2020.
Results: Of the 300 women, 12 samples were positive for GBS, giving a carriage rate of 4.0%. All the GBS isolates were susceptible to ampicillin, cefotaxime, vancomycin and nitrofurantoin. On the other hand, resistance was encountered against penicillin G, erythromycin and trimethoprim-sulfamethoxazole. None of the risk factors assessed was statistically predictive of vaginal carriage of GBS in the pregnant women.
Conclusion: Vaginal carriage of GBS remains relevant. Pending the introduction of an effective vaccine in Burkina Faso, a systematic screening policy for GBS in pregnant women would help reduce perinatal infections from GBS, and the attendant neonatal and infant mortality.

Bacteraemia at the tertiary care University Hospital Yalgado Ouedraogo: Bacterial species and their antibiotic resistance profiles

Tue, 02 Jul 2024 00:00:00 +0000

Background: Bloodstream infections are serious health problem because of the significant morbidity and mortality they cause. The number of deaths increases in the presence of multidrug resistant bacteria. The aim of this study was to determine the bacteriological and resistance profiles of bacteria isolated from blood cultures.
Methodology: This is a retrospective descriptive study over 3 years (1st January 2019 to 31st December 2021) of all blood cultures received in the Bacteriology-Virology Laboratory at CHU-YO. Bacteria were isolated from blood cultures after routine processing in automated BD BACTEC FX40 machine. Bacteria identification and antibiotic susceptibility test (AST) was by conventional biochemical tests and API 20E, and Kirby-Bauer disc diffusion method respectively from Jan to Sept 2019, and by BD Phoenix M50 from Sept 2019 to Dec 2021. All proven cases of bacteraemia documented by culture, identification and AST were included in the study. Data analysis was done using EPI-INFO 7.2.4.0 software.
Results: A total of 335 pathogenic bacteria were isolated from non-duplicate blood cultures collected from a total of 2345 patients, with 1209 males and 1136 females, giving a male to female ratio of 1.06. Gram-negative bacilli accounted for 63.6% (n=213) with a predominance of Enterobacteriaceae (40.6%, n=136). The leading species were Klebsiella spp (18.5%, n=62) followed by E. coli (14.0%, n=47). Gram-positive cocci accounted for 36.4% (n=122), mostly Staphylococcus aureus (22.1%, n=74). Klebsiella spp and E. coli strains showed high levels of resistance to beta-lactams (60 to 71.0% for piperacillin-tazobactam, 87 to 89.0% for amoxicillin-clavulanic acid
and 79 to 90.0% for ceftriaxone), fluoroquinolones (75 to 78.0% for ciprofloxacin) and sulphonamides (82 to 96.0% for cotrimoxazole). The lowest levels of resistance were observed with cefoxitin (5-20.0%) and imipenem (5-7.0%). Strain sensitivity to aminoglycosides was highly variable, ranging from 0-5.0% for amikacin to 54-67.0% for gentamicin. The main mechanism of resistance of Klebsiella spp and E. coli strains to beta-lactam antibiotics was ESBL production; 64.5% (40/62) and 60.0% (28/47), respectively. Staphylococcus aureus strains were resistant to methicillin (MRSA) in 13.0% of cases. All were sensitive to fusidic acid and vancomycin.
Conclusion: Klebsiella pneumoniae, E. coli and S. aureus are the main bacteria responsible for bacteremia in Burkina Faso. Their resistance to antibiotics is very high and remains of concern. The introduction of rapid tests to detect resistant bacteria directly from blood culture broths is essential for the early adaptation of empirical antibiotic therapy.

Antibiotic resistance in uropathogenic Escherichia coli strains at Brazzaville University Hospital, Congo and the therapeutic consequences

T. Mieret, E. N. Ontsira Ngoyi, A. Aloumba, B. R. Ossibi Ibara, A. W. S. Odzebe — Tue, 02 Jul 2024 00:00:00 +0000

Background: Urinary tract infections (UTIs) are a very frequent reason for consultations and antibiotic prescriptions in everyday practice. Excessive and inappropriate use of antibiotics is responsible for the emergence and spread of multidrug-resistant (MDR) uropathogenic bacteria. The aim of this study was to determine the frequency of isolation and antibiotic resistance of uropathogenic strains of Escherichia coli (UPEC) isolated in the bacteriology-virology laboratory of the University Hospital Centre (CHU) in Brazzaville, Congo.
Methodology: This was a descriptive retrospective study over a 6-month period (from 1 April to 31 September 2022) that included all non-redundant uropathogenic UPEC strains isolated from urine samples of patients with UTIs referred to the bacteriology-virology laboratory of the University Hospital of Brazzaville, Congo. The strains were isolated from urine samples after inoculation onto Cystine Lactose Electrolyte Deficient agar (CLED), and incubating aerobically at 37°C for 24 hours. Identification was carried out using BioMérieux API 20 E galleries and antibiotic susceptibility testing was performed on Mueller Hinton agar medium using selected antibiotic discs. Extended spectrum β-lactamase (ESBL) production by the isolates was confirmed by double disc synergy test.
Data were analysed using Microsoft Office Excel 2013.
Results: Of the 187 non-repetitive uropathogenic Enterobacteriaceae isolated from urine samples of 187 patients with clinical UTIs, 81 were strains of UPEC, giving an overall frequency of UPEC isolation of 43.0%. The modal age of patients from whom UPEC strains were isolated was 57 years (age range 2 to 86 years), with 49 from females and 32 from males (F: M ratio of 1.5). The UPEC strains showed high rates of resistance to amoxicillin (94.0%), amoxicillin-clavulanic acid (84.0%), piperacillin-tazobactam (73.0%), ceftriaxone (52.0%), cefixime (54.0%), cefotaxime (55.0%), ceftazidime (58.0%), gentamicin (42.0%), ciprofloxacin (55.0%) and sulfamethoxazole-trimethoprim (90.0%) but relatively low resistance rates were observed with imipenem (4.0%), fosfomycin (8.0%) and amikacin (18.0%). The ESBL-producing strains accounted for 24.5% (46/187) of all uropathogenic Enterobacteriaceae isolates, and compared to the non-ESBL producing strains, had significantly higher resistance rates to gentamicin (p=0.018), ciprofloxacin (p=0.0003), ceftazidime (p<0.0001), ceftriaxone (p<0.0001), cefixime (p<0.0001), cefotaxime (p<0.0001), piperacillin-tazobactam (p=0.0006), and amoxicillin-clavulanate (p=0.0024).
Conclusion: Our results show high rates of in vitro resistance of UPEC strains to commonly used antibiotics, which potentially limits therapeutic options and therefore a real public health challenge in Congo.

Bacteriological profiles of urinary tract infections in patients admitted to the nephrology-haemodialysis department of the Bogodogo University Teaching Hospital (CHU B), Ouagadougou, Burkina Faso

A. Ky/Ba, I. Tondé, E. A. Dienderé, A. Y. Ky, J. R. Tamini, M. Sanou, I. Sanou — Tue, 02 Jul 2024 00:00:00 +0000

Background: Urinary tract infections (UTI) constitute a major public health problem, especially in developing countries such as Burkina Faso. They are commonly encountered in hospitals, particularly in patients suffering from chronic kidney disease whose management requires special measures to avoid treatment failures which are frequent. The objective of this study is to determine the microbial profiles of urinary tract infections (UTIs) in these patients.
Methodology: This was a cross-sectional study of hospitalized patients with UTIs in the nephrology-haemodialysis department of the CHUB from August 1 to November 31, 2020. Socio-demographic and clinical data of selected patients were collected by a well-designed data collection form. Cytobacteriological analysis of urine (CBAU) was carried out on voided or catheter-urine sample of each patient using standard microbiological technique. The disc diffusion method in agar medium modified according to the recommendations of the 2020 CA-SFM-EUCAST was used to determine the antibiotic susceptibility of each isolate. Data were processed and analyzed using Excel 2013, IBM SPSS Statistics 25.0 and CSpro 7.5 software.
Results: Urine samples were collected from a total of 77 eligible participants, 49 (63.6%) of which were CBAU positive, with 56 microbial pathogens isolated. Enterobacterales represented 58.9% (n=33), including 39.4% Escherichia coli (n=13) and 36.4% Klebsiella spp (n=12). Non-fermentative Gram-negative bacilli represented 7.1% (n=4) including Acinetobacter baumannii (n=3) and Pseudomonas aeruginosa (n=1). Staphylococcus aureus was isolated in 5.4% (n=3) and Candida spp in 28.6% (n=16). The most active antimicrobials in vitro against the bacterial pathogens were amikacin and imipenem, and clotrimazole and nystatin against the Candida spp. A total 35.7% (n=20)
were multi-drug resistant bacteria with 32.1% by ESBL in Gram-negative bacteria and 66.7% (2/3) by MRSA in Grampositive bacteria.
Conclusion: The high resistance of pathogens to antimicrobials, resulting in therapeutic failures, constitutes a significant challenge in the management of urinary tract infection, especially in people with chronic kidney disease. It is therefore necessary to put in place urgent measures aimed at the rational use of antimicrobials and strict compliance with good hospital hygiene practices.

Phenotypic and molecular identification of antimicrobial resistance in Escherichia coli and Salmonella species isolated from apparently healthy broilers and zoo birds in Cameroon

Tue, 02 Jul 2024 00:00:00 +0000

Background: Knowledge of antimicrobial resistance patterns of bacteria in food and pet birds in our environment is a prerequisite to effective control of bacterial diseases in humans and other food animals. Particularly, there is a dearth of information on the prevalence of resistant bacteria in pet and zoo birds in Cameroon. This study was carried out to determine the antibiotic resistance profiles of Escherichia coli and Salmonella spp isolates in apparently healthy poultry and zoo birds in Cameroon and to phenotypically and genotypically identify extended spectrum β-lactamases (ESBLs) isolates in the poultry and aviary birds.
Methodology: This was a cross-sectional study of 320 randomly selected birds, which included 172 poultry and 148 zoo birds over a period of nine months, from which a total of 320 different non-repetitive samples were collected. The specimens were processed by standard microbiological culture methods at the National Veterinary Laboratory (LANAVET), Yaoundé annex, Cameroon. All isolated bacteria from cultures were identified as E. coli and Salmonella spp by conventional biochemical test scheme and confirmed with API®20E gallery. Antibiotic susceptibility test (AST) of confirmed isolates was done using the Kirby–Bauer disc diffusion technique, with AST results interpreted according to CLSI guidelines. Isolates with phenotypic characteristics of extended-spectrum beta-lactamase were subjected to molecular identification for bla_CTX-M, bla_TEM and bla_SHV genes. Data obtained were analyzed using descriptive statistics.
Results: Out of the 320 samples, a total of 88 E. coli and 17 Salmonella species were isolated from both broilers and zoo birds with an overall isolation prevalence of 27.5% and 5.3% respectively. High resistance of E. coli was observed among isolates from broiler, especially to trimethoprim-sulfamethoxazole (96.7%), ampicillin and ticarcillin (88.3%), norfloxacin (81.7%), piperacillin (78.3%) and ceftriaxone (63.3%). However, the resistance pattern among isolates from aviary birds was low with the highest resistance observed for imipenem (39.28%). The isolates had multiple antibiotic resistance (MAR) indices between 0.18-0.94 with an average of 0.3. A striking MAR index of 0.94 was observed in an ESBL isolate. Detection of β-lactamase genes in 16 phenotypic ESBL-producing E. coli and Salmonella isolates showed the presence of 75.0%, 6.3% and 12.5% for bla_CTX-M, bla_TEM, and bla_SHV genes respectively.
Conclusion: ESBL isolates were widespread among apparently healthy broilers in live-bird markets in Cameroon with ESBL-producing E. coli and Salmonella species showing high resistance to penicillin, quinolones and sulphonamides. In addition, there is evidence of antibiotic-resistant bacteria in wild birds which can be transmitted to humans through fecal droppings or by being in close contact with them.

Prevalence and antimicrobial resistance profiles of faecal Escherichia coli isolates from local chickens in Plateau State, Nigeria

Tue, 02 Jul 2024 00:00:00 +0000

Background: Poultry is a profitable business in Nigeria, with economic benefits to families and communities involved in this type of agriculture. However, infection of poultry birds by Escherichia coli can, in addition to causing mortality, results in reduction of egg production, with depletion of protein (egg and meat) and subsequent reduction in market value, consumer supply, cost of veterinary care, and medicines. The objectives of this study are to determine the prevalence and antimicrobial resistance profiles of faecal E. coli isolates from local chickens (Gallus domesticus) in Plateau State, northcentral Nigeria.
Methodology: This was a descriptive cross-sectional study of 540 local chickens for faecal carriage of E. coli, randomly selected from 9 local government areas (LGAs) (60 per LGA) in the 3 senatorial districts (180 per senatorial district) of Plateau State, Nigeria. Faecal samples were collected from the chickens for culture isolation and identification of E. coli using conventional microbiological methods. The isolates were confirmed by Vitek® 2 compact machine and PCR amplification of 16S rRNA gene. Antibiotic susceptibility test of 37 distinct E. coli strains to selected antibiotics (ampicillin, ampicillin/sulbactam, piperacillin, cefazolin, cefepime, ceftriaxone, ceftazidime, cefoxitin, ertapenem, meropenem, amikacin, gentamicin, tobramycin, ciprofloxacin, levofloxacin, nitrofurantoin and trimethoprim-sulfamethoxazole) was performed by the Vitek® 2 and read using the web system application. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) version 20.0 and R Commander version 2.9-1.
Results: The overall prevalence of faecal E. coli carriage among the chickens was 65.0% (351/540), with highest prevalence in Central Plateau senatorial district (76.1%, 137/180), which was significantly higher than Northern Plateau (62.2%, 112/180) and Southern Plateau (56.7%, 102/180) (x²=15.873, p=0.0004). The prevalence of E. coli was highest in Pankshin (86.7%, 52/60) and Mangu (85.0%, 51/60) LGAs and this was significantly higher than in Bokkos (56.7%, 34/60) (x²=18.761, p<0.000) and other LGAs. The antibiotic susceptibility of 37 distinct strains of E. coli showed that 64.9% (n=24) were resistant to at least one antibiotic, with the highest resistance rate being to trimethoprim-sulfamethoxazole (51.4%, n=19), ampicillin (48.7%, n=18), and piperacillin (43.2%, n=15). Multi-drug resistance (resistance to three or more antibiotic classes) was observed in 35.1% (n=13) of the E. coli strains. The multiple antibiotic resistance (MAR) index ranged from 0.06 (resistance to one antibiotic) to 0.76 (resistance to 13 antibiotics tested).
Conclusion: The results of this study provide evidence that resistance to multiple antibiotics is widespread among faecal E. coli isolates from local chickens in Plateau State, Nigeria, and thus poses potential risks for human infections with MDR E. coli.

Knowledge, attitude and prevention practice against hospital acquired infections among healthcare workers in National Hospital Abuja, Federal Capital Territory, Nigeria

O. R. Ilori, U. C. Attama, O. S. Ilori, V. T. Akin-Dosumu, N. E. Anegbe — Tue, 02 Jul 2024 00:00:00 +0000

Background: Hospital-acquired infections (HAIs) pose serious challenges to safe and high-quality healthcare delivery. They are associated with prolonged hospital stays, disability, economic burden, and mortality, and are usually consequences of poor infection prevention and control practices. The objective of this study was to assess the level of knowledge, attitude and practice of healthcare workers on infection prevention, and the determining factors at the National Hospital Abuja, Nigeria.
Methodology: This was a descriptive cross-sectional study of 300 participants selected by multi-stage and systematic random sampling techniques at the National Hospital Abuja. Data on knowledge of HAIs, attitude toward HAI prevention, and practice of HAI prevention were collected from each participant using selfadministered structured questionnaires. Data were analyzed using the Statistical Package for the Social Science, version 25.0. Chi-square test was used to determine the association between categorical variables, and the level of significance was set at p<0.05.
Results: Of the 300 questionnaires administered, 286 were duly filled and returned, resulting in a response rate of 95.3%. One hundred and three (53.0%) respondents were within the age group 31-40 years, over half of the respondents were females (58.7%) and 57.0% had work experience of less than 5 years. Based on the cut-off scores of 15.7, 32.2 and 8.5 that characterized respondents’ knowledge, attitude and practice of infection prevention respectively as good or poor, 50.4% of the respondents had good knowledge of HAIs, 71.0% had good attitude towards HAIs prevention and 55.5% had good infection prevention practices. However, good knowledge of HAIs was significantly associated with poor infection prevention practices (p=0.002). Female gender (p=0.029), work experience of less than 5 years (p=0.036), laboratory scientist profession (p=0.010), and no previous training on HAIs (p=0.005) were factors significantly associated with good infection prevention practices among the respondents.
Conclusion: In this study, good knowledge of HAIs, and infection prevention practices among the respondents were average, although good attitude towards HAIs prevention was high. These findings highlight the need to continue intensive and in-service trainings of healthcare workers toward HAIs prevention, including behavioral change, using innovative approaches.

Knowledge of antibiotic resistance and habits of antibiotic use among medical students of University of Nigeria Enugu: a descriptive cross-sectional survey

Tue, 02 Jul 2024 00:00:00 +0000

Background: The adverse effects of antimicrobial resistance (AMR) are manifesting worldwide. A major contributing factor to AMR is the inappropriate use of antimicrobials in humans and animals. It is imperative to raise awareness among medical students of the current public health challenges of AMR and make them antibiotic guardians because they are the future medical doctors. This survey was designed to assess the knowledge of AMR and habits of antimicrobial use (AMU) among medical students as a means to guide them in their future practice.
Methodology: This descriptive cross-sectional survey was conducted among medical students of the College of Medicine, University of Nigeria (UNN), Enugu State, Nigeria, from July to September 2021. The sample size of 602 was calculated using an online Raosoft sample size calculator. Pretested structured questionnaires, designed to collect information on students’ knowledge of antimicrobials and factors responsible for emergence of AMR as well as the students’ habits of antimicrobial use, were self-administered to consenting students. The data were analyzed using descriptive and inferential statistics.
Results: Of the 602 questionnaires administered to the students, 550 were filled out, giving a response rate of 91.4%. Out of the 550 respondents, 60.4% were females, majority (51.1%) of the respondents were between the ages of 21 and 25 years. Regarding knowledge, 97.2%, 62.5%, and 54.2% have heard of the terms ‘antibiotic resistance’, ‘multi-drug drug resistance’ and ‘antimicrobial stewardship’ respectively. About 97.3% knew that AMR was a global problem, however only 64.7% felt that it was a problem for medical students. Surprisingly, 20.4% indicated that viruses were sensitive to antibiotics. Regarding the students’ habit of antimicrobial use, only 22.2% always consult a doctor before starting an antibiotic, 13.1% go for laboratory tests, and 90.5% always take antibiotics anytime they have a fever. Above half of the participants (56.5%) do not complete the dosage of the antibiotics while 63.5% keep leftover antibiotics for future use. In assessing the factors responsible for AMR emergence, 88.8% responded not adhering to a doctor's prescription and 92.0% responded poor quality of drugs, while only 42.8% responded that overuse of antibiotics in livestock is a factor.
Conclusion: Our study gave an insight into the knowledge gap and the need to increase awareness and education on AMR and AMS among the medical students, especially in the early phase of their academic and professional training.

Blood culture contamination in Babcock University Teaching Hospital, Nigeria: A five-year retrospective study

T. O. Oluwole, I. I. Otaigbe, H. N. Okunbor, A. O. Osinowo, C. J. Elikwu — Tue, 02 Jul 2024 00:00:00 +0000

Background: Bloodstream infections are a leading cause of morbidity and mortality among in-patients globally. Blood culture is the ‘gold standard’ test for the diagnosis of bloodstream infections. The value of this valuable investigation in the diagnosis of infections however may be affected when an organism of questionable evidence is isolated, which occurs mainly due to contamination during the pre-analytical phase. Blood culture contamination can lead to the administration of unnecessary antibiotics, wastage of hospital resources, and risks to patient life. Hence, this study aimed to analyse the blood culture contamination rate in a private tertiary hospital in southwest Nigeria.
Methodology: This was a retrospective observational study of patients with clinical features of bloodstream infections at Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria between January 2018 and December 2022. Blood culture results of patients in the wards or units of the hospital were reviewed, and contamination rates and organisms isolated from positive blood cultures were documented. Data were analysed using SPSS version 22.0
Results: A total of 1,612 non-repetitive blood cultures were obtained from 1,612 patients (910 males and 702 females) during the study period, out of which 397 (24.6%) were positive, 1215 (75.4%) were negative, and 124 (7.7%) were deemed as contaminants. The contamination rate was higher in females (8.7%) than in males (6.9%), although the difference was not statistically significant (x²=1.501, OR=0.7816, 95% CI=0.5416-1.128, p=0.2204). The contamination rate was higher in adults (8.1%) than children (7.3%) with the highest contamination occurring in the age group 35-39 years (9.0%), although the difference was not statistically significant (x²=0.3227, OR=0.8835, 95% CI=0.6120-1.276, p=0.5700). The female surgical ward (11.9%) had the highest contamination rate while the accident and emergency had the lowest contamination rate (1.3%) but the difference was not statistically significant (x²=11.825, p=0.2970). Coagulase-negative staphylococci were the predominant blood culture contaminants. The contamination rate increased during the 5 years from 4.8% in 2018 to 9.4% in 2022
Conclusion: The rate of blood culture contamination in our study is higher than the acceptable international rate, and mainly due to normal skin microbiota, suggesting challenges during sample collection. There is a need for a multidimensional approach to minimize blood culture contamination and hence avoid unnecessary antibiotic use.

Candida bloodstream infection among immunocompromised paediatric patients admitted to the University College Hospital, Ibadan, Nigeria

C. E. Anozie, A. Okesola, O. Makanjuola, T. Ayanbekun, A. R. Mohammed, T. Fasuyi — Tue, 02 Jul 2024 00:00:00 +0000

Background: Invasive candidiasis is a major hospital acquired fungal infection in Nigeria. Despite advances in support of critically ill patients, candidaemia is still associated with high morbidity and mortality. Data on Candida bloodstream infection among paediatric patients is limited in Nigeria and this informed this study, which was undertaken to investigate the prevalence, species distribution, antifungal susceptibility pattern for blood stream infections due to Candida species in University College Hospital, Ibadan, Nigeria.
Methodology: This was a descriptive study which recruited 322 immunocompromised paediatric patients. All Candida isolates obtained from their blood samples through blood culture were identified to species level by germ tube test and PCR-Restriction Fragment Length Polymorphism (RFLP) analysis of 16S rRNA genes with MspI. Antifungal susceptibility test was performed on the isolates using the Vitek 2 system.
Results: Eighteen (5.6%) of the 322 patients had candidaemia, with Candida albicans accounting for 14 (77.0%), and Candida glabrata and Candida tropicalis accounting for 2 (11.0%) of the isolates each. Fourteen (77.0%) isolates were susceptible to fluconazole and voriconazole, 8 (44.0%) were susceptible to caspofungin and micafungin, 10 (55.0%) were susceptible to amphotericin B and 17 (94.0%) were susceptible to flucytosine.
Conclusion: This study highlights the reality of candidaemia in hospitalized immunocompromised children, mostly caused by Candida albicans and other Candida species, exhibiting resistance to echinocandins, azoles and amphotericin B. It is important to have a high index of suspicion and efforts should be made to rightly identify the concerned Candida species and perform susceptibility testing before initiating antifungal treatment. This will ensure better outcome for the patients.