ABSTRACT
Background: Today, bacterial resistance is a public health challenge throughout the world, and infections caused by resistant bacteria are associated with increased morbidity, mortality and health care costs. The objective of this descriptive study is to determine the prevalence and distribution of multi-drug resistant (MDR) clinical bacteria isolates at the National Hospital of Zinder, Niger Republic in 2021. Methodology: We conducted a descriptive cross-sectional study of in- and out-patients from whose clinical samples' bacteria were isolated at the bacteriology unit of the laboratory. Bacteria were isolated from the clinical samples following standard aerobic cultures and identified using conventional biochemical test schemes. Antibiotic susceptibility testing (AST) was performed by the agar disk diffusion technique, and categorization of the isolates into sensitive, intermediate or resistant was done according to the recommendations of the Antibiogram Committee of the French Society of Microbiology (CA-SFM) 2020 version 1.2. MDR was defined as resistance to at least one antibiotic in three or more categories, while selected MDR bacteria such as ESBL was identified using double disk synergy test, and MRSA by cefoxitin disk diffusion test. Results: Seventy-seven (6.7%) bacterial species were isolated from 1153 clinical samples processed at the bacteriology unit of the hospital laboratory between June and December 2021, of which 65.0% (50/77) were members of the order Enterobacteriales. Escherichia coli represented 40.3% (40/77) of the isolated bacteria, Staphylococcus aureus 13.0% (10/77) and Pseudomonas aeruginosa 11.7% (9/77). The overall prevalence of MDR was 44.2% (34/77), including 61.8% (21/34) ESBL-producing Enterobacteriales (ESBL-E), 26.5% (9/34) multi-resistant P. aeruginosa and 11.7% (4/34) MRSA, with 67.6% (23/34) of the MDR isolates from outpatients. Resistance rates of the Enterobacteriales to ciprofloxacin, gentamicin, amikacin and imipenem were 62.0%, 52.0%, 38.0% and 8.0% respectively. Resistance rates of P. aeruginosa were 100.0%, 88.9%, 77.8%, 33.3%, 22.2%, and 22.2% respectively to ceftazidime, ticarcillin, imipenem, ciprofloxacin, levofloxacin, and amikacin. Resistance rates of S. aureus were 100.0%, 50.0%, 40.0%, 10.0%, 0% and 0% to penicillin G,erythromycin, cefoxitin, tetracycline, fusidic acid, and chloramphenicol respectively. ESBL-E were 47.6%,85.7% and 0% resistant to amikacin, ciprofloxacin and imipenem, and MRSA resistance rates were 75.0%, 75.0%, 50.0% and 0% to erythromycin, tetracycline, gentamicin, and chloramphenicol respectively. Conclusion: This study reports high prevalence of MDR bacteria, mainly ESBL-E, with concerning high resistance to carbapenem. Rational use of antibiotics and implementation of surveillance system for MDR bacteria must be implemented in order to limit the emergence and spread of MDR bacteria in Niger Republic.
Subject(s)
Humans , Outpatient Clinics, Hospital , Genes, MDR , Bacteria , Inpatient Care Units , NigerABSTRACT
La vente illicite de médicaments est un problème de santé publique en Afrique. Au Bénin, un programme de commu n i c ation pour lutter contre ce fléau a été mis en Åuvre. Cette étude sur la consommation des médicaments à Cotonou (Bénin),qui s'est déroulée pendant trois jours dans différents quartiers de la ville, avait pour objet d'évaluer les pratiques d'achat des consommateurs , de façon à tenir compte de leurs préoccupations et de leurs croyances dans l'élab o ration de messages de com- munication pour les prochaines campagnes de lutte contre le marché illicite. Cette enquête est un outil pour la conception des messages et, répétée pendant et après ces campagnes, elle sera aussi un outil d'évaluation de leur impact. Un questionnaire explorant plusieurs thèmes liés à l'ach at de médicaments, a été administré par les enquêteurs au domicile de 600 ménages sélectionnés aléatoirement. Les principaux résultats sont les suivants : les mesures de répression visant à réduire l'offre du mar- ché illicite des médicaments sont nécessaires mais pas suffisantes. Le contenu des messages de sensibilisation devra être revu et réorienté ve rs des groupes cibles , car 86% des personnes interrogées pensent que les médicaments de trottoir sont de bonne qualité. Il faudra surtout augmenter la disponibilité géographique au plus près des populations des médicaments financièrement accessibles (notamment des génériques) et mettre en place des procédures allégées de dispensation et de pre s c ription suivies d'un conseil professionnel approprié