ABSTRACT
Background Stenotrophomonas maltophilia is a significant opportunistic pathogen that is associated with high mortality in immunocompromised individuals. In this study, we describe a multidrug-resistant (MDR) S. maltophilia clinical isolate from Kamuzu Central Hospital (KCH), Lilongwe, Malawi. Methods: A ceftriaxone and meropenem nonsusceptible isolate (Sm-MW08), recovered in December 2017 at KCH, was referred to theNational Microbiology Reference Laboratory for identification. In April 2018, we identified the isolate using MALDI Biotyper mass spectrometry and determined its antimicrobial susceptibility profile using microdilution methods. Sm-MW08 was analysed by S1-PFGE, PCR, and Sanger sequencing, in order to ascertain the genotypes that were responsible for the isolate`s multidrug-resistance (MDR) phenotype. Results Sm-MW08 was identified as S. maltophilia and exhibited resistance to a range of antibiotics, including all ß-lactams, aminoglycosides (except arbekacin), chloramphenicol, minocycline, fosfomycin and fluoroquinolones, but remained susceptible to colistin and trimethoprim-sulfamethoxazole. The isolate did not harbour any plasmid but did carry chromosomally-encoded blaL1 metallo-ßlactamase and blaL2 ß-lactamase genes; this was consistent with the isolate's resistance profile. No other resistance determinants were detected, suggesting that the MDR phenotype exhibited by Sm-MW08 was innate. Conclusion : Herein, we have described an MDR S. maltophilia from KCH in Malawi, that was resistant to almost all locally available antibiotics. We therefore recommend the practice of effective infection prevention measures to curtail spread of this organism
Subject(s)
Stenotrophomonas maltophilia , Therapeutics , Ceftriaxone , Carbapenems , Drug Resistance, Multiple, BacterialABSTRACT
Background: Acinetobacter baumannii has emerged as one of the most significant pathogen due to its ability to develop antimicrobial resistance to a broad range of commonly available antibiotics. It represents a serious iatrogenic complication of modern healthcare, where patients acquire infections in healthcare facilities with limited treatment options, resulting in increased morbidity, mortality and health costs. Methods: In this retrospective study, results of culture and antimicrobial susceptibility tests of samples collected from surgical wounds of patients from January to December 2017 were extracted from Laboratory information management system at Kamuzu Central Hospital (KCH) in Malawi.Results: This study ranks A. baumannii as the fourth common cause of surgical wound infections at KCH, with a prevalence of 12.3%. Other most prevalent isolates were: E. coli (25.9%), S. aureus (25.9%) and Proteus species (17.5%). All A. baumannii isolates were resistant to Amoxicillin/Clavulanate and Ceftriaxone; 96.4% were resistant to Ampicillin; 92.9% were resistant to Gentamycin, Ceftazidime and Sulphamethoxazole-trimethoprim; 89.3% were resistant to Ciprofloxacin; and 85.7% were resistant to Cefuroxime and Piperacillin/Tazobactam; while 17.9% were resistant to Meropenem. A total of 82% of the A. baumannii isolates were Multi-Drug Resistant (MDR), while 14% were Extremely Drug Resistant (XDR).Conclusion: The emergence of MDR and XDR A. baumannii at KCH calls for rational use of available antibiotics and regular monitoring of antimicrobial resistance patterns to prevent dissemination of current strains and emergence of new resistant strains.
ABSTRACT
Background: Reducing laboratory errors presents a significant opportunity for both cost reduction and healthcare quality improvement. This is particularly true in low-resource settings where laboratory errors are further exacerbated by poor infrastructure and shortages in a trained workforce. Informatics interventions can be used to address some of the sources of laboratory errors.Objectives: This article describes the development process for a clinical laboratory information system (LIS) that leverages informatics interventions to address problems in the laboratory testing process at a hospital in a low-resource setting.Methods: We designed interventions using informatics methods for previously identified problems in the laboratory testing process at a clinical laboratory in a low-resource setting. First, we reviewed a pre-existing LIS functionality assessment toolkit and consulted with laboratory personnel. This provided requirements that were developed into a LIS with interventions designed to address the problems that had been identified. We piloted the LIS at the Kamuzu Central Hospital in Lilongwe, Malawi.Results: We implemented a series of informatics interventions in the form of a LIS to address sources of laboratory errors and support the entire laboratory testing process. Custom hardware was built to support the ordering of laboratory tests and review of laboratory test results.Conclusion: Our experience highlights the potential of using informatics interventions to address systemic problems in the laboratory testing process in low-resource settings. Implementing these interventions may require innovation of new hardware to address various contextual issues. We strongly encourage thorough testing of such innovations to reduce the risk of failure when implemented