Pattern of inappropriate antibiotic use among patients in the medical wards of a tertiary hospital in southwest Nigeria

Background: The inappropriate use of antibiotics results in the emergence of antimicrobial resistance and adverse clinical and economic outcomes in hospital in-patients. A lack of institutional and national antibiotic guidelines promotes inappropriate antibiotic use. The objectives of this study are to evaluate the appropriateness of antibiotic prescribing, and the quality of antibiotic use in medical wards of the Lagos University Teaching Hospital, Lagos, Nigeria. Methodology: This was a descriptive cross-sectional study of patients admitted and placed on antibiotics in the medical wards of Lagos University Teaching Hospital between July 2013 and August 2014. The appropriateness of antibiotic therapy was determined by compliance with the guidelines of the Infectious Diseases Society of America (IDSA). Results: A total of 350 hospitalized patients on antibiotic therapy during the period of the study were reviewed, including 197 (56.3%) males and 153 females (43.7%). The mean age of the patients was 48.7±17.6 years and a total of 539 initial antibiotics were empirically prescribed. Antibiotic therapy was considered inappropriate in 290 (82.9%) patients, of which 131 (37.4%) patients had no evidence of infection. Pneumonia (23.1%) was the most common indication for antibiotic use, out of which 59.3% had inappropriate antibiotic therapy. Overall, the most frequently prescribed initial empirical antibiotic classes were imidazole derivatives (32.4%) and cephalosporins (22.0%), while the most frequently prescribed inappropriate antibiotic classes were carbapenems (100.0%) and quinolones (89.3%). Conclusion: The study revealed a high rate of inappropriate antibiotic therapy. There is an imperative need to establish antimicrobial stewardship programmes to curb the inappropriate use of antibiotics in the hospital.

Prevalence of carbapenemase production in Pseudomonas aeruginosa isolates causing clinical infections in Lagos University Teaching Hospital, Nigeria

Background: Pseudomonas aeruginosa has been highly associated with carbapenem resistance in which carbapenemases has been suggested to be a major contributory factor. Hence the objective of this study was to phenotypically detect KPC-type carbapenemase, metallo-ß-lactamase and OXA-48 carbapenemase production in clinical isolates of P. aeruginosa in Lagos University Teaching Hospital (LUTH), Nigeria Methodology: One hundred and seventy-one P. aeruginosa isolates consecutively recovered from clinical specimens of patients with infections at the Medical Microbiology and Parasitology laboratory of the hospital were identified using MicrobactTM 24E kit. Preliminary screening for carbapenem resistance was determined by the disc diffusion method on Mueller-Hinton agar using single discs of meropenem and imipenem. Phenotypic detection of carbapenemase production among carbapenem-resistant isolates was performed by the combination disc test of meropenem-phenylboronic acid (MRPBO) and meropenem-dipicolinic acid (MRPDP) as recommended by EUCAST 2013 guideline. Results: Out of the 171 P. aeruginosa isolates, 35 (20.5%) were carbapenem non-susceptible (resistant) while carbapenemase production was detected in 27 (77.1%) of these carbapenem resistant isolates, and no enzyme was detected in 8 (22.9%). Of the 27 carbapenemase producing isolates, 22 (81.5%) produced MBL, 1 (3.7%) produced KPC, while 4 (14.8%) produced both KPC and MBL enzymes. Conclusion: This study revealed that carbapenem resistance among P. aeruginosa clinical isolates in our institution is gradually increasing. The mechanism for this rise is associated with carbapenemases, with MBL being the major carbapenemase involved. There is the need to ensure strict compliance with the LUTH infection control guidelines in order to check the rising incidence of infection caused by carbapenem resistant P. aeruginosa

Correlation of H2O2 Production of Lactobacillus species with Nugent Scores of Young Nigerian Women.

Aim: To correlate H2O2 production of Lactobacillus species with the Nugent scores of young Nigerian women in order to assess their vaginal health. Study Design: Cross-sectional study. Place and Duration of Study: Departments of Medical Microbiology & Parasitology, Biochemistry and Obstetrics and Gynaecology, College of Medicine of the University of Lagos, between May and august 2009. Methodology: Ninety- seven isolates of Lactobacillus from eighty-two women without Bacterial vaginosis (BV) and fifteen women with BV were used for the study. BV was diagnosed using Nugent scoring method. Lactobacilli were isolated using MRS agar and categorized into facultative anaerobes and strict anaerobes. Hydrogen peroxide was detected and measured by titration using dilute sulphuric acid and reaction stopped with potassium permanganate. Results: Out of 97 isolates studied, 76 (78%) were facultative anaerobes, while 21 (22%) were strict anaerobes. The facultative anaerobes were obtained from 11 of 15 women with BV and 65 of 82 women without BV. Forty- nine (50.51%) of the 97 isolates produced H2O2. Forty- four of the H2O2 producers were from women without BV while five were from women with BV. Majority (67%) of the strains obtained from women with BV were non-hydrogen peroxide producing. Proportion of H2O2 producing Lactobacillus by Nugent score were 70%, 43% and 33% in negative, intermediate and BV Nugent scores respectively. There was no significant difference between the mean concentrations of H2O2 production in the various Nugent scores. Conclusion: The overall rate of hydrogen peroxide production was low. While the rates of hydrogen peroxide production correlated with Nugent scores, being highest in negative Nugent scores and lowest with BV scores, the concentration of hydrogen peroxide produced had no association with Nugent scores. The Nigerian women studied might have a relatively high susceptibility rate to vaginal infections.

Laboratory Survey of Significant Bacteriuria in a Family Practice Clinic - Is the Spectrum of Causative Agents Changing?

Urinary tract infection correlates with significant bacteriuria. Empiric and definitive therapy depends on the sensitivity pattern of the causative agents; so it is essential to keep abreast of changes in the causative organisms. This study was carried out to determine the causative agents of significant bacteriuria and their antibiotic sensitivity pattern. Mid stream urine specimens were collected from all patients attending the Family Medicine Clinic of the Lagos State University Teaching Hospital; Ikeja Lagos in July and August of 2005. The urine specimens were transported on ice to the Medical Microbiology and Parasitology Department of the College of Medicine; Idi-Araba. Significant bacteriuria was determined by the standard loop method. Culture was performed on MacConkey agar (oxoid) and blood agar base (Oxoid) and Isolates were identified by standard laboratory methods. Antibiotic sensitivity was by disc diffusion method. Four hundred and fifty urine specimens surveyed for bacteria were from 251 females (55.8) and 199 males (44.2) with age range 13 to 89 years. Ninety four patients (20.9) had significant bacteriuria and 14 were symptomatic; making the prevalence rate of symptomatic bacteriuria 3.1. Out of 91 patients who had been on antibiotics; a significantly higher proportion (52) had bacteriuria while only 13.4 of those who had not been on antibiotics had bacteriuria. Klebsiella and Enterobacter species were more commonly isolated than E. coli. Most of the isolates were resistant to cotrimoxazole (89); tetracycline (69.1) and amoxicillin (88.1) and amoxicillin (88.1). Sensitivity rates to the urinary antiseptics ranged from 54.2 to 55.9. Many of the bacteria were sensitive to ofloxacin (92.9)); ciprofloxacin (84.7); cefotaxime(72.9); ceftriaxone(86.4) and ceftazidime( 88.1). Sensitivity to the aminoglycosides ranged from 57.7 to 59.3