Secondary bacterial isolates from previously untreated Buruli ulcer lesions and their antibiotic susceptibility patterns in Southern Nigeria

Abstract INTRODUCTION: Mycolactones, secreted by Mycobacterium ulcerans, were previously believed to prevent super infection in Buruli ulcer lesions. However, little is known about secondary bacterial infections in these lesions. This study evaluated contaminating bacterial flora and their antibiotic susceptibility patterns in cases of previously untreated Buruli ulcer disease from three states in Southern Nigeria. METHODS A prospective analysis was conducted between January and June of 2015 using wound swabs from eligible patients with Buruli ulcer disease, confirmed by quantitative-polymerase chain reaction, with active ulcers. Microbiological analyses including isolation of bacteria, species identification of isolates, and drug susceptibility tests were performed. RESULTS Of 51 patients, 27 (52.9%) were female. One or more bacterial species of clinical importance was isolated from each patient. A total of 17 different microbial species were isolated; 76.4% were Gram-negative and 23.6% were Gram-positive isolates. The most common bacterial species detected was Staphylococcus aureus (24%), followed by Aeromonas hydrophila (13%), Pseudomonas aeruginosa (13%), and Klebsiella pneumoniae (11%). Drug susceptibility tests showed a particularly high frequency of resistance to commonly used antimicrobials in Nigeria for Staphylococcus aureus. CONCLUSIONS Super bacterial infections occur in Buruli ulcer lesions in Nigeria, and these infections are associated with high rates of resistance to commonly used antibiotics in the country.

Perception about Working in Rural Area after Graduation and Associated Factors: A Study among Final Year Medical Students in Medical Schools of Southeast Nigeria.

Aims: Aim of study was to determine the perception of rural medical practice among final year medical students in medical schools of southeast Nigeria and the associated factors. Study Design: Descriptive cross-sectional study. Place and Duration of Study: The six medical schools in southeast Nigeria, between March and May 2014. Methodology: All the final year medical students in southeast Nigeria were recruited and were eligible for voluntary participation in the study. The students were interviewed using a pretested, self-administered questionnaire. Data analysis was done using STATA statistical software; version 13 and level of significance was determined at a p value of less than 0.05. Results: Four hundred and fifty seven medical students participated in the study representing a response rate of 86.7%. The mean age of the students was 25.5±2.9 years and majority (57.1%) were male. A minor proportion of the students (13.6%) were willing to practice in the rural area after graduation. Majority of the students (80.1%) were of the opinion that doctors working in rural area should earn more than their urban counterparts. Factors associated with willingness to practice in rural area included family residence in an urban area (AOR= 0.4, 95% CI: 0.2 – 0.9); work experience before admission into medical school (AOR= 2.0, 95% CI: 1.1- 3.9); intention to specialize in Community Medicine (AOR= 3.1 95% CI: 1.2- 7.7) and satisfaction with rural community posting, (AOR=2.1, 95% CI: 1.2- 3.9). Conclusion: Majority of the students were unwilling to work in rural area after graduation. Knowing the need for doctors in rural practice, a re-orientation of the students on rural practice through adequate community exposure during rural posting is essential. There is also need for increased allowances for doctors working in rural areas and opportunities for training and or further studies should be encouraged.