Bacterial profile and antibiotic susceptibility patterns in patients with secondary peritonitis: a cross-sectional study in Uganda.

INTRODUCTION: Secondary peritonitis is the second leading cause of sepsis worldwide. Drug resistance to peritoneal cavity bacterial infection remains a public health threat, especially in resource-limited settings in Africa, including Uganda. This study aimed to determine the antibacterial susceptibility patterns and factors associated with secondary peritonitis among patients with acute abdomen who underwent surgery at a Regional Referral Hospital in Uganda. METHODS: This was a cross-sectional study conducted at Hoima Regional Referral Hospital (HRRH) that enrolled 126 patients with acute abdomen. Clinical samples were aseptically collected at laparotomy from patients with secondary peritonitis for culture and sensitivity using standard Microbiological methods. Binary logistic regression was used to identify factors associated with secondary peritonitis among patients with acute abdomen. RESULTS: The majority of the patients were males (61.9%) with a mean age of 37.9(SD ± 21.8). Secondary peritonitis was found in 57(45.2%) of the patients. Gram-negative bacteria were the most commonly isolated organisms with Escherichia coli (35.8%) and Klebsiella spp (17.0%) predominating. Imipenem 88.8%(8/9), Amikacin 88.8%(8/9), Ciprofloxacin 44.4%(4/9) and Gentamicin 44.4%(4/9) demonstrated sensitivity to the different isolated organisms at varying degrees. Being a male (AOR = 3.658; 95% CI = 1.570-8.519, p = 0.003) and presenting 3 days after onset of symptoms (AOR = 2.957; 95% CI = 1.232-7.099, p = 0.015) were independently associated with secondary peritonitis. CONCLUSION: Imipenem, Amikacin, Ciprofloxacin, and Gentamicin should be considered for empirical therapy in cases of secondary peritonitis. Patients, more especially males with abdominal pain should be encouraged to present early to the hospital to minimize progression to secondary peritonitis.

A Systematic Review of the Microbial Landscape of Diabetic Foot Ulcers in Uganda.

Background: Diabetes is a growing health concern globally. Poorly managed diabetes may result in diabetic foot ulcers (DFU), which can become a source of chronic infection known as diabetic foot infections. The increasing trend of diabetes in Uganda speaks to the potential for diabetic foot ulcers which may eventually become infected and their attendant impact on the quality of life of diabetic patients. This review assesses the microbial diversity of DFUs in Uganda, aiming to guide treatment and identify research gaps. Main Body of the Abstract: We searched PubMed, Scopus and Embase for studies conducted in Uganda that reported isolating microorganisms from diabetic foot ulcers. Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA), we included two eligible studies that reported isolating 122 bacteria spread across eleven (11) species using swab samples and conventional culture methods. Significant isolates included World Health Organization priority pathogens including: Enterobacter specie, Staphylococcus aureus, Klebsiella pneumoniae, and Acinetobacter specie. Methicillin resistant Staphylococcus aureus (MRSA) constituted 33.3% of Staphylococci species and 26% of all bacterial isolates while extended-spectrum beta-lactamase producing Escherichia coli and Klebsiella specie constituted 14.29% of total microbial isolates. Most bacteria showed susceptibility to Imipenem, Vancomycin, Ciprofloxacin, and Clindamycin, but resistance to Cotrimoxazole and Ampicillin was noted. Short Conclusion: We conclude that data on the microbiology of DFUs in Uganda is scarce; however, the bioburden of DFUs in the country is similar to those in other parts of the world, and MRSA poses a challenge to antibiotic therapy. Consequently, the continued use of swab samples and conventional culture and sensitivity methods may limit the isolation, identification, and presentation of other important isolates. We recommend characterization of bacterial isolates to better understand their genetic makeup, and the development of a national guideline for managing diabetic foot infections.

Prevalence and factors associated with malaria, typhoid, and co-infection among febrile children aged six months to twelve years at kampala international university teaching hospital in western Uganda.

Background: Paediatric febrile illnesses pose diagnostic challenges in low-income countries. Western Uganda is endemic for both malaria and typhoid but the true prevalence of each individual disease, their co-infections and associated factors are poorly quantified. Objective: To determine the prevalence of malaria, typhoid, their co-infection, and associated factors amongst febrile children attending the paediatrics and child health department of Kampala International University Teaching Hospital (KIU-TH) in Western Uganda. Methods: Cross-sectional study used a survey questionnaire covering demographics, clinical and behavioural variables. We obtained blood for peripheral films for malaria and cultures for typhoid respectively; from 108 consecutively consented participants. Ethical approval was obtained from KIU-TH research and ethics committee (No. UG-REC-023/201,834). Multivariate regression analysis was performed using Stata 14.0 (StataCorp. 2015) at 95% confidence interval, regarding p < 0.05 as statistically significant. Results: Majority of participants were males 62% (n = 67), cared for by their mothers 86.1% (n = 93). The prevalence of malaria was 25% (n = 27). The prevalence of typhoid was 3.7% (n = 4), whereas the prevalence of malaria-typhoid co-infection was 2.8% (n = 3). Using treated water from protected public taps was associated with low malaria-typhoid co-infection [p = 0.04; aOR = 0.05, 95%CI [0.003-0.87], whereas drinking unboiled water from open wells increased the risk for the co-infection [p = 0.037, cOR = 17, 95%CI (1.19-243.25)]. Conclusions: The prevalence of blood culture confirmed malaria-typhoid co-infection in children was lower than previously reported in serological studies. These findings emphasize the need to use gold standard diagnostic investigations in epidemiological studies. Educational campaigns should focus on the use of safe water, hygienic hand washing, and proper waste disposal; and should target mothers who mainly take care of these children.

A Global Perspective of Vibrio Species and Associated Diseases: Three-Decade Meta-Synthesis of Research Advancement.

Outbreaks of Vibrio infections have a long history of global public health concern and threat to the aquaculture industry. This 3-decade (1990-2019) meta-synthesis of global research progress in Vibrio species and associated disease outbreaks was undertaken to generate the knowledge needed to design effective interventions with policy implications. Using PRISMA protocol, we obtained data on the online version of the Institute for Scientific Information (ISI), Web of Science (WOS), and Scopus from January 1990 to September 2021 by title search of the keywords "Vibrio species OR Vibrio spp. OR vibriosis." On the 3-decade survey, the result has shown that a total of 776 publications document types were published on the subject, with an average of 24.25 ± 13.6 published documents per year with an annual growth rate of 4.71%. The year 2020 recorded the highest output of 52 published documents accounting for 6.70% of the total. The most prolific author, Blanch A., published 12 articles on the subject and has received citations of 1003 with an h-index of 10. While the most global cited paper author is the journal of J. Bacteriol (Bassler et al), receiving total citation (TC) (550) and per Year (22). The top active corresponding authors country is the United States of America with (92) articles, freq. 12.40%; TC of 3103. The observations in this study, such as the collaborations network map, and index, which have outlined a big difference between countries based on economic status, have underscored the need for a sustained research mentorship program that can define future policies.

Fluoroquinolone resistant bacterial isolates from the urinary tract among patients attending hospitals in Bushenyi District, Uganda.

INTRODUCTION: bacterial resistance to fluoroquinolones is on the rise globally, bacteria causing urinary tract infections (UTIs) are no exception to this fact. Judicious use of the current antibiotics by clinicians is therefore deemed necessary to combat development of resistance. This study determined fluoroquinolone resistant profiles, multiple antibiotic resistance indices (MARI), factors associated with fluoroquinolone resistance and their strength among patients attending hospitals in Bushenyi District, Uganda. METHODS: this was a cross-sectional study in which a total of 86 bacterial uropathogens isolated previously by standard microbiological methods were subjected to antibiotic susceptibility testing using Kirby Bauer disk diffusion method. Data for factors suspected to be associated with fluoroquinolone resistant UTI were obtained by use of questionnaires. RESULTS: the most resisted fluoroquinolone was ofloxacin with 29/83 (34.9%), followed by moxifloxacin 27/83 (32.5%), levofloxacin 24/86 (27.9%) and ciprofloxacin 23/86 (26.7%). The bacterial uropathogens that exhibited the highest frequency of fluoroquinolone resistant strains were P. mirabilis with 2/3 (66.7%) and E. faecalis with 2/3 (66.7%), followed by E. coli 19/36 (52.8%), S. aureus 13/27 (48.1%), K. oxytoca 2/6 (33.3%), K. pneumoniae 2/10 (20.0%) and P. vulgaris 0/1 (0.0%). All the bacterial uropathogens tested showed MARI of ≥ 0.2. Hospitalization, history of fluoroquinolones use in the last 12 months and wrong prescription of antibiotics were found to bear statistically significant relationships (p < 0.05) with fluoroquinolone resistant UTI. CONCLUSION: antibiotic susceptibility testing of the first generation quinolones such as nalidixic acid in hospitalized patients, patients with history of fluoroquinolones' use in the last 12 months and wrong prescription of antibiotics should be adopted to avoid fluoroquinolone abuse. For empiric treatment of UTIs in Bushenyi District, ciprofloxacin still remains the first line of choice among the fluoroquinolone class of antibiotics.

Contamination Potentials of Household Water Handling and Storage Practices in Kirundo Subcounty, Kisoro District, Uganda.

Introduction: Waterborne diseases constitute a major public health burden in developing and underdeveloped countries. Consumption of contaminated water causes health risk to the public, and the situation is alarming in rural areas. The objective of this study was to assess the contamination potentials of different house water handling and storage practices in the Kirundo subcounty, Kisoro District, Uganda. Material and Methods: A cross-sectional and descriptive study in which 344 water samples were collected randomly and analysed for bacteriological contamination, total coliforms (TCs) and Escherichia coli per 100 ml, using the Most Probable Number (MPN) technique and reported in terms of CFU/100 ml. Results: The 43.2% samples from unprotected water sources had total coliforms and 34.1% had Escherichia coli. In analysed household drinking water, 25% had total coliforms and 8.7% had Escherichia coli. Most drinking water sources were found to have coliform counts above the recommended national and international guidelines. There was a statistically significant difference among water sources with respect to total coliforms and Escherichia coli (p < 0.05). Conclusion: The overall results indicated that there is a strong linkage between microbiological water quality and water source sanitation; hence, the protected water source was safer than unprotected water sources. For the unprotected water sources, protection strategies as well as monitoring are recommended for this community.

Prevalence of Bacterial Urinary Tract Infections and Associated Factors among Patients Attending Hospitals in Bushenyi District, Uganda.

Urinary tract infections (UTIs) are one of the major causes of morbidity and comorbidities in patients with underlying conditions, and it accounts for the majority of the reasons for hospital visit globally. Sound knowledge of factors associated with UTI may allow timely intervention that can easily bring the disease under control. This study was designed to determine the prevalence of UTI by isolating and characterizing the different bacterial etiological agents and to evaluate the factors associated with UTI. In this cross-sectional study, a total of 267, clean catch midstream urine (MSU) samples were collected aseptically and analyzed using standard microbiology methods. Data for the factors associated with UTI were obtained by use of questionnaires and standard laboratory tests for selected underlying conditions. The study revealed 86/267 (32.2%) UTI prevalence among patients attending hospitals in Bushenyi District, Uganda. Escherichia coli was the most prevalent bacterial uropathogen with 36/86 (41.9%) followed by Staphylococcus aureus 27/86 (31.4%), Klebsiella pneumoniae 10/86 (11.6%), Klebsiella oxytoca 6/86 (7.0%), Proteus mirabilis 3/86 (3.5%), Enterococcus faecalis 3/86 (3.5%), and Proteus vulgaris 1/86 (1.2%). This study has demonstrated that age ≤19 years, female gender, married individuals, genitourinary tract abnormalities, diabetes, hospitalization, indwelling catheter <6 days, and indwelling catheter >6 days had statistically significant relationships (p < 0.05) with UTI. Screening for UTI in hospitalized patients, female gender, married individuals, genitourinary tract abnormalities, indwelling catheter, and diabetics should be adopted.

Distribution of yeast species associated with oral lesions in HIV-infected patients in Southwest Uganda.

Oropharyngeal candidiasis remains a significant clinical problem in HIV-infected and AIDS patients in regions of Africa where anti-retroviral therapy isn't readily available. In this study we identified the yeast populations associated with oral lesions in HIV-infected patients in Southwest Uganda who were receiving treatment with nystatin and topical clotrimazole. Samples were taken from 605 patients and 316 (52%) of these yielded yeast growth following incubation on Sabouraud dextrose agar. Samples were subsequently re-plated on CHROMagar Candida medium to facilitate identification of the yeast species present. The majority (56%) of culture-positive samples yielded a mix of two or more species. Candida albicans was present in 87% (274/316) of patient samples and accounted for 87% (120/138) of single species samples. Candida glabrata, Candida tropicalis and Candida norvegensis were also found in cultures that yielded a single species. No Candida dubliniensis isolates were identified in this population.

Prevalence of Quinolone-susceptible Pseudomonas aeruginosa and Staphylococcus aureus in Delayed-healing Diabetic Foot Ulcers in Ekpoma, Nigeria .

UNLABELLED: Aim. To investigate the prevalence and antibiogram of Pseudomonas aeruginosa and Staphylococcus aureus from delayed-healing foot ulcers among patients with diabetes in Ekpoma. METHODS: Using standard aseptic microbiological methods, 220 delayed-healing diabetic foot ulcer samples were analyzed for bacteria isolation, identification, and susceptibility before and 12 weeks after antibiotic administration. Chi-squared (α = 0.01) was used to test for statistical significance. RESULTS: Out of the 220 samples analyzed, 181 (82.3%) were infected (P aeruginosa [41.8%]; S aureus [30%]; co-infection of P aeruginosa and S aureus [10.5%]). Wound healing was significantly (P < 0.01) dependent on the presence of P aeruginosa and S aureus in the study population. S aureus and P aeruginosa showed the highest (74.2% and 71.3%, respectively) and lowest (38.2% and 34.8%) susceptibilities to levofloxacin and sparfloxacin, respectively. P aeruginosa was 68.7% susceptible to rifampicin; 53% to erythromycin, 52.2% to vancomycin; 38.3% to ceftriazone; 36.5% to cefuroxin; and 32.2% to oxacillin. S aureus was 51.7% susceptible to rifampicin, 37.1% to cefuroxin; 33.7% to ceftriazone; 28.1% to vancomycin; and 25.8% to oxacillin. Twelve weeks after antibiotic administration, 54% of samples had no growth and showed accelerated wound healing; 26.7% yielded P aeruginosa, while 19.3% yielded S aureus. CONCLUSION: Delayed-healing diabetic foot ulcers in Ekpoma are colonized by levofloxacin- and sparfloxacin-susceptible P aeruginosa and S aureus. Microbial load reduction due to appropriate antibiotic administration contributed to the acceleration of the wound healing process for 54% of patients who participated in the follow-up procedures. Surveillance with improved diagnostic facilities is recommended.

Zero prevalence of parasites associated with oral lesions of HIV infected and AIDS patients in South Western Uganda.

BACKGROUND: Despite paucity of information regarding oral lesions with parasitic etiology, parasitic diseases continue to be problematic among impoverished and immunocompromised individuals in developing countries. OBJECTIVE: To determine the prevalence of parasites in the oral lesions of Ugandan HIV infected and AIDS patients, in South Western Uganda. METHODS: Adult HIV/AIDS positive patients attending The AIDS Support Organization Clinics in South Western Uganda with oral lesions were recruited for this study. Standard parasitological methods (direct microscopy, saline and iodine wet preparations, Giemsa-Romanosky staining of smears and culture) were adopted in analysis of randomly collected six hundred and five samples (469 from females; 136 from males) for parasites. RESULTS: No ova, cyst, trophoziotes, lava or segment of parasites were seen in the oral lesions identified among the studied population. CONCLUSION: Parasites were absent and therefore may not be implicated as etiologic microbial agents of observed oral lesions associated with HIV infected and AIDS patients living in South Western Uganda.

Appraisal of oral lesions status of HIV/AIDS patients in South Western Uganda

Aim: To establish a regional surveillance data that may contribute to improvement of oral health prevention/control programs in South Western Uganda. Methods: Using WHO guidelines, HIV-associated oral lesions were identified among 605 HIV/AIDS patients (469 females and 136 males), selected at random from 4 districts of South Western Uganda. Pearson¡¦s Chi square test of independence („´=0.01), was used to compare results. Results: Prevalence of oral lesions was 73.2%. Pseudomembranous Candidiasis (PC) showed the highest overall prevalence of 71.1% (34.9% single and 36.2% mixed); followed by 39.9% prevalence of Erythematous Candidiasis (EC) (13.2%) single; 26.7% mixed) and 18.8% prevalence of Angular Chelitis (AC) (3.1% single and 15.7% mixed). There was: 23.6% co-infection of PC and EC; 12.6% PC and AC, 3.1% were EC and AC, and 17.0% intra-oral pigmentation. Prevalence of oral lesions was significantly (p<0.01) dependent on host pre-exposure to antimicrobials. Conclusions: Oral infections are still highly prevalent among the studied HIV/AIDS patients in South Western Uganda. This observation may be due to inadequate antimicrobial agents and oral/dental care. There¡¦s urgent need to train primary health care workers in management of oral lesions associated with HIV/AIDS. More studies are needed to evaluate HIV/AIDS oral lesions in the populace.