Prevalence of Extended Spectrum beta-Lactamase-Producing Klebsiella Species at the University of Ilorin Teaching Hospital

Background: Persistent blind antibiotic treatment of patients; in resource poor nations like Nigeria; makes the prevalence of antibiotic resistance to increase sporadically. Extended spectrum beta-lactamase (ESBL) production is one of the ways by which bacteria become resistant to antibiotics. For this reason; isolation; identification; sensitivity and screening for possible resistance genes is very important before prescription; if the affected patients must receive qualitative care particularly when their condition is chronic. Materials and Methods: Four hundred suspected isolates of Klebsiella belonging to various species obtained from routine specimens such as swabs; urine; blood; and sputum from May to October 2009 were studied. The identity of all isolates obtained was biochemically analyzed. The isolates were subjected to antibiotic susceptibility testing using modified Kirby-Bauer method and ESBL production was phenotypically determined using double disc synergy test for laboratory detection and reporting of bacteria by CLSI method. Results: Ninety-eight (24.5%) isolates expressed ESBL. Majority of the ESBL producing isolates were from swab specimens 59 (14.75%) followed by blood culture 16 (4.0%); urine 13 (3.25%); and sputum 10 (2.5%). Sensitivity patterns of ESBL producing Klebsiella spp. revealed that all ware resistant to augmentin (AUG); ceftazidime (CAZ); cefotaxime (CTX); cefuroxime (CRO); cefpodoxime (CPD); and none resistant to imipenem (IMP).Conclusion: ESBL producing Klebsiella spp.; were present in University of Ilorin Teaching Hospital. They are resistant to augmentin (AUG); CAZ; CTX; and CPD. Presence of ESBL in any Klebsiella spp. has made cephalosporins which are first line antibiotics usually given non-effective; thereby reducing the treatment options. We; therefore; suggest screening and confirmation for ESBL; in other to prevent treatment failure

Methicillin resistant Staphylococcus aureus: awareness, knowledge and disposition to screening among healthcare workers in critical care units of a Nigerian hospital.

BACKGROUND: Awareness level about methicillin resistant Staphylococcus aureus (MRSA) is high in the western world but the status in developing countries is not well defined. OBJECTIVE: To assess MRSA awareness level, knowledge and disposition to screening among critical healthcare givers (HCGs) in Nigeria. METHODS: A self-administered questionnaire was used to assess the level of awareness and knowledge of HCGs in critical care units of the University of Ilorin Teaching Hospital, Ilorin, Nigeria on MRSA and their willingness to submit to screening. RESULTS: Only 103 (52.0%) of the 198 participants were aware of MRSA but all were favourably disposed to screening for the organism. Awareness was through hospital rounds 65(63.1%) and journals/ textbooks 35(34.0%), and Many, 120 (60.6%) considered MRSA as a threat in the hospital, while only 27 (13.6%) thought otherwise and 51(25.8%) were indifferent. Most HCGs, 124 (87.9%) reported that there were no MRSA control measures in their respective duty post. The age, cadre of work, and number of years in the hospital's critical care units correlated positively with awareness level. CONCLUSION: Methicillin resistant Staphylococcus aureus awareness level among the HCGs in our hospital is just a little above 50.0% with substantial proportion of them not realizing the medical implication of the organism. However, majority are well disposed to MRSA screening. Inadequate publicity is a major contributor to poor knowledge and awareness. There is need for educational intervention and sensitization programs on MRSA and other infection control techniques for HCGs in developing nations especially Nigeria.

Risk factors, threats and prevention of highly pathogenic avian influenza (HPAI) in African countries

Highly pathogenic avian influenza (HPAI) is a viral disease that affects the digestive; nervous and respiratory systems of all domestic and wild birds with high morbidity and mortality. It is highly contagious disease which can be fatal in humans. The avian influenza viruses (AIVs) are classified as types A; B and C with 15 subtypes of the type A. To date; all disease causing HPAI Viruses belong to H5 or H7 subtypes; and affect pigs and humans with the pigs serving as a mixing vehicle for re-assortment of the virus. The domestic ducks get infected without showing clinical signs and serve as a source of infection for domestic poultry. Outbreaks of HPAl in Europe; Asia and Turkey are reported to be associated; with the presence of wet lands and lakes where migratory birds rest. In some African countries like Nigeria; such wet lands exist with free flying wild birds and domestic ducks visiting and resting. The possible source of introduction into a country could be through importation or smuggling of infected poultry products across the borders and through migratory birds that fly through identified pathways. The status of HPAl in many African countries including Nigeria is still under investigation so that appropriate strategies / measures to prevent introduction of the disease into the country can be implemented and / or strengthened through restriction of importation of poultry and poultry products from high risk countries; effective disease surveillance; functional National Veterinary services; quarantine and community based participatory epidemiological system for HPAI surveillance and control. This article reviewed the global epidemiology and risk factors of HPAI infection in Nigeria and other African countries with emphasis on specific preventive measures that can reduce introduction of the virus into the country and the epidemiological surveillance for case detection / identification; screening and management. This review provides useful information and updates for health workers in tropical countries on the trends of AIVs and HPAI; diagnostic criteria using case definitions for both community and health facility levels and management protocols for confirmed cases as recommended by the World health Organization

Endometrial tuberculosis in the Nigerian middle belt: an eight-year review.

Endometrial tuberculosis (TB) is a known cause of infertility in women which, because of the global increase in the spread of TB, should always be considered when investigating the cause of infertility. We undertook this review in order to determine its incidence among infertile women in the Nigerian middle belt. This is a retrospective study of all histopathological slides of infertile women seen at the University of Ilorin Teaching Hospital, Ilorin, Nigeria, between 1997 and 2004 who were evaluated for infertility by endometrial biopsy. The slides were reviewed and, where necessary, new sections were cut from tissue blocks and stained with haematoxylin and eosin. Ziehl-Neelsen stain used to demonstrate acid-fast bacilli. Clinical reports were extracted from histopathological request form. A total of 661 patients were included in the study. Primary infertility constituted 30%, secondary 69% and unspecified cases 1%. TB endometritis was seen in 0.45%. Endometrial TB is not a frequent cause of infertility in our set-up. However, with the worldwide resurgence of TB, its possible presence should always be taken into consideration.

Non-gonococcal bacterial agents of conjunctivitis and their antibiotic susceptibility patterns in Ilorin, Nigeria.

Periodic bacteriological surveillance of purulent ocular discharge is a necessity. To determine the prevalent bacterial agents of purulent conjunctivitis and their antibiotic susceptibility patterns at the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria. All bacterial isolates obtained during routine processing of conjunctival swab specimens were studied at the Department of Microbiology UITH between January and December 2004. The isolates were obtained after inoculation of the specimens onto blood, chocolate and MacConkey agar plates, incubated at 37 degrees C for 18-24hours under aerobic conditions except for chocolate agar plates which were kept in candle extinction jar. The isolates were identified using a combination of colony morphology, biochemical and/or serological tests as applicable. Antibiotic sensitivity testing was performed using the modified Kirby Bauer method. One hundred and four conjunctival swabs from 104 patients were analysed and 72 were bacteriologically positive, giving prevalence rate of 69.2%. The positive samples were from 42 males and 30 females with M:F ratio of 1.4:1. The age range was from 5 hours of life to 80 years. Well over half (61.1%) of the swabs were from neonatal age group. The isolated organisms included Staphylococcus aureus 43.1%, Klebsiella pneumoniae 22.2%, Pseudomonas aeruginosa 3.9%, Streptococcus pneumoniae 11.1%, and Escherichia coli 9.7%. Most of the isolates were sensitive to fluoroquinolones while erythromycin has the least bacterial coverage. The most common bacterial agent of purulent conjunctivitis in Ilorin is Staphylococcus aureus and fluoroquinolones have the best coverage for common bacterial agents of purulent conjunctivitis.

Bacterial pneumonia in the AIDS patients.

OBJECTIVE: To determine the incidence, microbiological pattern and prognostic factor of bacterial pneumonia in AIDS patients. STUDY DESIGN: Prospective study of AIDS patients from July 2001 to Dec 2002. METHODOLOGY: Adults AIDS patients on HAART drugs that develop acute fever, cough with bronchial breathing or lung crepitations had diagnostic evaluation that included chest x-ray, paired sputum microscopy, culture and sensitivity, paired blood culture and haematological profiles including CD4' cell count. RESULTS: Twenty-one patients (22.6%), 9 males and 12 females developed community acquired pneumonia during this 16-month period. Pneumonia was confirmed in 9 patients (42.9%), presumed in 4 (19%) and probable in 8 (38%). Streptococcus pneumoniae accounted for 22% of the cases when immunity was less impaired. Staplhylococcus aureus accounted for another 22 % while Klebsiella pneumoniae, Pseudomonas aeraginosa and Escherichial coli were isolated in 11% each when immunity was severely compromised. Fifteen patients (71.4%) were successfully treated with routine antibiotics. Six cases (28.6%) died. All had anaemia, leucopoenia and low CD4 cell count. Four (66.7%) of this had positive bacterial culture with bacteremia in three of them. CONCLUSION: Bacterial pneumonia in HIV-infected patients has similar presentation to that in the general population, Staphylococcus aureus and gram-negative bacilli especially Klebsiella pneumoniae were seen in a good proportion of the cases. Outcome of treatment was poor in the presence of positive bacterial culture, anemia, leucopoenia and very low CD4+ lymphocytes.

Bacterial isolates of blood cultures in patients with suspected septicaemia in Ilorin, Nigeria.

Periodic bacteriologic surveillance of blood cultures is a necessity. To determine currently prevalent bacterial pathogens of blood cultures in patients with suspected septicaemia in Ilorin. Nigeria. Three thousand and fifty-seven patients from all age and sex groups with clinical suspicion of septicaemia underwent bacteriologic screening of their blood specimen over a 13 month period starting from January. 2003. Twenty point three percent were positive for bacterial growth. An incidence of 41.7 per 1000 admissions was recorded which was a statistically significant (p< 0.05) marginal increase when compared with the previous incidence of 37.9 per 1000 admissions from this centre. Majority of the isolates were gram negative (51.61%) though the single predominant isolate was Staphylococcus aureus (35.85%). Other isolates included Escherichia coli (32.48%), Klebsiella pneumoniae (11.74%), Proteus spp (0.32%), coagulase negative Staphylococcus (1.61%), Salmonella typhi (0.48%). beta-hemolytic Streptococcus (0.48%) and Acinetobacter spp (0.32%). No anaerobe was isolated. Most isolates were sensitive to fluoroquinolones (ofloxacin, perfloxacin and ciprofloxacin) and third generation cephalosporins (ceftriaxone and ceftazidime) except Acinetobacter that was 100% resistant to both groups of antibiotics. Gram positive isolates were resistant to the second generation cephalosporin, cefuroxime. We hereby recommend the use of combination of a third generation cephalosporin and fluoroquinolones where not contraindicated, in the empiric treatment of septicaemia before sensitivity results are available.

Campylobacter enteritis in Ilorin, Nigeria.

BACKGROUND: Campylobacterje junilcoli is one of the most commonly identified bacterial causes of acute gastroenteritis worldwide. In Nigeria, it has been reported in the northern part of the country, extensive work has also been done in the south-west leaving behind the middle-belt of the country. OBJECTIVE: To determine the role of Campylobacter jejunilcoli as an agent of diarrhoea in the middle-belt of Nigeria. DESIGN: A prospective case control study. SETTING: University of Ilorin Teaching Hospital (UITH), private hospitals and primary health centers all in Ilorin, Nigeria. SUBJECTS: Three hundred and six children with diarrhoea and 100 without diarrhoea were randomly selected. MAIN OUTCOME MEASURES: Isolation of Campylobacter jejuni/coli from stool samples. Biological characteristics of the isolates. RESULTS: Twenty five (8.2%) of the patients and none of the controls had the organism. Campylobacter jejuni and C. coli were 56% and 44% respectively. All the isolates were susceptible to erythromycin and ciprofloxacin. None of the isolates harboured plasmids. CONCLUSION: C. jejunil coli is an important diarrhoea agent in our geographic environment, further characterisation is desired of these local strains.

Antibiotic disc sensitivity pattern of pseudomonas aeruginosa isolates obtained from clinical specimens in Ilorin, Nigeria.

The choice of antibiotics used for first line treatment of infectious disease depends largely on previously known antibiogram within a specified locality among other factors. Antibiotic sensitivity pattern of Pseudomonas aeruginosa isolates obtain from clinical specimen in Ilorin, Nigeria was studied over a 12 month period, starting from January 2003. A total of 102 isolates were recovered from various clinical specimens and their antibiotic sensitivity patterns were determined by disc diffusion method on antibiotic sensitivity agar (ASA). Single antibiotic discs (AD) were used. The isolates were incubated at 37 degrees C for 18-24 hours following inoculation on ASA and application of AD before the results were read. Most isolates were sensitive to ofloxacin (77.6%), cefuroxime (76.6%), ciprofloxacin (75.3%), perfloxacin (66.0%), streptomycin (64.0%) and gentamicin (59.8%). Appreciable resistance to ceftazidime (50.7%) and increasing resistance to gentamicin (40.2%) than is previously known, were recorded. Urinary isolates were generally more resistant than isolates from other sources. Majority of the isolates were recovered from patients attending the general out-patient department of the hospital indicating extension of multi-drug resistant microbial isolates beyond hospital settings. Review of antibiotic sensitivity pattern of clinical isolates regularly and the antibiotics prescribing policy in the country is advocated. Combination of quinolones and aminoglycosides, where these are no contraindications, is recommended for first line treatment of suspected cases of Pseudomonas aeruginosa infections because of non-availability of anti-pseudomonad drugs in the country.