AWaRe classification of antibiotics prescribed within 2018-2021 for hospitalised medical and surgical patients in Uyo, Nigeria.

Introduction: point prevalence surveys have been used as a standardized tool to monitor antibiotic consumption to inform antimicrobial stewardship interventions in many countries. The 2021 WHO model list of Essential Medicines has classified antibiotics into three groups: access, watch and reserve. The aim of this paper is to describe the antibiotics used within a space of three years between 2018 and 2021 at the University of Uyo Teaching Hospital based on WHO AWaRe classification. Methods: three point-prevalence surveys were conducted in the wards in our 500-bed tertiary hospital in 2018, 2019 and 2021. Each ward was surveyed on a particular day within a four-week period. The wards were grouped into medical and surgical for comparison. Antibiotics were classified as access, watch, and reserve. Validated data were analyzed with IBM SPSS Statistics for Windows, Version 20.0 (Armonk, NY: IBM Corp.). Results: a total of 526 patients were surveyed out of which 344 were on antimicrobial therapy with a total of 687 antibiotic prescriptions. The overall prevalence of patients who received at least one antimicrobial was 65.4% (62.4 -72.8%). The Access group of antibiotics made up 48.2% of prescriptions while the watch group made up 50.5% of prescriptions. More watch Antibiotics were prescribed by surgical wards (49.7%) than by medical wards (43.7%). Conclusion: the use of Access group antibiotics in our hospital falls below the WHO target level in both medical and surgical wards. There is a need for strengthening antibiotic stewardship activities to reduce the use of watch group antibiotics and limit antimicrobial resistance.

Tuberculosis of the Cervix Mimicking Cervical Carcinoma: A Case Report.

Tuberculosis of the cervix is reported to be very rare with clinical features that are indistinguishable from that of invasive cancer of the cervix. We report the case of a 31-year-old nulliparous lady that presented with intermenstrual bleeding and a persistent abnormal vaginal discharge after receiving several forms of treatment for cervical cancer. Vaginal examination revealed an extensive friable erythematous lesion affecting the entire ectocervix. Tuberculosis was confirmed following biopsy of the lesion, and the patient was successfully managed with a course of anti-tuberculosis medication.

Wide spread of carbapenemase-producing bacterial isolates in a Nigerian environment.

OBJECTIVES: The presence of carbapenemase-producing bacterial isolates is found not only in hospital and community settings but also in the environment. Carbapenemase production may be related to acquired, usually plasmid-borne, ß-lactamase genes or to chromosomal genes intrinsic to various species. The aim of this study was to evaluate the occurrence of such carbapenemase-producing bacterial isolates among environmental samples from Nigeria. METHODS: A total of 122 environmental samples were plated on carbapenem-containing media. A total of 259 isolates were recovered, among which 124 were carbapenemase-producers according to the results of the Rapidec® Carba NP test. RESULTS: The majority of isolates (n=112) recovered corresponded to natural producers of carbapenemases, i.e. Stenotrophomonas maltophilia (n=108), Burkholderia cepacia (n=1), Shewanella sp. (n=1), Sphingobacterium sp. (n=1) and Chryseobacterium gleum (n=1). Ten isolates (mainly Enterobacteriaceae and Acinetobacter baumannii) produced an acquired carbapenemase, most commonly of the NDM type. In addition, two Pseudomonas otitidis isolates were identified as producing the Ambler class B carbapenemase POM-1, further confirming that this carbapenemase is naturally produced in this environmental species. Finally, several isolates co-producing 16S rRNA methylases (ArmA, RmtC) and/or extended-spectrum ß-lactamases (CTX-M-9, CTX-M-15) were also identified. CONCLUSION: This study revealed the presence and diversity of clinically-relevant antimicrobial-resistant bacteria in the environment in Nigeria.

SURVEILLANCE FOR VANCOMYCIN RESISTANT ENTEROCOCCI IN A TERTIARY INSTITUTION IN SOUTH WESTERN NIGERIA.

BACKGROUND: Enterococci are responsible for up to 12% of cases of healthcare associated infections worldwide and cause life threatening infections among critically ill patients. They show intrinsic and acquired resistance to a wide range of antimicrobial agents. Glycopeptide resistance is due to vanA, vanB, vanC, vanD, vanE, vanG and vanL genes. OBJECTIVES: To determine the carriage rate of VRE among patients on prolonged hospitalization in Lagos University Teaching Hospital, assess the antimicrobial resistance pattern of VRE, identify factors associated with VRE colonization and describe the genetic determinants of enterococcal resistance to Vancomycin. METHODS: VRE were isolated from rectal swabs collected from patients hospitalized for seven days or more in Lagos University Teaching Hospital and identified by Matrix Assisted Laser Desorption Ionization (MALDI) and Polymerase Chain Reaction (PCR). Antimicrobial susceptibility testing was performed by E-test. PCR assay for Vancomycin resistance genes was also performed. Data on demographic and risk factors collected by questionnaire was tested for significance using Chi square. RESULTS: Thirteen of 319 patients surveyed were colonized with VRE; one with vanA E. faecium, two with vanB E. faecium, ten with E. gallinarum and one with E. casseliflavus. Univariate analysis for risk factors associated with VRE colonization was only significant for the ward of admission. Only one VRE isolate showed full resistance to Vancomycin and Teicoplanin. Three were resistant to Ampicillin and nine to Ciprofloxacin but all were susceptible to Linezolid. High-level resistance to Gentamicin was found in four VRE isolates. CONCLUSION: There is a low prevalence of VRE in Lagos University Teaching Hospital which may be spreading among patients in affected wards.