Prevalence of tet genes mediating tetracycline resistance in Escherichia coli clinical isolates in Osun State, Nigeria.

The occurrence of tetracycline resistance determinants in 203 Escherichia coli isolates recovered from clinical samples at three different hospitals in Nigeria between June 2009 and May 2010 was investigated. The isolates were subjected to standard procedures. Antibiotic susceptibility to a panel of eight antibiotics was also performed, and resistance genes were detected with the polymerase chain reaction (PCR) technique. One hundred and six E. coli isolates (52.2%) were obtained at LAUTECH Teaching Hospital Osogbo, 85 (41.9%) from OAUTHC Ile Ife and 12 (5.9%) from Osun State Hospital Asubiaro Osogbo. Result of the disk diffusion antibiotic susceptibility test showed 96.1% isolates to be resistant to ampicillin, 77.8% to tetracycline, 37.9% to cotrimoxazole, 38.4% to nalidixic acid, 20.7% to ofloxacin, 17.7% to ceftriaxone, 11.8% to gentamycin, and 2% to nitrofurantoin. One hundred and sixty two (79.9%) isolates had minimum inhibitory concentration (MIC) of tetracycline ≥ 128 µg/ml. The polymerase chain reaction (PCR) detected tetA gene in 89 (43.8%) isolates, tetB gene in 65 (32.0%), and both tetA and tetB genes in 9 (4.4%) isolates. The study demonstrated a relatively high level of gene mediated antibiotic resistance to tetracycline and other antibiotics in E. coli clinical isolates in Southwest region of Nigeria.

Nosocomial infections and the challenges of control in developing countries

Nosocomial infection is a recognized public health problem world-wide with a prevalence rate of 3.0-20.7and an incidence rate of 5-10. It has become increasingly obvious that infections acquired in the hospital lead to increased morbidity and mortality which has added noticeably to economic burden. However; after about three decades of nosocomial infection surveillance and control world-wide; it still remains an important problem for hospitals today. Studies have shown that most hospitals in developing countries especially Africa; have no effective infection control programme due to lack of awareness of the problem; lack of personnel; poor water supply; erratic electricity supply; ineffective antibiotic policies with emergence of multiply antibiotic resistant microbes; poor laboratory backup; poor funding and non-adherence to safe practices by health workers. It is recommended that the cost of hospital infection control programme should be included in the health budget of the country and fund allocated for the infection control committee for routine control purposes and to bear the cost of outbreaks. There is need for adequate staffing and continuous education of staff on the principles of infection control; especially hand washing which is the single most important effective measure to reduce the risks of cross infection

Methicillin resistance in Staphylococcus aureus: a review of the molecular epidemiology, clinical significance and laboratory detection methods.

BACKGROUND: Despite the volume of knowledge, enhanced surveillance and infection control measures adopted by health care institutions to address the endemicity and frequent disease outbreaks by methicillin-resistant Staphylococcus aureus (MRSA) in hospitals and health care facilities worldwide, infections due to this organism are still responsible for about 50% of hospital acquired S. aureus infections, with increasing morbidity and mortality. OBJECTIVE: To provide regional clinicians with current information on the molecular epidemiology, laboratory detection and clinical aspects of MRSA. METHODS: A review of published literatures on MRSA in Medical Libraries and bibliographic citations on PubMed, Medline and Africa Index Medicus on molecular epidemiology and clinical diseases caused by MRSA and the assessment of the recent laboratory diagnostic approaches. RESULTS: This review showed that there has been intercontinental spread of some highly pathogenic clones of MRSA threatening to create public health hazard of unprecedented proportion, with the greatest challenge to mankind, being the development of resistance to multiple antibiotics, which in recent times had included resistance to vancomycin and other glycopeptides, the only antibiotic group effective against it. Added to this burden is the emergence of more virulent strains of community-associated MRSA (CAMRSA) which at the turn of the century, has been increasingly reported to cause infections and outbreaks in populations without predisposing risk factors, with attendant high morbidity and mortality. CONCLUSION: There is need for active MRSA surveillance by healthcare institutions in Africa to identify potential outbreaks, and vigilance in the enforcement of infection control measures such as rational prescription of antibiotics, handwashing, disinfection and sterilization that can limit the emergence and spread of more resistant clones of MRSA.

Methicillin Resistance in Staphylococcus aureus: a Review of the Molecular Epidemiology; Clinical Significance and Laboratory Detection Methods

BACKGROUND: Despite the volume of knowledge; enhanced surveillance and infection control measures adopted by health care institutions to address the endemicity and frequent disease outbreaks by methicillin-resistant Staphylococcus aureus (MRSA) in hospitals and health care facilities worldwide; infections due to this organism are still responsible for about 50of hospital acquired S. aureus infections; with increasing morbidity and mortality. OBJECTIVE: To provide regional clinicians with current information on the molecular epidemiology; laboratory detection and clinical aspects of MRSA. METHODS: A review of published literatures on MRSA in Medical Libraries and bibliographic citations on PubMed; Medline and Africa Index Medicus on molecular epidemiology and clinical diseases caused by MRSA and the assessment of the recent laboratory diagnostic approaches. RESULTS: This review showed that there has been intercontinental spread of some highly pathogenic clones of MRSA threatening to create public health hazard of unprecedented proportion; with the greatest challenge to mankind; being the development of resistance to multiple antibiotics; which in recent times had included resistance to vancomycin and other glycopeptides; the only antibiotic group effective against it. Added to this burden is the emergence of more virulent strains of community-associated MRSA (CAMRSA) which at the turn of the century; has been increasingly reported to cause infections and outbreaks in populations without predisposing risk factors; with attendant high morbidity and mortality. CONCLUSION: There is need for active MRSA surveillance by healthcare institutions in Africa to identify potential outbreaks; and vigilance in the enforcement of infection control measures such as rational prescription of antibiotics; handwashing; disinfection and sterilization that can limit the emergence and spread of more resistant clones of MRSA

Widal agglutination titres in the diagnosis of typhoid fever.

BACKGROUND: Typhoid fever has continued to pose considerable health problems world-wide. This problem is made worse by misdiagnosis through the use of a single pretreatment Widal agglutination test in may developing countries. OBJECTIVE: This is to enable us establish the appropriate titres suitable for a reliable diagnosis of typhoid fever in our environment. METHODS: A total of 300 subjects were recruited into the study comprising 260 apparently healthy individuals aged 12 years and above and 40 patients with typhoid fever confirmed by isolation of S. typhi from blood and/or stool. The Widal slide agglutination test method was first used to screen subjects. Serum samples showing agglutination were then serially diluted with 0.85% saline from 1/40 to 1/1280 and subjected to tube dilution. RESULTS: Thirty-six (13.8%) of the healthy subjects had S. typhi 'O' agglutinin and 48(18.5%) had 'H' agglutinin in their serum while 37(92.5%) of patients with culture-confirmed typhoid fever had 'O' agglutinin and 38(95.0%) had 'H' agglutinin. At a cut-off titre of 'O' agglutinin = 80, the diagnostic sensitivity and specificity were 90% and 87.3%, and for 'H' agglutinin = 80, the sensitivity and specificity are 90% and 88.5% respectively. The predictive value of a positive test at 'O' = 80 is 52.2% and of a negative test is 98.3% while the positive predictive value of 'H' = 80 is 54.6% and negative predictive value is 98.3%. CONCLUSION: Because of the difficulties in isolating S. typhi from blood, stool or other body fluids in developing countries, a diagnostic Widal agglutination titre of 'O' and 'H' agglutinins = 80 will be considered useful in the diagnosis of typhoid fever in our environment.

Loa loa meningoencephalitis in Southwestern Nigeria.

BACKGROUND: Neurological complication of loiasis is an uncommon event, and is usually precipitated by treatment especially if microfilaria loads are high. OBJECTIVE: To report an unusual presentation of loiasis with central nervous system involvement. CASE REPORT: A 60-year-old farmer of Yoruba origin from Southwestern Nigeria, developed meningoencephalitis from Loa loa, unrelated to antifilarial drug treatment. The presentation was unusual hence there was a slight delay in diagnosis. This case draws attention to L. loa, a neglected filarial, and highlights the unusual manifestation and diagnostic difficulties it can pose even in areas endemic for the infection. CONCLUSION: This case illustrates the high mortality associated with L. loa infection when the central nervous system is directly involved.

A 12-year review of cases of adult tetanus managed at the University College Hospital, Ibadan, Nigeria.

In this review, hospital case records of 202 adult tetanus managed between January 1990 and December 2001 in a tertiary institution in Southwestern Nigeria were reviewed. The mean age of the patients was 36.1+/-17.8 years with male:female ratio of 2.2:1 and an overall mortality rate of 64%. Patients with unfavourable outcomes spent 4.5+/-0.41 days compared with 16.6+/-1.2 days by those who survived. Factors associated with poor prognosis are age >60 years (P=0.029), incubation period <7 days (P=0.007), period of onset <48 h (P=0.0001), tachycardia with pulse rate >120/min (P=0.001) and spasm (P=0.002). Gender (P=0.11), post-injury vaccination (P=0.48) and types of antibiotics administered (P=0.49) were not significantly associated with increased mortality. The three most common complications were aspiration pneumonitis, sepsis and urinary bladder obstruction while complications with highest mortality (100%) were sepsis and cardiac arrest.

Tuberculosis treatment outcomes in State Hospital, Osogbo, southwestern Nigeria: a four year review.

BACKGROUND: A retrospective review of all cases of tuberculosis (TB) enrolled in the directly observed treatment-short course chemotherapy (DOT-SCC) between June 2000 and June 2004 at a General Hospital in Southwestern Nigeria was undertaken. The aim is to determine treatment outcomes and ascertain the effectiveness of the programme for TB control. METHODOLOGY: Case registers of all TB patients enrolled were reviewed and data obtained analyzed by statistical methods. RESULTS: A total of 879 TB patients (467 males, 412 females; M: F ratio 1.13:1) aged 1 to 80 years (mean age 33.0 +/- 14.0 years) were enrolled. The disease was pulmonary in 98.4% and extrapulmonary in 1.6%. Seven hundred and thirty four (83.6%) patients complied with the DOTS-SCC regimen, 127 (14.4%) defaulted while 18 (2%) transferred out. The overall treatment success rate was 76.3% while 3.8% had treatment failures. Outcome was not significantly affected by types of TB lesion (P = 0.1103), patient category (P = 0.4968), age (P = 0.7198), gender (P = 0.1726) or smear positivity (P = 0.5497). CONCLUSION: Although the currently advocated DOT-SCC regimen achieved a high success rate in this locality, it fell below the 85% recommended target. There is need to step up health education campaign on compliance with therapy and aggressively follow up defaulters to forestall the emergence of multidrug resistant M. tuberculosis.

Clinical and microbiological profiles of ear infections in Osogbo, Nigeria.

Despite the fact that discharging ears (DE) are one of the most common presentations to ear, nose and throat (ENT) clinics in the tropics, few reports have documented the aetiologic agents involved. The pathogenesis is therefore not fully understood and treatment remains controversial. We present in this report the microbiological characteristics of DE over a 3-year-period at the ENT clinic of Ladoke Akintola University Teaching Hospital, Osogbo, Southwest Nigeria.

Molecular epidemiology of methicillin-resistant Staphylococcus aureus in Ilorin, Nigeria.

BACKGROUND: Nosocomial infections caused by methicillin-resistant strains of Staphylococcus aureus constitute significant epidemiologic problems. Defining an outbreak requires the use of rapid and highly discriminatory epidemiologic methods to determine the epidemic strains involved in such outbreak. STUDY DESIGN: A descriptive laboratory based surveillance study for MRSA was undertaken. One hundred and forty seven Staphylococcus aureus isolates from clinical specimens were screened for methicillin resistance at the University of Ilorin Teaching Hospital between January and December 2001. Fifty one (34.7%) methicillin resistant strains recovered were epidemiologically characterized using Eco R1 restriction enzyme analysis of their plasmid DNAs. RESULT: Forty five (88.2%) MRSA isolates were associated with infections and 6 (11.8 %) were colonizing strains; 36 (70.6%) and 15 (29.4%) were hospital and community acquired respectively. Skin and soft tissues were sites of infection in 36 (70.6 %) cases and surgical, emergency and ICU accounted for 33 (64.7%) isolates. All isolates were resistant to more than two antibiotics but sensitive to vancomycin. Forty two (82.4 %) isolates contained plasmids including 9 (21.4 %) that contained more than one plasmid. Restriction Enzyme Analysis of the Plasmid DNA (REAP) divided the isolates into 9 Eco R1 profiles, with profile 2 accounting for 41.7% of all nosocomial infections in the wards, implying that it is endemic. The remaining nosocomial profiles occurred less frequently, suggesting that they are sporadic strains originating from outside the hospital. The community strains showed diverse digestion pattern indicating that they are from different clones. CONCLUSION: The spread of MRSA can be controlled through reinforcement of appropriate use of antibiotics, hand washing and laboratory surveillance for MRSA, particularly in the surgical wards and intensive care units, in order to identify sources of outbreaks.

Risk of nosocomial bacteria transmission: evaluation of cleaning methods of probes used for routine ultrasonography.

BACKGROUND: There exists a small but definite risk of nosocomial infection transmission attributable to ultrasonography probes and coupling gels. OBJECTIVE: Our objective was to ascertain whether the current method of probe disinfection in between patients is adequate to prevent cross infection, and to determine the best and safest method of probe disinfection applicable during routine ultrasonography in our institution. MATERIALS AND METHOD: Forty consecutive patients sent for routine ultrasonography at the Radiology Department of our institution in the month of January 2004 were studied. Each patient had a standardized ultrasound scan of the abdomen, after which swabs were taken from the surface of the unclean probe and after probe disinfection by single and double paper wipe cleaning method. The swabs were cultured on Blood agar to determine the characteristics of the colony forming units (CFU). RESULT: Forty four bacterial isolates were recovered from 37 patients who cultured positive, with MRSA constituting 36.4 %, MRCONS 22.7 %, MSSA 13.6 %, MSCONS 13.6%, Klebsiella spp 9.1% and Proteus mirabilis 4.6%. The average CFU transmitted by the unclean probe was significantly higher (P<0.05) than that transmitted by the probe after single or double paper wipe. Also, the average CFU transmitted following single and double paper wipe, in the inpatients was significantly higher (P<0.05) than in the outpatients. CONCLUSION: Single paper wipe is adequate for outpatients, but for inpatients, especially those with high risk of cross infection, double paper wipe is preferred with probe thoroughly wiped until visibly clean.