Assessment of antimicrobial resistance laboratory-based surveillance capacity of hospitals in Zambia: findings and implications for system strengthening.

BACKGROUND: A well-established antimicrobial resistance (AMR) laboratory-based surveillance (LBS) is of utmost importance in a country like Zambia which bears a significant proportion of the world's communicable disease burden. This study assessed the capacity of laboratories in selected hospitals to conduct AMR surveillance in Zambia. METHODS: This cross-sectional exploratory study was conducted among eight purposively selected hospitals in Zambia between August 2023 and December 2023. Data were collected using the self-scoring Laboratory Assessment of Antibiotic Resistance Testing Capacity (LAARC) tool. FINDINGS: Of the assessed facilities, none had full capacity to conduct AMR surveillance with varying capacities ranging from moderate (63% (5/8)) to low (38% (3/8)). Some of the barriers of AMR-LBS were the lack of an electronic laboratory information system (63% (5/8)) and the lack of locally generated antibiograms (75% (6/8)). Quality control for antimicrobial susceptibility testing (AST), pathogen identification and media preparation had the lowest overall score among all of the facilities with a score of 14%, 20% and 44%, respectively. The highest overall scores were in specimen processing (79%), data management (78%), specimen collection, transport and management (71%), and safety (70%). Most facilities had standard operating procedures in place but lacked specimen-specific standard operating procedures. CONCLUSION: The absence of laboratories with full capacity to conduct AMR surveillance hinders efforts to combat AMR and further complicates the treatment outcomes of infectious diseases. Establishing and strengthening LBS systems are essential in quantifying the burden of AMR and supporting the development of local antibiograms and treatment guidelines.

Bacterial contamination of mobile phones of healthcare workers at the University Teaching Hospital, Lusaka, Zambia.

BACKGROUND: Mobile telephones (henceforth 'phones') have become an essential part of everyday life in both healthcare and community settings. However, the widespread use of mobile phones in healthcare facilities is of concern because they can act as vehicles for transmitting pathogenic bacteria. This study aimed to investigate the bacterial contamination of mobile phones of healthcare workers (HCWs) at the University Teaching Hospital, Lusaka, Zambia. METHODS: This cross-sectional study, from May to July 2019, involved 117 HCWs. A self-administered questionnaire was used to gather sociodemographic and phone usage data. The mobile phones of HCWs were swabbed for culture and antimicrobial susceptibility testing. RESULTS: The overall prevalence of mobile phone contamination was 79%. The predominant isolates were coagulase-negative staphylococci (50%), Staphylococcus aureus (24.5%) and Bacillus spp. (14.3%). Other isolates were Escherichia coli, Acinetobacter spp., Pseudomonas spp., Klebsiella sp. and Proteus sp. Most isolates were susceptible to tetracycline, gentamicin and cotrimoxazole, while all Gram-positive organisms were resistant to penicillin. Meticillin resistance was detected in 25% and 48% of S. aureus and coagulase-negative staphylococci isolates, respectively. No significant association was found between mobile phone contamination and age group, gender, profession, mobile phone disinfection or work area. CONCLUSION: Mobile phones of HCWs carry potentially pathogenic bacteria and can be a source of healthcare-associated infections in healthcare settings. Hence, regulations regarding the use of mobile phones need to be developed, especially in critical areas, to reduce the dissemination of pathogenic bacteria from hands to phones and, potentially, to patients.

Prevalence and antibiotic susceptibility of group A beta-haemolytic streptococcal isolates in children presenting with acute pharyngitis in Lusaka, Zambia

Background. Group A beta-haemolytic streptococci (GABHS)-associated pharyngitis can complicate into rheumatic fever and rheumatic heart disease (RHD).Objectives. To determine the prevalence and antibiotic susceptibility of GABHS isolates in children presenting with acute pharyngitis and assess the utility of Zambian Treatment Guideline (ZTG) criteria as a local clinical scoring system.Methods. This descriptive cross-sectional study was conducted at the paediatric outpatient department of the University Teaching Hospital in Lusaka, Zambia. The study cohort, comprising children aged 3 - 15 years (n=146), were recruited as presenting with symptoms of pharyngitis. The children underwent a clinical assessment that included a detailed case history, presenting symptoms and a throat swab that was subsequently cultured. Microbial isolates were typed and the antibiotic sensitivity of cultured GABHS to penicillin and erythromycin determined.Results. GABHS were cultured from 22 (15.1%) children within this study. All the GABHS isolates (n=22) were susceptible to penicillin G; however, 19% of isolates displayed reduced susceptibility to erythromycin. None of the ZTG criteria, when used individually, was sufficiently sensitive to detect GABHS pharyngitis among this cohort.Conclusion. The prevalence of GABHS pharyngitis is similar that been described elsewhere. While GABHS remains highly susceptible to penicillin, which is used in the local RHD control programmes, concern remains for children treated with erythromycin owing to the resistance noted in some of the isolates. The ZTG clinical criteria displayed poor sensitivity in identifying GABHS pharyngitis. This has significant implications for effective diagnosis and treatment of pharyngitis and associated complications within this high RHD endemic area