PREVALENCE OF NOSOCOMIAL INFECTIONS AND ANTIBIOTICS SUSCEPTIBILITY PROFILE OF BACTERIA ISOLATES IN SOME HOSPITALS IN ILORIN, NIGERIA
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Abstract
Prevalence of nosocomial infections and antibiotics susceptibility profiles of bacterial isolates in six private hospitals and University of Ilorin Teaching Hospital (UITH) in Ilorin town Kwara State, Nigeria were investigated. . A 1-year retrospective study of the private hospitals and 3-years retrospective analysis of the university of Ilorin teaching hospital were carried out. A 2-year prospective study surgical site nosocomial infection in the teaching hospital was also carried out. Patients’ folders and Microbiology laboratory records were used for the determination of prevalence of nosocomial infections in retrospective study. Bacteriological analysis of Floor and air of theater and surgical wards of the private hospitals and swabs of surgical wounds, floors and air of theater and surgical wards of the teaching hospital were done, using diagnostic media and biochemical tests. Antibiotic susceptibility profiles of the bacterial isolates were determined using tube dilution and agar diffusion methods as described in official monographs. Multi Antibiotic Resistant (MAR) isolates were screened for β-lactamase production by iodometric method. Presence of plasmids in the MAR isolates was determined using the agar gel electrophoresis technique. Plasmid curing, to determine if antibiotic resistance was due to plasmids was also carried out by treating the isolates with acridine orange and redetermining of their MIC values. Susceptibility of the isolates to some commonly used hospital disinfectants were determined by the broth- dilution technique, for two years. Insitu efficacies of some hospital disinfectants indicated reduction level of microbial count of the floors and airs of theater and surgical wards. Result of the retrospective study of the six private hospitals showed that nosocomial infections are common in the hospitals, with a prevalence rate of 15.23%. Analysis of incidence of nosocomial infection rates showed that Surgical site infection ranked the highest with prevalence rate of 26.1%, followed by infection of the blood stream, urinary tract and respiratory tract in descending order. In the university teaching hospital the average rate of nosocomial infection in the wards for the 3 years was 1.27%. With highest rate of prevalence of 67.42% also occurring in surgical site followed distantly by UTI, Blood stream and Respiratory tract infections in descending order. Comparative analysis of results of retrospective study on leading causative agents of nosocomial infection in both private and the teaching hospitals showed that S. aureus, Ps. 22 aeruginosa, S. epidermidis and E. coli are the leading causative pathogens nosocomial infections in decreased order of frequencies. Isolates from both private and Teaching hospital environments equally incriminated S. aureus, S. epidermidis and Ps. aeruginosa as the leading causative agents. The results of susceptibility tests showed that all the isolated bacterial species from both the private hospital and university teaching hospital environments were multiple antibiotics resistant (MAR). The MAR indices ranged from 0.4-0.8. Bacteriological study of surgical site infections at UITH showed nosocomial infection prevalence rate of 30- 45.7% with appendicectomy having the highest figure of 46.7%. Other commonly infected surgical sites were laparatomy, mastectomy, thyroidectomy, and herniorrhaphy. A total of ten (10) different bacterial species were isolated from the surgical sites, with S. aureu, S. epidermidis, Ps. aeruginosa, E. coli, Kl. pneumonia, and Pr. mirabilis constituting 89% of the isolates. Most of the isolates from the surgical sites were multiantibiotic resistant, with MAR indices ranging from 0.6-0.8. Only the quinolones and aminoglycosides showed good inhibitory activities against most of the isolates. Sixty- four percent (90 out of 149) of the bacteria isolated from the surgical sites were βlactamase producers with Staphylococci constituted 90% of the β-lactamase producers. Results of plasmid curing analysis showed that 61.2% of the multiple antibiotic resistant isolates, which also produced β-lactamase, harboured plasmids. After plasmid curing 61.2% of these isolates became sensitive to some of the antibiotics which they were initially resistant to. The result of electrophoresis analysis of the resistant isolates showed different plasmid numbers and sizes, with some isolates having the same number of plasmid bands and sizes confirming that resistance observed with the isolates were plasmid- mediated and the likely origin of the these isolates. There was decrease in efficacies of the disinfectants from 2004 to 2005 which resulted in high bacterial counts in most of the wards in the hospital. Generally, surgical site infection was the leading nosocomial infection in the investigated hospitals in Ilorin. S. aureus, S. epidermidis, Ps. aeruginosa, E. coli and Kl. pneumoniae. Which were the causative pathogens They were resistant to commonly prescribed antibiotics. Antibiotic resistance in the isolates was largely due to production of βlactamases and transfer of resistance plasmid among the isolates. Ineffective disinfection of the clinical environment was mostly responsible for the high number of the bacteria contaminants in the hospital wards.
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