Adewale A Amupitan, Adeyemi T Adeyemo, Adefunke O Amupitan, Temitope O Obadare, Aaron O Aboderin
{"title":"尼日利亚一家医院的菌血症：实施抗菌素耐药性监测。","authors":"Adewale A Amupitan, Adeyemi T Adeyemo, Adefunke O Amupitan, Temitope O Obadare, Aaron O Aboderin","doi":"10.4102/jphia.v16i1.655","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Surveillance of drug-resistant infections is crucial for antimicrobial resistance (AMR) control. Implementing surveillance in low- and middle-income countries (LMICs) is challenging.</p><p><strong>Aim: </strong>To investigate bacteraemia and describe AMR surveillance.</p><p><strong>Setting: </strong>Tertiary healthcare facility.</p><p><strong>Methods: </strong>Case finding was by WHO Global AMR and Use Surveillance System (GLASS). Blood samples were processed between May 2017 and June 2018, using BACTEC blood culture system. Bacterial identification, antibiotic susceptibility testing and detection of AMR genes followed standard protocols.</p><p><strong>Results: </strong>Aerobic blood cultures were conducted in a third of clinical sepsis cases (<i>n</i> = 601/1851), of which 114 (19.0%) were true positives, with a 2.2% contamination rate. Pathogens recovered included six priority blood pathogens reportable to WHO GLASS. Sixteen (30.2%) of 53 Gram-negative isolates were extended-spectrum beta-lactamase producers, predominantly harbouring <i>bla</i> <sub>CTX-M,</sub> three (5.7%) were AmpC beta-lactamase producers, and 20 (37.7%) were carbapenem-resistant, predominantly harbouring <i>bla</i> <sub>KPC</sub>. Twenty-nine (50.9%) of 57 <i>Staphylococcus aureus</i> isolates were methicillin-resistant; 17 (58.6%) of these harboured <i>mec</i>A genes. Hospital-acquired infection (odds ratio [OR] = 0.3, 95% confidence interval [CI]=0.1-0.7, <i>p</i> = 0.004) was identified as a predisposing factor for the development of multidrug-resistant (MDR) bacteraemia. Bacteraemia with MDR organisms was significantly associated with mortality (OR = 3.8, 95% CI = 1.6-9.1, <i>p</i> = 0.001).</p><p><strong>Conclusion: </strong>A wide variety of bacteria are responsible for bacteraemia in our setting, with more than half being multidrug-resistant. Bacteraemia with multidrug-resistant organisms was significantly associated with mortality, hence, the need for this AMR surveillance initiative.</p><p><strong>Contribution: </strong>Implementing healthcare facility-based surveillance of AMR in LMICs is achievable despite limited microbiological laboratory capacity.</p>","PeriodicalId":44723,"journal":{"name":"Journal of Public Health in Africa","volume":"16 1","pages":"655"},"PeriodicalIF":0.6000,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905166/pdf/","citationCount":"0","resultStr":"{\"title\":\"Bacteraemia in a Nigerian hospital: Implementing antimicrobial resistance surveillance.\",\"authors\":\"Adewale A Amupitan, Adeyemi T Adeyemo, Adefunke O Amupitan, Temitope O Obadare, Aaron O Aboderin\",\"doi\":\"10.4102/jphia.v16i1.655\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Surveillance of drug-resistant infections is crucial for antimicrobial resistance (AMR) control. Implementing surveillance in low- and middle-income countries (LMICs) is challenging.</p><p><strong>Aim: </strong>To investigate bacteraemia and describe AMR surveillance.</p><p><strong>Setting: </strong>Tertiary healthcare facility.</p><p><strong>Methods: </strong>Case finding was by WHO Global AMR and Use Surveillance System (GLASS). Blood samples were processed between May 2017 and June 2018, using BACTEC blood culture system. Bacterial identification, antibiotic susceptibility testing and detection of AMR genes followed standard protocols.</p><p><strong>Results: </strong>Aerobic blood cultures were conducted in a third of clinical sepsis cases (<i>n</i> = 601/1851), of which 114 (19.0%) were true positives, with a 2.2% contamination rate. Pathogens recovered included six priority blood pathogens reportable to WHO GLASS. Sixteen (30.2%) of 53 Gram-negative isolates were extended-spectrum beta-lactamase producers, predominantly harbouring <i>bla</i> <sub>CTX-M,</sub> three (5.7%) were AmpC beta-lactamase producers, and 20 (37.7%) were carbapenem-resistant, predominantly harbouring <i>bla</i> <sub>KPC</sub>. Twenty-nine (50.9%) of 57 <i>Staphylococcus aureus</i> isolates were methicillin-resistant; 17 (58.6%) of these harboured <i>mec</i>A genes. Hospital-acquired infection (odds ratio [OR] = 0.3, 95% confidence interval [CI]=0.1-0.7, <i>p</i> = 0.004) was identified as a predisposing factor for the development of multidrug-resistant (MDR) bacteraemia. Bacteraemia with MDR organisms was significantly associated with mortality (OR = 3.8, 95% CI = 1.6-9.1, <i>p</i> = 0.001).</p><p><strong>Conclusion: </strong>A wide variety of bacteria are responsible for bacteraemia in our setting, with more than half being multidrug-resistant. 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引用次数: 0
摘要
背景：耐药感染监测是控制抗微生物药物耐药性（AMR）的关键。在低收入和中等收入国家实施监测具有挑战性。目的：探讨细菌血症及抗菌素耐药性监测情况。环境：三级保健设施。方法：采用世卫组织全球抗生素耐药性和药物使用监测系统（GLASS）进行病例发现。2017年5月至2018年6月期间，使用BACTEC血液培养系统处理血液样本。细菌鉴定、药敏试验和AMR基因检测按标准程序进行。结果：1/ 3的临床脓毒症患者（n = 601/1851）进行了有氧血培养，其中真阳性114例（19.0%），污染率2.2%。回收的病原体包括六种需向世卫组织GLASS报告的重点血液病原体。53株革兰氏阴性菌株中，广谱β -内酰胺酶产生菌16株（30.2%），以bla CTX-M菌株为主；AmpC β -内酰胺酶产生菌3株（5.7%）；耐碳青霉烯型菌株20株（37.7%），以bla KPC菌株为主。57株金黄色葡萄球菌耐甲氧西林29株（50.9%）；其中17例（58.6%）携带mecA基因。医院获得性感染（优势比[OR] = 0.3, 95%可信区间[CI]=0.1-0.7, p = 0.004）被确定为发生多药耐药菌血症的易感因素。耐多药菌血症与死亡率显著相关（OR = 3.8, 95% CI = 1.6-9.1, p = 0.001）。结论：在我们的环境中，引起菌血症的细菌种类繁多，其中一半以上是多重耐药的。耐多药菌菌血症与死亡率显著相关，因此有必要开展抗菌素耐药性监测行动。贡献：尽管微生物实验室能力有限，但在中低收入国家实施基于医疗机构的抗菌素耐药性监测是可以实现的。
Bacteraemia in a Nigerian hospital: Implementing antimicrobial resistance surveillance.
Background: Surveillance of drug-resistant infections is crucial for antimicrobial resistance (AMR) control. Implementing surveillance in low- and middle-income countries (LMICs) is challenging.
Aim: To investigate bacteraemia and describe AMR surveillance.
Setting: Tertiary healthcare facility.
Methods: Case finding was by WHO Global AMR and Use Surveillance System (GLASS). Blood samples were processed between May 2017 and June 2018, using BACTEC blood culture system. Bacterial identification, antibiotic susceptibility testing and detection of AMR genes followed standard protocols.
Results: Aerobic blood cultures were conducted in a third of clinical sepsis cases (n = 601/1851), of which 114 (19.0%) were true positives, with a 2.2% contamination rate. Pathogens recovered included six priority blood pathogens reportable to WHO GLASS. Sixteen (30.2%) of 53 Gram-negative isolates were extended-spectrum beta-lactamase producers, predominantly harbouring blaCTX-M, three (5.7%) were AmpC beta-lactamase producers, and 20 (37.7%) were carbapenem-resistant, predominantly harbouring blaKPC. Twenty-nine (50.9%) of 57 Staphylococcus aureus isolates were methicillin-resistant; 17 (58.6%) of these harboured mecA genes. Hospital-acquired infection (odds ratio [OR] = 0.3, 95% confidence interval [CI]=0.1-0.7, p = 0.004) was identified as a predisposing factor for the development of multidrug-resistant (MDR) bacteraemia. Bacteraemia with MDR organisms was significantly associated with mortality (OR = 3.8, 95% CI = 1.6-9.1, p = 0.001).
Conclusion: A wide variety of bacteria are responsible for bacteraemia in our setting, with more than half being multidrug-resistant. Bacteraemia with multidrug-resistant organisms was significantly associated with mortality, hence, the need for this AMR surveillance initiative.
Contribution: Implementing healthcare facility-based surveillance of AMR in LMICs is achievable despite limited microbiological laboratory capacity.
期刊介绍：
The Journal of Public Health in Africa (JPHiA) is a peer-reviewed, academic journal that focuses on health issues in the African continent. The journal editors seek high quality original articles on public health related issues, reviews, comments and more. The aim of the journal is to move public health discourse from the background to the forefront. The success of Africa’s struggle against disease depends on public health approaches.
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