Kumburu Happiness Houka, Sonda Tolbert, Mmbaga Blandina Theophil, Alifrangis Michael, Lund Ole, Kibiki Gibson, Aarestrup Frank M
Kilimanjaro Clinical Research Institute, Moshi, Tanzania.
Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
Trop Med Int Health. 2017 Apr;22(4):454-464. doi: 10.1111/tmi.12836. Epub 2017 Feb 3.
To determine the causative agents of infections and their antimicrobial susceptibility at a tertiary care hospital in Moshi, Tanzania, to guide optimal treatment.
A total of 590 specimens (stool (56), sputum (122), blood (126) and wound swabs (286)) were collected from 575 patients admitted in the medical and surgical departments. The bacterial species were determined by conventional methods, and disc diffusion was used to determine the antimicrobial susceptibility pattern of the bacterial isolates.
A total of 249 (42.2%) specimens were culture-positive yielding a total of 377 isolates. A wide range of bacteria was isolated, the most predominant being Gram-negative bacteria: Proteus spp. (n = 48, 12.7%), Escherichia coli (n = 44, 11.7%), Pseudomonas spp. (n = 40, 10.6%) and Klebsiella spp (n = 38, 10.1%). Wound infections were characterised by multiple isolates (n = 293, 77.7%), with the most frequent being Proteus spp. (n = 44, 15%), Pseudomonas (n = 37, 12.6%), Staphylococcus (n = 29, 9.9%) and Klebsiella spp. (n = 28, 9.6%). All Staphylococcus aureus tested were resistant to penicillin (n = 22, 100%) and susceptible to vancomycin. Significant resistance to cephalosporins such as cefazolin (n = 62, 72.9%), ceftriaxone (n = 44, 51.8%) and ceftazidime (n = 40, 37.4%) was observed in Gram-negative bacteria, as well as resistance to cefoxitin (n = 6, 27.3%) in S. aureus.
The study has revealed a wide range of causative agents, with an alarming rate of resistance to the commonly used antimicrobial agents. Furthermore, the bacterial spectrum differs from those often observed in high-income countries. This highlights the imperative of regular generation of data on aetiological agents and their antimicrobial susceptibility patterns especially in infectious disease endemic settings. The key steps would be to ensure the diagnostic capacity at a sufficient number of sites and implement structures to routinely exchange, compare, analyse and report data. Sentinel sites (hospitals) across the country (and region) should report on a representative subset of bacterial species and their susceptibility to drugs at least annually. A central organising body should collate the data and report to relevant national and international stakeholders.
确定坦桑尼亚莫希一家三级护理医院感染的病原体及其抗菌药物敏感性,以指导优化治疗。
从内科和外科收治的575例患者中采集了共590份标本(粪便(56份)、痰液(122份)、血液(126份)和伤口拭子(286份))。通过传统方法确定细菌种类,并采用纸片扩散法确定分离出的细菌的抗菌药物敏感性模式。
共249份(42.2%)标本培养呈阳性,共分离出377株菌株。分离出多种细菌,最主要的是革兰氏阴性菌:变形杆菌属(n = 48,12.7%)、大肠杆菌(n = 44,11.7%)、假单胞菌属(n = 40,10.6%)和克雷伯菌属(n = 38,10.1%)。伤口感染的特点是有多种分离菌株(n = 293,77.7%),最常见的是变形杆菌属(n = 44,15%)、假单胞菌属(n = 37,12.6%)、葡萄球菌属(n = 29,9.9%)和克雷伯菌属(n = 28,9.6%)。所有检测的金黄色葡萄球菌对青霉素均耐药(n = 22,100%),对万古霉素敏感。革兰氏阴性菌对头孢唑林(n = 62,72.9%)、头孢曲松(n = 44,51.8%)和头孢他啶(n = 40,37.4%)等头孢菌素类药物有显著耐药性,金黄色葡萄球菌对头孢西丁也有耐药性(n = 6,27.3%)。
该研究揭示了多种病原体,对常用抗菌药物的耐药率令人担忧。此外,细菌谱与高收入国家常见的不同。这凸显了定期生成病因病原体及其抗菌药物敏感性模式数据的必要性,特别是在传染病流行地区。关键步骤是确保足够数量场所的诊断能力,并建立常规交换、比较、分析和报告数据的机制。全国(及地区)的哨点医院(医院)应至少每年报告具有代表性的细菌种类子集及其对药物的敏感性。一个中央组织机构应整理数据并向相关国家和国际利益相关者报告。