Nagelkerke Marjolijn M B, Sikwewa Kapembwa, Makowa Dennis, de Vries Irene, Chisi Simon, Dorigo-Zetsma J Wendelien
Saint Francis' Hospital, Katete, Zambia.
Department of Medical Microbiology, Tergooi Hospital, Hilversum, The Netherlands.
BMC Res Notes. 2017 Aug 10;10(1):378. doi: 10.1186/s13104-017-2710-x.
Antimicrobial resistance is an increasing global health problem. Very little data on resistance patterns of pathogenic bacteria in low-income countries exist. The aim of this study was to measure the prevalence of antimicrobial drug resistant bacteria carried by in- and outpatients in the resource constraint setting of a secondary care hospital in Zambia. Nasal and rectal samples from 50 in- and 50 outpatients were collected. Patients were randomly selected and informed consent was obtained. Nasal samples were tested for the presence of methicillin-resistant Staphylococcus aureus (MRSA), and rectal samples for Gram-negative rods (family of Enterobacteriaceae) non-susceptible to gentamicin, ciprofloxacin and ceftriaxone. Additionally, E-tests were performed on ceftriaxone-resistant Enterobacteriaceae to detect extended-spectrum β-lactamases (ESBLs).
14% of inpatients carried S. aureus, and 18% of outpatients. No MRSA was found. 90% of inpatients and 48% of outpatients carried one or more Enterobacteriaceae strains (75% Escherichia coli and Klebsiella pneumonia) resistant to gentamicin, ciprofloxacin and/or ceftriaxone (p < 0.001). Among inpatients gentamicin resistance was most prevalent (in 78%), whereas among outpatients ciprofloxacin resistance prevailed (in 38%). All ceftriaxone-resistant Enterobacteriaceae were ESBL-positive; these were present in 52% of inpatients versus 12% of outpatients (p < 0.001). We conclude it is feasible to perform basic microbiological procedures in the hospital laboratory in a low-income country and generate data on antimicrobial susceptibility. The high prevalence of antimicrobial drug resistant Enterobacteriaceae carried by in- and outpatients is worrisome. In order to slow down antimicrobial resistance, surveillance data on local susceptibility patterns of bacteria are a prerequisite to generate guidelines for antimicrobial therapy, to guide in individual patient treatment and to support implementation of infection control measures in a hospital.
抗菌药物耐药性是一个日益严重的全球健康问题。低收入国家关于病原菌耐药模式的数据非常少。本研究的目的是在赞比亚一家二级护理医院资源有限的环境中，测量住院患者和门诊患者携带的抗菌药物耐药菌的流行率。收集了50名住院患者和50名门诊患者的鼻腔和直肠样本。患者是随机选取的，并获得了知情同意。对鼻腔样本检测耐甲氧西林金黄色葡萄球菌（MRSA）的存在情况，对直肠样本检测对庆大霉素、环丙沙星和头孢曲松不敏感的革兰氏阴性杆菌（肠杆菌科）。此外，对耐头孢曲松的肠杆菌科进行E试验以检测超广谱β-内酰胺酶（ESBLs）。
14%的住院患者携带金黄色葡萄球菌，门诊患者为18%。未发现MRSA。90%的住院患者和48%的门诊患者携带一种或多种对庆大霉素、环丙沙星和/或头孢曲松耐药的肠杆菌科菌株（75%为大肠杆菌和肺炎克雷伯菌）（p<0.001）。住院患者中庆大霉素耐药最为普遍（78%），而门诊患者中环丙沙星耐药最为普遍（38%）。所有耐头孢曲松的肠杆菌科均为ESBL阳性；这些在52%的住院患者中存在，而门诊患者中为12%（p<0.001）。我们得出结论，在低收入国家的医院实验室进行基本微生物学程序并生成抗菌药物敏感性数据是可行的。住院患者和门诊患者携带的抗菌药物耐药肠杆菌科的高流行率令人担忧。为了减缓抗菌药物耐药性，关于细菌局部敏感性模式的监测数据是制定抗菌治疗指南、指导个体患者治疗以及支持医院感染控制措施实施的先决条件。
