Seni Jeremiah, Akaro Inyasi Lawrence, Mkinze Baraka, Kashinje Zengo, Benard Modest, Mboowa Gerald, Aruhomukama Dickson, Sserwadda Ivan, Joloba Moses L, Mshana Stephen E, Kidenya Benson R
Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
Department of Surgery, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
Infect Drug Resist. 2021 May 11;14:1733-1745. doi: 10.2147/IDR.S303860. eCollection 2021.
The dual burden of road traffic accidents and antimicrobial resistance in orthopaedic infections is challenging already strained health-care systems. Limited information exists in Tanzania on antimicrobial resistance surveillance to delineate the potential sources of multi-drug-resistant bacteria for specific mitigation strategies among orthopaedic patients.
A longitudinal study was conducted at Bugando Medical Centre in Mwanza city between January and May 2020. It involved the collection of rectal swabs/stools, hand swabs, and environmental sampling to identify extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacteria. Participants' data were collected using a structured questionnaire and analysed to determine factors associated with ESBL colonization among index orthopaedic patients and correlates with other ESBL sources using OR (95% CI) and a cut-off -value of ≤0.05.
We found that 47.2% (125/265) of index patients, 77.8% (14/18) of neighbouring patients, 8.3% (2/24) of health-care workers, 72.2% (13/18) of non-medical caregivers, and 31.4% (27/86) of samples taken from the hospital environment had ESBL producers. and spp. predominated among participants and spp. predominated in the environmental samples. Patients with open fractures had increased odds of being colonized with ESBL producers [OR (95% CI): 2.08 (1.16-3.75); =0.015]. The floor below patients' beds was commonly contaminated; however, the odds of environmental contamination decreased on the third round of sampling [OR (95% CI: 0.16 (0.04-0.67); =0.012], apparently as a result of parallel infection prevention and control responsive measures against coronavirus disease 2019 (COVID-19).
We found a high occurrence of ESBL colonization among participants and in the environmentat this tertiary hospital. The importance of routine ESBL surveillance among orthopaedic patients with open fractures on admission and strengthened decontamination of health-care premises is reiterated.
道路交通事故和骨科感染中的抗菌药物耐药性双重负担，正给本就不堪重负的医疗保健系统带来挑战。坦桑尼亚关于抗菌药物耐药性监测的信息有限，难以确定多重耐药菌的潜在来源，以便为骨科患者制定具体的缓解策略。
2020年1月至5月期间，在姆万扎市的布甘多医疗中心开展了一项纵向研究。该研究包括收集直肠拭子/粪便、手部拭子和环境样本，以鉴定产超广谱β-内酰胺酶（ESBL）的革兰氏阴性菌。使用结构化问卷收集参与者的数据，并进行分析，以确定与索引骨科患者中ESBL定植相关的因素，并使用OR（95%CI）和≤0.05的临界值来确定与其他ESBL来源的相关性。
我们发现，47.2%（125/265）的索引患者、77.8%（14/18）的相邻患者、8.3%（2/24）的医护人员、72.2%（13/18）的非医疗护理人员以及31.4%（27/86）的医院环境样本中产ESBL菌。参与者中 和 菌占主导，环境样本中 菌占主导。开放性骨折患者被ESBL菌定植的几率增加[OR（95%CI）：2.08（1.16 - 3.75）； =0.015]。患者病床下方的地面普遍受到污染；然而，在第三轮采样时环境污染的几率降低了[OR（95%CI）：0.16（0.04 - 0.67）； =0.012]，这显然是针对2019冠状病毒病（COVID - 19）采取的平行感染预防和控制应对措施的结果。
我们发现，在这家三级医院的参与者和环境中，ESBL定植的发生率很高。重申了对开放性骨折入院骨科患者进行常规ESBL监测以及加强医疗场所消毒的重要性。
