Date Published: December 4, 2018
Author(s): Moti Tolera, Degu Abate, Merga Dheresa, Dadi Marami.
Nosocomial infections remain a major cause of mortality and morbidity worldwide. Despite the highly specialized interventions and policies, the rate of infection is still high due to the emergence of antimicrobial-resistant bacteria. This study described the prevalence of bacterial nosocomial infections and antimicrobial susceptibility pattern of isolates among patients admitted at Hiwot Fana Specialized University Hospital, Eastern Ethiopia. A hospital-based cross-sectional study was conducted among 394 nosocomial infection-suspected patients from March 2017 to July 2017. Data were collected using a structured questionnaire. Specimens from the respective site of infections were collected and examined for the presence of pathogenic bacteria and their antimicrobial susceptibility using standard culture and serological tests. Data were summarized using descriptive statistics. The prevalence of culture-confirmed bacterial nosocomial infection was 6.9% (95% CI: 4.3–7.9). Staphylococcus aureus (18.5%) was the most common isolate followed by Escherichia coli (16.7%). S. aureus showed 80% resistance to chloramphenicol and erythromycin, and 70% to cephalexin and tetracycline, respectively. A methicillin-resistant S. aureus made up 88.9% of all S. aureus isolates. Pseudomonas aeruginosa showed 83.7% resistance to each of ceftazidime and cephalexin, and 66.7% to chloramphenicol. The most common multidrug-resistant isolates were P. aeruginosa (30.4%) and S. aureus (21.7%). The prevalence of nosocomial infections in this study was comparable with other findings; however, the high rates of antimicrobial resistant isolates represent a substantial threat to the patients, communities, health care providers, and modern medical practices. Bacterial nosocomial infection treatment should be supported by culture isolation and antimicrobial susceptibility testing.
A nosocomial infection (NI) (also known as hospital-acquired infection) is a localized or a systemic infection resulting from an adverse reaction to infectious agents or its toxins that develops in 48 hours or more after admission and was not incubating on admission [1, 2]. The most common type of NIs are urinary tract infections (usually catheter associated) (31%)  followed by surgical site infections (SSIs) (17%), primary bloodstream infections (BSIs) (usually associated with the use of an intravascular device) (14%), and pneumonia (usually ventilator associated) (13%) [3, 4]. The main bacteria associated with NIs are S. aureus, coagulase-negative staphylococci (CoNS), Streptococcus pneumoniae, Escherichia coli, P. aeruginosa, Haemophilus influenzae, Klebsiella pneumoniae, Acinetobacter, and Enterococci [5, 6]. The transmission within the hospital occurs through cross-contamination of the patients via the contaminated hands of health care staffs who come in frequent contact with patients or through contaminated objects [4, 7].
Nosocomial infections are one of the major public health problems around the world that vary from one country to the other. The prevalence of culture-confirmed NIs in this study was 6.9% (95% CI: 4.3–7.9). This was lower compared with a previous study conducted in a Tertiary Care Hospital, Ethiopia (35.8%) , and Rabat, Morocco (10.3%) , but higher compared to the study reported in Lambarene, Gabon (0.3%) , and Mazandaran, India (1.03%) . The higher prevalence of NIs in the present study might be due to the inclusion of all age groups and a large number of different kinds of specimens from different wards; the other studies only looked at adult patients and focused on limited types of specimens.
In conclusion, the prevalence of culture-confirmed bacterial NIs in this study was comparable with other similar study findings. The most common infections were surgical site and bloodstream. S. aureus, E. coli, and S. pneumoniae were the most frequent causes of NIs. Most of the isolates were resistant to commonly used antimicrobials in the testing panel. The treatment and management of bacterial NIs need to be supported by culture isolation and antimicrobial susceptibility testing. Ciprofloxacin, ceftriaxone, and gentamycin should be used for the treatment of NIs when empiric treatment is unavoidable. Future studies are recommended to measure the true prevalence of NIs and antimicrobial resistance by including district hospitals, discharged patients, and communities.