Antibiotic resistance in patients with clinical features of healthcare-associated infections in an urban tertiary hospital in Sierra Leone: a cross-sectional study

Sulaiman Lakoh,Eili Y Klein,Joshua M Coker,Le Yi,Tiecheng Wang,Olukemi Adekanmbi,Shuchao Wang,Stephen Sevalie,Guang Yang,Weiyang Sun,Abdulrazaq G Habib,Letian Li,Oladimeji Adebayo,Xuejun Guo

doi:10.1186/s13756-020-0701-5

Abstract

BackgroundAvailable data on antibiotic resistance in sub-Saharan Africa is limited despite its increasing threat to global public health. As there is no previous study on antibiotic resistance in patients with clinical features of healthcare-associated infections (HAIs) in Sierra Leone, research is needed to inform public health policies. Our study aimed to assess antibiotic resistance rates from isolates in the urine and sputum samples of patients with clinical features of HAIs.MethodologyWe conducted a cross-sectional study of adult inpatients aged ≥18 years at Connaught Hospital, an urban tertiary care hospital in Freetown between February and June 2018.ResultsOver the course of the study, we enrolled 164 patients. Risk factors for HAIs were previous antibiotic use (93.3%), comorbidities (58.5%) and age (≥65 years) (23.9%). Of the 164 samples, 89.6% were urine. Bacterial growth was recorded in 58.8% of cultured specimens; the type of specimen was an independent predictor of bacterial growth (p < 0.021). The most common isolates were Escherichia coli and Klebsiella pneumoniae; 29.2% and 19.0% in urine samples and 18.8% and 31.3% in sputum samples, respectively.The overall resistance rates were 58% for all extended-spectrum beta-lactamase (ESBL)-producing organisms, 13.4% for carbapenem-resistant non-lactose fermenting gram-negative bacilli, 8.7% for carbapenem-resistant Acinetobacter baumannii (CRAB) and 1.3% for carbapenem-resistant Enterobacteriaceae (CRE). There were no carbapenem-resistant P. aeruginosa (CRPA) isolates but all Staphylococcus aureus isolates were methicillin-resistant S. aureus.ConclusionWe demonstrated a high prevalence rate of ESBL-producing organisms which are a significant burden at the main tertiary hospital in Sierra Leone. Urgent action is needed to strengthen microbiological diagnostic infrastructure, initiate surveillance on antibiotic resistance and develop and implement policy framework on antibiotic stewardship.

Highlights

The growing burden of antibiotic resistance (AR) is a serious global public health problem, presenting a significant threat to the success of treatment, prevention, and control of infectious diseases [1]
We demonstrated a high prevalence rate of extended-spectrum beta- lactamase (ESBL)-producing organisms which are a significant burden at the main tertiary hospital in Sierra Leone
The growing burden of healthcare-associated infections (HAIs) which are driven by poor infection prevention and control (IPC) practices are among the drivers of antibiotic resistance

Summary

Introduction

The growing burden of antibiotic resistance (AR) is a serious global public health problem, presenting a significant threat to the success of treatment, prevention, and control of infectious diseases [1]. While AR poses potential long-term problems globally, currently, patients with AR have worse outcomes including prolonged hospital stays, increased healthcare costs, and increased morbidity and risks of mortality [2]. These factors are worsened in low-and-middle-income countries (LMICs) where infrastructure is lacking and the availability of second- and third-line antibiotic therapies that may be more effective are not widely available [3].

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