Comparison of susceptibility trends of Escherichia coli from intra-abdominal infections in high- vs. low-to-middle-income countries: SMART 2008-2012

Abstract

Background: Bacterial resistance to antibiotics is a major public health problem. In Africa, few data are available however in this field. Thus, at the Hopital Principal of Dakar, a data collecting system andmonthly resistance analyses has been implemented by the Committee against nosocomial infections (CLIN). We present here the results compiled over a year to help guide prevention activities. Methods & Materials: This is a prospective study from January 1 to December 31, 2012 in the various departments of Hopital Principal. Every day, multiresistant laboratory isolates are subject to clinical and biological data collection using a questionnaire, this after removing duplicates. These isolates include Enterobacteriaceae producing extended-spectrum beta-lactamase (ESBL) and derepressed cephalosporinase, multiresistant Pseudomonas aeruginosa and Acinetobacter (Ceftazidime and/or imipenem resistant), Staphylococcus aureus Methicillin Resistant (MRSA). Was considerednosocomial origin any infection revealing after 48hours of hospitalization. The data are then analyzed with Epi Info. Results:Threehundred and sixty (360)MRBwere collectedduring the study period. The average age was 32 years [4 days, 95 years] with a sex ratio of 1.70. It was essentially ESBL-producing Enterobacteriaceae (87%) followed by multiresistant Acinetobacter (8%), multiresistant Pseudomonas aeruginosa (2%) and methicillinresistant Staphylococcus aureus (3%), respectively. ESBLs were as follows: Klebsiella (59%), E. coli (24%), Enterobacter (12%), and the remaining (5%). Bacteremia was the most common sites (45%), followed respectively by urinary tract infections (30%) and abscesses (15%).According to the incidencedensityper1000patient-days, the most affected departments were respectively intensive care units (7 ‰), Pediatrics (5.4 ‰), Medicine (2.7 ‰) and finally surgery (1.1 ‰). A catheter was present in 91% of patients with sepsis and 66% of infections with ESBL-producing Enterobacteriaceae were considered as nosocomial origin. Conclusion: This study shows the need for Hopital Principal of Dakar to prevent more effectively the spread of MRB (especially ESBL) through an extension of hand washing especially with the use of alcoholic solutions and a more rational use of antibiotics.