Abstract
BackgroundInfections with multi drug resistant (MDR) organisms are a major problem in intensive care units (ICUs). Proper infection control procedures are mandatory to combat the spread of resistant organisms within ICUs. Well stablished surveillance programmes will enhance the adherence of the staff to infection control protocols. The study was conducted to assess the feasibility of using basic molecular typing methods and routine hospital data for laboratory surveillance of resistance organisms in resource limited settings.MethodsA retrospective study was conducted using consecutive Gram negative isolates obtained from an ICU over a six month period. Antibiotic sensitivity patterns and random amplified polymorphic DNA (RAPD) based typing was performed on the given isolates.ResultsOf the seventy isolates included in the study, seven were E.coli. All E.coli were MDRs and Extended Spectrum β lactamse (ESBL) producers carrying blaCTX-M. Fourteen isolates were K.pneumoniae, and all were MDRs and ESBL producers. All K.pneumoniae harboured blaSHV while 13 harboured blaCTX-M. The MDR rate among P.aeruginosa was 13% (n=15) while all acinetobacters (n=30) were MDRs. Predominant clusters were identified within all four types of Gram negatives using RAPD and the ICU stay of patients overlapped temporally.ConclusionWe propose that simple surveillance methods like RAPD based typing and basic hospital data can be used to convince hospital staff to adhere to infection control protocols more effectively, in low and middle income countries.
Highlights
Infections with multi drug resistant (MDR) organisms are a major problem in intensive care units (ICUs)
Antibiotic resistance is a major concern in the Sri Lankan health care sector, in relation to Healthcare Associated Infections (HAI), with higher rates of cephalosporin resistance than community isolates [5]
This study was carried out in order to identify the feasibility of using random amplified polymorphic DNA (RAPD) and minimal clinical data for laboratory surveillance in resource limited settings. This laboratory based study was conducted on consecutive Gram negative isolates obtained from cultured respiratory tract specimens received from patients admitted to the ICU of Teaching Hospital Peradeniya (THP) from March to September 2015
Summary
Infections with multi drug resistant (MDR) organisms are a major problem in intensive care units (ICUs). Improper use of antibiotics, poor sanitation and shortfalls in infection control facilitate the amplification and dissemination of resistant strains in health care institutes and the community [1]. Increasing air travel, global mobility, health tourism, animal exports and international trade facilitate the spread of resistant organisms to countries worldwide [2]. The World Health Organization (WHO) in February 2017 published a list of priority organisms that needs new antibiotics urgently. These include carbapenem resistant Acinetobacter baumanii, carbapenem resistant Pseudomonas. Carbapenem resistance is known to be widespread among many institutions [6,7,8]
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