Surfaces in the neonatal unit of a Nigerian tertiary hospital harbor antibiotic-resistant organisms: Implications for infection prevention and control

Abstract

Background: Babies hospitalized in neonatal units have high rates of antibiotic use and are exposed to contaminated healthcare environment/equipment leading to increased risks of antibiotic resistance. This study assessed bacterial contamination and antibiotic resistance patterns of isolates from surfaces and equipment in the Neonatal Special Care Unit (NSCU) of a large tertiary hospital in Nigeria Methods and materials: Samples were collected from the equipment and inanimate surfaces in the in-born and out-born sections of the NSCU of Alex Ekwueme Federal University Teaching Hospital Abakaliki, Ebonyi State, Nigeria. Samples were cultured in blood and chocolate agar and incubated at 37 °C for 18–24 h. Isolates were identified using morphology and standard biochemical tests. Microsoft Excel was used for data entry and analysis Results: A total of 31 and 35 items were sampled in the in-born and out-born NSCU sections respectively. The commonest equipment/surfaces sampled were incubators, resuscitaires, baby cots, phototherapy machines, air conditioner vents, and stethoscope diaphragms. In both sections, the bacterial contaminants were Bacillus species, Staphylococcus aureus, Methicillin-Resistant Staphylococcus Aureus (MRSA), coagulase-negative staphylococcus (CoNS) and Entamoeba coli. In the in-born section, Streptococcus species was identified while Klebsiella species and Pseudomonas species were only cultured from the out-born section. Lockers (9.7%), sinks (8.6%), and stethoscope diaphragms (5.4%) were the most contaminated in both sections. In the in-born subdivision, all organisms were resistant to ceftazidime, ceftriaxone, and cefuroxime except streptococcus species. All organisms were resistant to oxacillin except S.aureus and Streptococcus species. Each organism was resistant to Cloxacillin except CoNS. There was resistance to vancomycin, erythromycin, mupirocin and ofloxacin, gentamicin by S.aureus. In the out-born section, all organisms were resistant to ceftriaxone. Only S.aureus was sensitive to ceftazidime, cefuroxime, oxacillin, and augmentin. Bacillus species, E.coli, Klebsiella and Pseudomonas species were resistant to vancomycin, ofloxacin, and erythromycin while S.aureus and Bacillus species were both resistant to gentamicin and cloxacillin Conclusion: Commonly used fomites in this study harbored a variety of bacterial organisms resistant to different classes of frequently used antibiotics. We recommend intensified infection prevention and control practices, surveillance for antibiotic-resistant pathogens and training of health workers on judicious use of antibiotics