Knowledge, attitudes and practices about nosocomial infections and antibiotic susceptibility among Staphylococcus aureus isolated from surfaces in Nakasongola Military Hospital

Abstract

Antibiotic resistance in nosocomial infection (NI) management is a major problem globally. The aim of this study was to assess the knowledge, attitudes, practices about nosocomial infections, antibiotic resistance and to determine the prevalence of tetM gene for tetracycline resistance in Staphylococcus aureus isolated from Nakasongola Military Hospital (NMH). A cross-sectional study design was employed and this involved two sub studies. The first one was the mixed field survey sub-study which was both qualitative and quantitative. It assessed the knowledge, attitudes and practices of Nakasongola Military Hospital health workers and patients about nosocomial infections prevention and control, their association with antimicrobial resistance (AMR) as well as antibiotic use. Structured questionnaires were used to collect general information from health workers (n꞊96) and patients (n꞊301), followed by key informant interviews to collect qualitative information from expert health workers (n꞊16) and observations to collect data basing on activities done at the hospital for 15 days. The second one was a laboratory-based sub-study which determined antibacterial resistance profiles on Staphylococcus aureus isolates from contact surfaces. Antibacterial resistance profiles against 13 antibiotics were performed using the Kirby-Bauer method. Genotypic studies were performed using conventional Polymerase Chain Reaction (PCR) to determine the presence of tetM gene among tetracycline resistant Staphylococcus aureus. Findings from the survey revealed that health workers generally had high (96.9%) knowledge, favorable (96.9%) attitudes and good (93.8%) practices whereas a few patients had high (7%) knowledge, favorable (24.9%) attitudes and good (19.6%) practices regarding NIs, AMR and antibiotic use. Observations revealed absence of regulations for visitors and lack of proper hygiene practices by visitors. Amoxicillin and Trimethoprim/ sulfamethazole were the most commonly (100%) prescribed antibiotics. Ampicillin, imipenem (2.8%), cefixime (11.3%) and ciprofloxacin (14.1%) showed the lowest bacterial resistance. Staphylococcus aureus showed high resistance against amoxycillin (85.9%), Trimethoprim/sulfamethazole (71.8%) and tetracycline (70.4%). About 78% of the hospital surfaces were contaminated by Staphylococcus aureus, 50/71 isolates exhibiting resistance against tetracycline; only (10%) harbored the tetM gene of resistance. The study recommends that NMH should emphasize sensitization of people about NIs and AMR. Cefixime and ciprofloxacin may be used as the best choice for empirical treatment at NMH. Further studies should be carried out to establish other markers for tetracycline resistance in Staphylococcus aureus.