Extended spectrum beta lactamase gram negative bacteria contamination of inanimate objects in Paediatric wards at Mulago National Referral Hospital in Uganda

Abstract

Background: Antimicrobial resistance (AMR) is a global crisis that endangers the efficacy of antibiotics and also the treatment provided. Extended Spectrum Beta Lactamase (ESBL) resistance among beta lactams especially third generation cephalosporins is one of the most common among enterobacteriaceae worldwide and its upward trend is of increasing clinical concern. Infections with these ESBL producing organisms continue to be associated with higher rates of mortality, morbidity, and healthcare costs. These multidrug resistant bacteria are often found on inanimate objects and cross contamination leads to Hospital Care Associated Infections (HCAIs) which are believed to be transmitted by touching contaminated environmental surfaces that are often a source of infections to these paediatrics. This study was intended to find out the extent of colonization of ESBLs and their associated genes among the different enterobacteriaceae that colonize inanimate objects in paediatric wards at Mulago hospital. Methods: A cross sectional study looking at ESBL contamination on inanimate objects in paediatric wards at Mulago hospital was conducted after ethical approval from College of Health Sciences and Mulago hospital. Inanimate objects were aseptically swabbed and samples taken to MBN laboratories for analysis. These were cultured and organisms identified were tested for susceptibility to antibiotics using the disk diffusion method to identify possible ESBL producing organisms. Results were analysed using ms excel, SPSSIBM Statistics v.20 to determine the descriptive statics as well as the diagnostic accuracy measurements and then summarised in graphs and tables. Results: From the 150 swab samples, we isolated a total of 93 gram negative bacterial organisms. The first six most resistant drugs were Amoxixillin Clavulanic acid with the highest level of resistance followed by Piperacillin tazobactum, ceftriaxone, cefotaxime, ceftazidime and then Ampicilin. Citrobacter species 9 (9.6%), Acinetobacter species 34 (36.5%), Enterobacter species 9 (9.6%) Escherichia coli 20 (21.5%), Klebshiella species 7 (7%), Yersinia species 3.3% (3/91), Bordetella species 3 (3.2%), Pseudomonas species 2 (2.2%), Alcaligens species 1 (1.1%) and Moraxella species 5 (5%). Conclusion: The prevalence of ESBL in our study is high 11.6%, with the commonest ESBL isolate being Enterobacter species. Isolates are resistant to ampicilin and chloramphenicol are highly susceptible to imipenem.