Molecular Epidemiology of Acinetobacter species associated with prolonged admissions in three specialist hospitals of Kano State Nigeria

Description

Introduction: Health care associated infection (HAIS) is a global problem. It is associated with increased cost, prolong hospital stay and could leads to patient‟s morbidity or mortality.This study was designed todetermine molecular epidemiology of hospital associated bacterial of infections with emphasis on Acinetobacterbaumannii, in three specialist hospitals in Kano State, Nigeria.Material and methods:A retrospective analysis of health records of 994 patients was done to determine the prolonged hospital stay from three hospitals which included patients 18 years and above admitted in Surgical, Medical, and Orthopedicand burn Care Centre Wards. Four hundred and one urine, wound swabs/ surgical site infection pus, catheter and nasogastric tube Samples were collectedand processed using standard microbiological methods. The isolated bacterial isolates were identified using phenotypic biochemical tests including analytical profile index (API 20 NE Biomeroux France). Suspected Acinetobacter spp were further confirmed using polymerase chain reaction (PCR) and Sanger sequencing methods. Antibiotics resistant pattern of bacterial isolates were determined using standarddisk diffusion method. All data obtained were analyzed using both Uni-variate, Bivariate and multivariate analysis and p value (0.05) were considered significant. Results:The prevalence of prolonged hospitals stay was 40.34% with MMSH having the highest prevalence (41.4%). Out of 401 samples collected 34.4% were found to have HCAIs. The prevalence of HCAIs according to age group showed that age groups 39-48years had the highest prevalence 76 (55.1%). Prevalence of HCAIs was found more among patients with wound from oethopedic /surgical ward 48(34.8%). Escherichia coli was the most prevalent 36(26.1%) bacteria while Acinetobacter species was found to have the least prevalence 14(10.1%). Antibiotics resistance pattern of bacterial isolates from three hospitals ranged from (0 - 100%) with Acinetobacter ssp having the highest resistance (100%) to Cotrimaxole. Significant (p = 0.05) potential risk factors that influence prolonged hospitals admission were lack of staffs,equipment in the laboratories, theater wards.Multivariate analysis of risk factors for occurrence of HCAIS were age 29-70, length of hospital stay (95% CI 0.27, 0.91 p = 0.02), wound/surgical site, urinary catherization. Molecular analysis using Sanger sequencing method revealed the presence 9 Acinetobacterbaumannii. Conclusion:HCAIsbacteria including Acinetobacter species significantly contributed to delayed hospital admissions through observed 100% resistance to used antibiotics. Recommendation: The healthcare managers of these hospitals and the ministry of health need to take measures against this resistant bacteria (especially Acinetobacter spp) especially on prescribing antibiotics that showed 100% resistant from these studied hospitals.