Conference abstract

Anti-bacterial resistance patterns and trends among septicaemic patients in Kampala, Uganda, 2010-2015

Pan African Medical Journal - Conference Proceedings. 2017:6(7).20 Dec 2017.
doi: 10.11604/pamj-cp.2017.6.7.489

Contact the corresponding author
Keywords: Septicaemia, bacterial, resistance, patients, Uganda
Plenary

Anti-bacterial resistance patterns and trends among septicaemic patients in Kampala, Uganda, 2010-2015

Christine Kihembo1,2,&, Alex Riolexus Ario2, Lydia Nakiire2,3, Issa Makumbi3, Monica Musenero1, Frank Kaharuza4, Florence Najjuka5, Henry Kajumbula5

1Epidemiology and Surveillance Division, Ministry of Health, Kampala, Uganda, 2Uganda Public Health Fellowship Program, Field Epidemiology Track, Kampala, Uganda, 3Public Health Emergency Operations Centre, Ministry of Health, Kampala, Uganda, 4Makerere University School of Public Health, Kampala, Uganda, 5Makerere University Medical Microbiology Laboratory, Kampala, Uganda

&Corresponding author
Christine Kihembo, Epidemiology and Surveillance Division, Ministry of Health, Uganda Public Health Fellowship Program, Kampala, Uganda

Abstract

Introduction: bacterial infections cause 20% of hospital deaths and 25% of under-five mortality in Uganda. We analyzed laboratory data on Antibiotic Resistance (ABR) patterns in Kampala, Uganda, to inform interventions to reduce ABR.

Methods: we abstracted culture and sensitivity data from 10 laboratory registers for all blood specimens cultured from 2010 - 2015 using a standardized data abstraction form. We defined high ABR as ≥ 50% of species resistant to a drug in a year; moderate ABR as 10-49% resistant; low as < 10% resistant. Multi-drug resistant (MDR) Salmonella species were those resistant to first line drugs, Cotrimaxazole (CTX), Chloramphenicol (CAF) and Ampicillin (AMP). Methicillin-Resistant Staphylococcus aureus (MRSA) was Staphylococcal species resistant to Oxacillin or Cefoxitin.

Results: among gram-positive species, Staphylococcus accounted for 86% (1541/1794) of the infections; under-five (incidence = 218/100,000) and elderly (incidence = 125/100,000) age-groups were most affected. Of gram-negative species, Salmonella accounted for 21% (251/1193) of the infections; the age-specific incidence (/100,000) ranged from 7 (young adults age-group) to 17 (under-fives). Non-specified coliforms were identified in 28% of the isolates. 11% of the Staphylococcal species had moderate ABR and 89% had high ABR to commonly used antibiotics (CAF, CTX, Erythromycin, Tetracycline). Over the sixth year study period, MRSA increased from 44% to 81% (p = 0.03, Chi-square for trends); among Salmonella species, ABR to first line antibiotics reduced from high to moderate levels; MDR Salmonella ranged from 0-20%; intermediate resistance levels to Ciprofloxacin increased from 2% to 39% (p < 0.001, Chi-square for trends) and intermediate resistance to Ceftriaxone increased from 2% to 20% (p = 0.01, Chi-square for trends).

Conclusion: Salmonella and Staphylococcus were the most common causes of septicaemia. MRSA was at a high level, with rapidly increasing ABR to Ciprofloxacin and Ceftriaxone. Susceptibility to first-line antibiotics among Salmonella species gradually returned. We recommend adherence to ABR testing standards and rational use of antibiotics guided by ABR patterns to prevent ABR.