Antimicrobial resistance profile of common bacterial pathogens and impact on patient treatment outcomes at Kigali University Teaching Hospital (KUTH)

Abstract

Introduction: Antimicrobial drug resistance (AMR) is not a new problem but remains a serious health issue. Antimicrobial resistance represents an opportunity to develop and test new antibiotics, however in developing countries, the limited availability and affordability of antimicrobial agents remains a significant barrier. We conducted a prospective observational study to assess the prevalence of AMR among common disease causing pathogens in KUTH and to assess the treatment outcomes of patients with MDR infections. Methods: This prospective observational study evaluated culture and sensitivity results of positive bacterial cultures obtained from urine, blood, sputum and wound swabs in 141 hospitalized patients admitted to the internal medicine wards at KUTH. Sample collection, processing and antibiotic susceptibility testing was performed according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: 54.2 % of the 155 positive culture results at KUTH were cultured from urine specimens Blood specimens made up 25.4% followed by wound swabs with 15.5% and lastly sputum specimens at 5.1%. In UTIs, E.coli were the most prevalent bacteria cultured at 58.75 %. MDR E.coli were noted in UTIs: Ciprofloxacin (64.3 %), norfloxacin (38.6 %), amoxicillin/CA (88 %), cotrimoxazole (78 %) and ampicillin (90 %). In bacteremia, Klebsiella spp.were resistant to almost all tested antibiotics, including 3rd generation cephalosporins: cefotaxime (90%), ceftriaxone (80 %). Klebsiella spp. were significantly isolated across all types of clinical specimens but were more frequently identified in blood specimens (28.2%). After Klebsiella spp, S.aureus was the second most frequently cultured organism in blood cultures (23%). In general, S.aureus was highly resistant to the penicillin class of antibiotics. ESBL E.coli and ESBL Klebsiella spp. were evaluated at 35.1% and 56.3 % respectively. MRSA was screen in 45.5 of cases. Imipenem, vancomycin and amikacin have shown to be susceptible to all isolates. The mortality rate in our study was evaluated at 19.15% and the septic shock was identified to be associated with it with a p value < 0.0001. Conclusions and recommendations: Antimicrobial resistance is a serious and alarming problem in KUTH. A surveillance system should be setup to monitor antibiotic prescription patterns and to inform guidelines and indications for antibiotic use.