Antibiogram Development in the Setting of a High Frequency of Multi-Drug Resistant Organisms at University Teaching Hospital, Lusaka, Zambia

Abstract

Antimicrobial resistance is a global challenge requiring reliable surveillance data collection and use. Prior studies on resistance in Zambia depended on laboratory methods with limited standardization. Since 2015, the University Teaching Hospital (UTH) microbiology laboratory has used the Vitek 2 Compact (bioMerieux, Inc., Marcy-l’Étoile, France) for standardized identification and susceptibility testing. We conducted a cross-sectional study of 2019 bacterial isolates collected from July 2015 to April 2017 to identify bacterial causes of infections, their susceptibility to commonly used antibiotics at UTH, and develop hospital antibiograms with a multidisciplinary team using World Health Organization guidance. We found high levels of antibiotic resistance among Gram negative bacteria. Escherichia coli and Klebsiella pneumoniae were highly resistant to all antibiotics except amikacin and carbapenems. E. coli had susceptibilities of 42.4% to amoxicillin/clavulanic acid, 41.4% to ceftriaxone, 40.2% to ciprofloxacin, and 10.4% to trimethoprim/sulfamethoxazole (TMP/SMX). K. pneumoniae had susceptibilities of 20.7% to amoxicillin/clavulanic acid, 15.6% to ceftriaxone, 48.5% to ciprofloxacin, and 12.3% to TMP/SMX. The high resistance to 3rd generation cephalosporins indicates high rates of beta-lactamase production. This is information that clinicians need to inform clinical decision making and choice of empiric antibiotics and that UTH requires to inform antimicrobial stewardship such as improvements in antibiotic use.

Phenotypic and genotypic antibiotic susceptibility profiles of Gram-negative bacteria isolated from bloodstream infections at a referral hospital, Lusaka, Zambia

“…The high resistance to 3GCs (75%) observed in this study confirmed an increase from what was previously observed at the same hospital in 2015 to 207 [40]. This finding confirms the growing problem of 3GC resistance in our hospital, thereby emphasizing the need for improved rapid laboratory diagnostic capacity and AMR screening with decent turn-around time, continuous hospital-based surveillance and yearly antibiogram revision.…”

“…Prematurity and malnutrition are other factors associated with high BSI prevalence in this age group and are common in low-resource countries [17,38]. The high prevalence of E. coli and Klebsiella pneumoniae observed in this study is comparable to findings in a previous Zambian study at the same hospital [40] and other studies done in, Tanzania, Ethiopia, South Africa and Botswana [41][42][43]. Only one MDR Acinetobacter baumannii was associated with HAI in a burns patient.…”

Enhancing the empiric antibiotic selection by introducing an antibiogram toolkit in a tertiary care hospital in Southern India – A prospective study

“…In our study, four-gram-negative organisms and one-gram-positive organisms were included. Among that, E. coli was highly resistant to most drugs except for Imipenem, Amikacin and Cotrimoxazole which was in line with the study conducted by Brenna M Roth et al3 In a study conducted by Litegebew Yitayeh et al15 in…”

“…Antibiogram is a valuable clinical tool that antimicrobial stewardship entities may utilize to design empiric treatment pathways. 3 It provides a detailed overview of a microorganism's antimicrobial susceptibility testing results against a variety of antimicrobial medications. 4 It can also improve hospital antibiotic formulary decisions and local protocols such as surgical prophylaxis or empirical treatment guidelines.…”

“…One of the major strategies to alleviate antimicrobial resistance is the early detection and response at the local and regional levels. Antibiogram is a valuable clinical tool that antimicrobial stewardship entities may utilize to design empiric treatment pathways 3 . It provides a detailed overview of a microorganism's antimicrobial susceptibility testing results against a variety of antimicrobial medications 4 .…”