Genotypic diversity among multidrug resistant Pseudomonas aeruginosa and Acinetobacter species at Mulago Hospital in Kampala, Uganda

Abstract

BackgroundMultidrug resistant Pseudomonas aeruginosa and Acinetobacter species are common causes of nosocomial infections worldwide. Recently we reported the occurrence of carbapenem resistant Enterobacteriaceae, P. aeruginosa and Acinetobacter species at Mulago National Referral Hospital in Kampala, Uganda, but the isolates were not analyzed for genetic relatedness. Herein we report the intra-species genotypic diversity among P. aeruginosa and Acinetobacter baumannii isolated from hospitalized patients and the environment at Mulago Hospital, using repetitive elements-based PCR (Rep-PCR) genotyping.ResultsA total of 736 specimens from hospitalized patients were processed for culture and sensitivity testing yielding 9 (1.2%) P. aeruginosa and 7 (0.95%) A. baumannii. Similarly, 100 samples from the hospital environment were processed yielding 33 (33%) P. aeruginosa and 13 (13%) A. baumannii. Altogether, 62 non-repetitive isolates were studied (42 P. aeruginosa and 20 A. baumannii), of which 38% (16/42) P. aeruginosa and 40% (8/20) A. baumannii were multidrug resistant (isolates resistant to three or more classes of antimicrobials). Carbapenem resistance prevalence was 33 and 21% for P. aeruginosa from patients and the environment, respectively, while it was 14 and 86% for A. baumannii from patients and environment, respectively. Cluster analysis of the Rep-PCR fingerprints revealed a high level of genetic diversity among the isolates within each species as few isolates were clustered (at 100% level of similarity). More to this, the clustered isolates revealed a complex nature of multidrug resistant P. aeruginosa and A. baumannii clones circulating at Mulago Hospital. Importantly, certain isolates from the environment and patients were clustered, implying that hospitalized patients at Mulago were probably infected with strains from the environment.ConclusionsThe prevalence of multidrug resistant P. aeruginosa and A. baumannii is high at Mulago Hospital but carbapenem resistance prevalence remains relatively low in isolates from hospitalized patients. Importantly, the prevalence of carbapenem resistance in isolates from the environment is high implying the infection control practices at the hospital might be inadequate.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-017-2612-y) contains supplementary material, which is available to authorized users.

Multi-drug resistance of blood stream, urinary tract and surgical site nosocomial infections of Acinetobacter baumannii and Pseudomonas aeruginosa among patients hospitalized at Felegehiwot referral hospital, Northwest Ethiopia: a cross-sectional study

“…High patient load, overcrowding, poor infrastructure, poor infection control practices of the hospital and differences in trained medical staff for aseptic procedures might be the possible explanations. This finding was coherent with reports in Tikur Anbessa Hospital, Ethiopia (8.12%) [25], Uganda (7.39%) [26], Italy (9.3%) [27] and Gaza city (6.9%) [28]. However, it was higher compared to reports from Hiwot Fana Hospital, Ethiopia (0.5%) [8], Gabon (5.7%) [29], China (0.78%) [30] and Indonesia (3.5%) [31].…”

“…The proportion of nosocomial MDR A. baumannii infection (3.8%) in the present study was in agreement with earlier studies conducted in Africa (2.4-5.7%) [26,29,32]. However, it was lower compared with findings from Sodo (15.3%), Ethiopia [18] and Gaza city (6.9%) [28].…”

“…In contrast, it was higher than findings from previous studies in elsewhere (0.42-0.95%) [27,30]. Similarly, the magnitude of nosocomial MDR P. aeruginosa infection (4.6%) in the present study was comparable with a study in Uganda (5%) [26]. However, it was lower than findings from other parts of Ethiopia (11.1-66.7%) [8,18,25], Ghana (19.5%) [32], India (76.8%) [39] and Italy (8.7%) [27].…”

“…The relatively lower proportion resistance against meropenem in the present study might be linked with the nonexistence of meropenem prescription practice in the study hospital. In contrast, lower level of resistance against meropenem was reported in Uganda (14%) [26] and Turkey (20.4%) [40]. This could be due to variation in the availability of meropenem in each localities, prescription difference, misuse and inappropriate use of antibiotics.…”

A systematic review: the current status of carbapenem resistance in East Africa

“…E. coli, Enterobacter spp, Serratia marcescens, Proteus mirabilis, Citrobacter freundii, Klebsiella oxytoca and Pantoea agglomerans Jan 2013–Mar 2014PCR. Disk diffusion and Modified Hodge test[30]Uganda6586810.3VIM and OXA-48 E. coli, K. pneumoniae, Proteus mirabilis, Salmonella spp, Morganella morganii, Enterobacter sakazaki and Stenotrophomonas sppSept 2013–Jun 2014PCR and disk diffusion[31]Uganda869 (clinical)101.2 (10/869)24 (10/42)IMP-like, VIM-like, SPM-like and NDM-1-like P. aeruginosa (42/658 = 5%)Feb 2007–Sep 2009PCRPhoenix AutomatedMicrobiology System[32]91.1 (9/869)31 (9/29)OXA-23,24, 58 like and VIM-like A. baumannii (29/658 = 3%)80 (environmental)1518.8 (15/80)33 (15/46)IMP-like, VIM-like, SPM-like and NDM-1-like P. aeruginosa 57.5% (46/80)67.5 (6/80)55 (6/11)OXA-23,24, 58 like and VIM-like A. baumannii 14% (11/80)Uganda736 (clinical)30.41 (3/736)33 (3/9)– P. aeruginosa (9/736 = 1.2%)Sept 2012–Oct 2013Rep-PCR and disk diffusion[33]10.14 (1/736)14 (1/7)– A. baumannii (7/736 = 0.95%)100 (environmental)77 (7/100)21 (7/33)– P. aeruginosa (33/100 = 33%)66 (6/100)46 (6/13)– A. baumannii (13/100 = 13%)Tanzania9088.9…”