High Levels of Antibiotic Resistance Patterns in Two Referral Hospitals during the Post-Ebola Era in Free-Town, Sierra Leone: 2017–2019

Abstract

The Post-Ebola era (2017–2019) presented an opportunity for laboratory investments in Sierra Leone. US CDC supported the Ministry of Health and Sanitation to establish a microbiological unit for routine antimicrobial sensitivity testing in two referral (pediatric and maternity) hospitals in Freetown. This study describes resistance patterns among patients’ laboratory samples from 2017 to 2019 using routine data. Samples included urine, stool, cerebrospinal fluid, pus-wound, pleural fluid, and high vaginal swabs. Selected Gram-positive and Gram-negative bacterial isolates were tested for antimicrobial susceptibility. Of 200 samples received by the laboratory, 89 returned positive bacterial isolates with urine and pus-wound swabs accounting for 75% of positive isolates. The number of positive isolates increased annually from one in 2017 to 42 in 2018 and 46 in 2019. Resistance of the cultures to at least one antibiotic was high (91%), and even higher in the pediatric hospital (94%). Resistance was highest with penicillin (81%) for Gram-positive bacteria and lowest with nitrofurantoin (13%). Gram-negative bacteria were most resistant to ampicillin, gentamycin, streptomycin, tetracycline, cephalothin and penicillin (100%) and least resistant to novobiocin (0%). Antibiotic resistance for commonly prescribed antibiotics was high in two referral hospitals, highlighting the urgent need for antimicrobial stewardship and access to reserve antibiotics.

Culture Requests and Multi-Drug Resistance among Suspected Urinary Tract Infections in Two Tertiary Hospitals in Freetown, Sierra Leone (2017–21): A Cross-Sectional Study

“…The rate of multidrug resistance among all the bacterial isolates was lower than that reported among non-E. coli Enterobacteriaceae in a small private facility in Sierra Leone [11], although similar to the 47% rate reported from a teaching hospital in Nigeria [24]. The prevalence of resistance to commonly used antibiotics such as ciprofloxacin (15%), nitrofurantoin (32%), and TMP-SMX (47%), although of concern, was lower than previously reported from the same two hospitals when they analysed AMR patterns from various different samples such as stool, urine, cerebrospinal fluid, pus wounds, pleural fluid, and high vaginal swabs [30]. The previous reports from Sierra Leone in other hospitals have shown high levels of resistance to TMP-SMX among uropathogens [12], a high prevalence of ESBL-producing uropathogens [11], and high levels of multidrug resistance [11], and our study adds to the evidence base.…”

A three years antimicrobials consumption in Ethiopia from 2017 to 2019: A cross- sectional study

“…These two drugs were not among the top five most commonly consumed antibiotics in Ethiopia. This might be due to limited access to extended spectrum penicillin’s, differences in diseases causing microbes as well as status of resistance in these countries [ 29 , 30 ]. Similar to other countries, the prevalence of AMR to these highly consumed antimicrobials is alarmingly increasing in Ethiopia particularly for gram-negative bacteria’s with a >50% pooled prevalence of resistance and may jeopardize the clinical decision and clinical outcomes [ 31 – 33 ].…”

Assessing Changes in Surgical Site Infections and Antibiotic Use among Caesarean Section and Herniorrhaphy Patients at a Regional Hospital in Sierra Leone Following Operational Research in 2021

“…However, there have been challenges in the supply chain for IPC commodities, with frequent stockouts of essential IPC materials. In addition, overuse of antibiotics in the context of IPC may lead to AMR in the hospital setting [ 15 ].…”