Transmission Dynamics of Antimicrobial Resistance at a National Referral Hospital in Uganda

Abstract

Reliable data on antimicrobial resistance (AMR) transmission dynamics in Uganda remains scarce; hence, we studied this area. Eighty-six index patients and “others” were recruited. Index patients were those who had been admitted to the orthopedic ward of Mulago National Referral Hospital during the study period; “others” included medical and non-medical caretakers of the index patients, and index patients’ immediate admitted hospital neighbors. Others were recruited only when index patients became positive for carrying antimicrobial-resistant bacteria (ARB) during their hospital stay. A total of 149 samples, including those from the inanimate environment, were analyzed microbiologically for ARB, and ARB were analyzed for their antimicrobial susceptibility profiles and mechanisms underlying observed resistances. We describe the diagnostic accuracy of the extended-spectrum β-lactamase (ESBL) production screening method, and AMR acquisition and transmission dynamics. Index patients were mostly carriers of ESBL-producing Enterobacteriaceae (PE) on admission, whereas non-ESBL-PE carriers on admission (61%) became carriers after 48 hours of admission (9%). The majority of ESBL-PE carriers on admission (56%) were referrals or transfers from other health-care facilities. Only 1 of 46 samples from the environment isolated an ESBL-PE. Marked resistance (>90%) to β-lactams and folate-pathway inhibitors were observed. The ESBL screening method’s sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 50%, 90%, and 100%, respectively. AMR acquisition and transmission occurs via human–human interfaces within and outside of health-care facilities compared with human–inanimate environment interfaces. However, this remains subject to further research.

Knowledge and perceptions of antimicrobial resistance and antimicrobial stewardship among staff at a national cancer referral center in Uganda

“…21 For example, in a recent study from Mulago National Referral Hospital in Kampala, resistant gram-negative bacteria primarily spread through direct contact between patients and healthcare providers or nonmedical caretakers. 22 It is also important to address environmental limitations that occur in low-resource settings (eg, lack of alcohol-based hand gel, inadequate handwashing facilities), which remain an ongoing challenge at UCI. The appropriate use of microbiologic diagnostics to guide therapeutic decisions, or diagnostic stewardship, is another important aspect of antimicrobial stewardship.…”

Unraveling virulence determinants in extended-spectrum beta-lactamase-producing Escherichia coli from East Africa using whole-genome sequencing

“…The study population constituted of whole-genome sequence data obtained from a total of 142 multi-drug resistant E. coli bacterial isolates provided by the mother study titled, “Understanding Transmission Dynamics and Acquisition of Antimicrobial Resistance at Referral Hospitals and Community Settings in East Africa using Conventional Microbiology and Whole-Genome Sequencing”. The multi-drug isolates were collected from both study sites in Uganda (n = 57) and Tanzania (n = 85) from patients, the immediate non-medical caretakers of these patients, the immediate health workers attending to these patients and the patients’ environment as previously discussed in detail by the recent publications from Uganda [ 1 ] and Tanzania [ 13 ].…”

“…The antimicrobial resistance (AMR) phenomenon has spread rapidly over the course of the past decades to establish itself as a major global public health threat [ 1 ] in spite of the strides made by modern medicine to apply the use of antibiotics to ensure safe surgical procedures and improve the quality of medical care that have greatly reduced morbidity and mortality in public health [ 2 , 3 ]. The bacterial infections that have been able to exhibit AMR have become fatal and given birth to a possible post-antibiotic era which initially was thought to be an apocalyptic fantasy before the 21st century [ 2 , 4 ].…”

Health workers’ perspectives on the occurrence and management of antimicrobial resistance at the human-animal-environment interface in Uganda

“…Such existence of AMR in the three components is usually via contact with wastewater, contaminated foods, and food animal residues among others even though country-level data are scanty in Uganda [15]. Despite the complexity of the AMR phenomena, links could be drawn from the practices of healthcare workers and community behavior towards the use of antimicrobials in the management of human and animal infections and diseases as well as in general agricultural production [17]. The role of human, animal and environmental health workers is essential in the management of infectious agents including AMR in low-resource settings [19].…”