Evaluation of antibiotic susceptibility patterns of pathogens isolated from routine laboratory specimens at Ndola Teaching Hospital: A retrospective study

Autoři: Warren Chanda aff001;  Mespa Manyepa aff003;  Ephraim Chikwanda aff002;  Victor Daka aff003;  Justin Chileshe aff002;  Mathias Tembo aff002;  Joseph Kasongo aff004;  Allen Chipipa aff004;  Ray Handema aff002;  John A. Mulemena aff001
Působiště autorů: Mulungushi University, School of Medicine and Health Sciences, Livingstone, Zambia aff001;  Tropical Diseases Research Centre, Ndola, Zambia aff002;  Copperbelt University, School of Medicine, Ndola, Zambia aff003;  Department Pathology, Ndola Teaching Hospital, Ndola, Zambia aff004
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226676


Periodic monitoring of antibiotic susceptibility patterns in clinical settings is vital to ascertain the potency as well as re-establishing empirical therapy. This retrospective study aimed to evaluate the antibiotic susceptibility patterns of pathogens isolated from routine laboratory specimens at Ndola Teaching Hospital. A retrospective study was conducted on routine specimens received between May 2016 and July 2018. Specimens were cultured on standard media and Kirby-Bauer disc diffusion method was used for susceptibility testing in accordance with the Clinical and Laboratory Standard Institute’s recommendations. A total of 693 specimens were analyzed, of which 65.9% (457) specimens came from inpatient departments and 49.1% (340) came from female patients. The commonest specimens were urine (58.6%), blood (12.7%) and wound swabs (8.5%), and the most common microorganisms were coliform (29.3%), Staphylococcus aureus (15.4%), coagulase negative Staphylococci (CoNS, 13.4%), and Escherichia coli (13%). The highest percentage of resistance to any particular antibiotic was co-trimoxazole (91.7%, 33) followed by nalidixic acid (75.2%, 279), norfloxacin (69.0%, 100), ceftazidime (55.7%, 185), nitrofurantoin (46.6%, 191), chloramphenicol (43%, 111) and ciprofloxacin (8.6%, 271). Furthermore, patient location had resistance effect on coliform (p = 0.014), CoNS (p = 0.031), Streptococcus species (p = 0.024) and Klebsiella species (p = 0.004) to nitrofurantoin, ceftazidime, nitrofurantoin and chloramphenicol, respectively. Besides coliform, resistance of Enterobacter species to ceftazidime and Proteus species to nalidixic acid were more from female patients. Generally, the most effective antibiotics were chloramphenicol and nitrofurantoin with addition of ceftazidime on blood pathogens and ciprofloxacin on wound swab pathogens. The common isolates were coliform, S. aureus, coagulase negative Staphylococci and Escherichia coli. The resistance of most bacteria to ceftazidime and nitrofurantoin were influenced by both gender and location. Our study presents a broad overview of the resistance profiles of bacterial isolates. However, more nosocomial prevalence and antibiogram studies on individual routine specimens are required to provide a more detailed picture of resistance patterns.

Klíčová slova:

Antibiotic resistance – Antibiotics – Bacterial pathogens – Blood – Chloramphenicol – Inpatients – Nosocomial infections – Staphylococcus aureus


1. CDC. Antimicrobial Resistance 2015 [updated September 8, 2015. http://www.cdc.gov/drugresistance/about.html.

2. Thormar H. Antibacterial effects of lipids: historical review (1881 to 1960). Lipids and essential oils as antimicrobial agents: John Wiley & Sons, Ltd; 2011. p. 25–45.

3. Bell BG, Schellevis F, Stobberingh E, Goossens H, Pringle M. A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC infectious diseases. 2014;14:13. doi: 10.1186/1471-2334-14-13 24405683

4. Nolte O. Antimicrobial resistance in the 21st century: a multifaceted challenge. Protein and peptide letters. 2014;21(4):330–5. doi: 10.2174/09298665113206660106 24164264

5. Hollenbeck BL, Rice LB. Intrinsic and acquired resistance mechanisms in enterococcus. Virulence. 2012;3(5):421–569. doi: 10.4161/viru.21282 23076243

6. Martínez JL. Natural antibiotic resistance and contamination by antibiotic resistance determinants: the two ages in the evolution of resistance to antimicrobials. Frontiers in microbiology. 2012;3:1-. doi: 10.3389/fmicb.2012.00001 22275914

7. van Hoek AHAM, Mevius D, Guerra B, Mullany P, Roberts AP, Aarts HJM. Acquired antibiotic resistance genes: an overview. Frontiers in microbiology. 2011;2:203-. doi: 10.3389/fmicb.2011.00203 22046172

8. Chamoun K, Farah M, Araj G, Daoud Z, Moghnieh R, Salameh P, et al. Surveillance of antimicrobial resistance in Lebanese hospitals: retrospective nationwide compiled data. International journal of infectious diseases. 2016;46:64–70. doi: 10.1016/j.ijid.2016.03.010 26996458

9. Kouchak F, Askarian M. Nosocomial infections: the definition criteria. Iranian journal of medical sciences. 2012;37(2):72–3. 23115435

10. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care 2013; associated infection and criteria for specific types of infections in the acute care setting. American journal of infection control. 2008;36(5):309–32. doi: 10.1016/j.ajic.2008.03.002 18538699

11. Weinstein RA. Nosocomial infection update. Emerging infectious diseases 1998;4(3):416–20. 9716961

12. Galvin S, Dolan A, Cahill O, Daniels S, Humphreys H. Microbial monitoring of the hospital environment: why and how? J Hosp Infect. 2012;82(3):143–51. doi: 10.1016/j.jhin.2012.06.015 23022372

13. Huang SS, Datta R, Platt R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Archives of internal medicine. 2006;166(18):1945–51. doi: 10.1001/archinte.166.18.1945 17030826

14. Nseir S, Blazejewski C, Lubret R, Wallet F, Courcol R, Durocher A. Risk of acquiring multidrug-resistant Gram-negative bacilli from prior room occupants in the intensive care unit. Clinical microbiology and infection. 2011;17(8):1201–8. doi: 10.1111/j.1469-0691.2010.03420.x 21054665

15. Hui C, Lin M-C, Jao M-S, Liu T-C, Wu R-G. Previous antibiotic exposure and evolution of antibiotic resistance in mechanically ventilated patients with nosocomial infections. Journal of critical care. 2013;28(5):728–34. doi: 10.1016/j.jcrc.2013.04.008 23731818

16. Zhang L, Kinkelaar D, Huang Y, Li Y, Li X, Wang HH. Acquired antibiotic resistance: Are we born with it? Applied and environmental microbiology. 2011;77(20):7134. doi: 10.1128/AEM.05087-11 21821748

17. Zhang L, Huang Y, Zhou Y, Buckley T, Wang HH. Antibiotic administration routes significantly influence the levels of antibiotic resistance in gut microbiota. Antimicrobial agents and chemotherapy. 2013;57(8):3659. doi: 10.1128/AAC.00670-13 23689712

18. Rohr U, Kaminski A, Wilhelm M, Jurzik L, Gatermann S, Muhr G. Colonization of patients and contamination of the patients’ environment by MRSA under conditions of single-room isolation. International journal of hygiene and environmental health. 2009;212(2):209–15. doi: 10.1016/j.ijheh.2008.05.003 18667356

19. Cassir N, Rolain J-M, Brouqui P. A new strategy to fight antimicrobial resistance: the revival of old antibiotics. Frontiers in microbiology. 2014;5:551. doi: 10.3389/fmicb.2014.00551 25368610

20. Hirsch EB, Tam VH. Impact of multidrug-resistant Pseudomonas aeruginosa infection on patient outcomes. Expert review of pharmacoeconomics & outcomes research. 2010;10(4):441–51.

21. CLSI. Performance Standards for antimicrobial susceptibility testing. 26 ed. Wayne PA: Clinical and laboratory standards institute; 2016. 252 p.

22. Magliano E, Grazioli V, Deflorio L, Leuci AI, Mattina R, Romano P, et al. Gender and age-dependent etiology of community-acquired urinary tract infections. The scientific world journal. 2012;2012:349597-.

23. Pondei K, Fente BG, Oladapo O. Current microbial isolates from wound swabs, their culture and sensitivity pattern at the niger delta university teaching hospital, okolobiri, Nigeria. Trop Med Health. 2013;41(2):49–53. doi: 10.2149/tmh.2012-14 23874138

24. Azene MK, Beyene BA. Bacteriology and antibiogram of pathogens from wound infections at Dessie laboratory, North-east Ethiopia. Tanzania journal of health research. 2011;13(4):68–74. doi: 10.4314/thrb.v13i4.64901 26592050

25. Hart CA, Kariuki S. Antimicrobial resistance in developing countries. BMJ (Clinical research ed). 1998;317(7159):647–50.

26. Beyene G, Tsegaye W. Bacterial uropathogens in urinary tract infection and antibiotic susceptibility pattern in jimma university specialized hospital, southwest ethiopia. Ethiop J Health Sci. 2011;21(2):141–6. doi: 10.4314/ejhs.v21i2.69055 22434993

27. Hameed T, Al Nafeesah A, Chishti S, Al Shaalan M, Al Fakeeh K. Community-acquired urinary tract infections in children: resistance patterns of uropathogens in a tertiary care center in Saudi Arabia. International journal of pediatrics and adolescent medicine. 2019;6(2):51–4. doi: 10.1016/j.ijpam.2019.02.010 31388546

28. Shill MC, Huda NH, Moain FB, Karmakar UK. Prevalence of uropathogens in diabetic patients and their corresponding resistance pattern: results of a survey conducted at diagnostic centers in Dhaka, Bangladesh. Oman Med J. 2010;25(4):282–5. doi: 10.5001/omj.2010.82 22043358

29. Anyadoh-Nwadike Sylvia O., Okorondu Sylvester I., Obiajuru Ifeanyi O.C., Nwadike Peter O., Nwaokorie F.O, Akerele JO. Comparative study of the prevalence and antibiogram of bacterial isolates from the urinary and genital tracts of antenatal patients 2015; 10(1):[15–9 pp.]. Available from: https://pdfs.semanticscholar.org/f96e/27302b602d1d11258f2624495524a7e6e226.pdf.

30. Olorunmola FO, Kolawole DO, Lamikanra A. Antibiotic resistance and virulence properties in Escherichia coli strains from cases of urinary tract infections. African journal of infectious diseases. 2013;7(1):1–7. doi: 10.4314/ajid.v7i1.1 24381720

31. Nicolle LE, Yoshikawa TT. Urinary tract infection in long-term-care facility residents. Clinical infectious diseases. 2000;31(3):757–61. doi: 10.1086/313996 11017826

32. Genao L, Buhr GT. Urinary tract infections in older adults residing in long-term care facilities. The Ann Long-term Care. 2012;20(4):33–8.

33. Cheung Anne, Karmali Gulzar, Noble Sandina, Song H. Antimicrobial stewardship initiative in treatment of urinary tract infections at a rehabilitation and complex continuing care hospital 2017 23 November 2018; 70(2):[144–9 pp.]. Available from: www.cjhp-online.ca/index.php/cjhp/article/download/1648/2527.

34. Ghadiri H, Vaez H, Khosravi S, Soleymani E. The antibiotic resistance profiles of bacterial strains isolated from patients with hospital-acquired bloodstream and urinary tract infections. Critical care research and practice. 2012;2012:890797-.

35. Boucher HW, et al. Bad bugs, no drugs: no ESKAPE! an update from the infectious diseases society of America. Clin Infect Dis. 2009;48:1–12. doi: 10.1086/595011 19035777

36. McGregor JC, Elman MR, Bearden DT, Smith DH. Sex- and age-specific trends in antibiotic resistance patterns of Escherichia coli urinary isolates from outpatients. BMC family practice. 2013;14:25-. doi: 10.1186/1471-2296-14-25 23433241

37. Honkinen M, Lahti E, Österback R, Ruuskanen O, Waris M. Viruses and bacteria in sputum samples of children with community-acquired pneumonia. Clinical microbiology and infection. 2012;18(3):300–7. doi: 10.1111/j.1469-0691.2011.03603.x 21851481

38. Amin Omar M. Prevalence of infections with pathogenic bacteria in fecal specimens of patients with GI symptoms but without intestinal parasites.2011; 20(2). Available from: https://www.researchgate.net/publication/268223308_Prevalence_of_infections_with_pathogenic_bacteria_in_fecal_specimens_of_patients_with_GI_symptoms_but_without_intestinal_parasites.

39. Kim WJ, Kim B-G, Chang K-H, Oh J-H. Detection of bacteria in middle ear effusions based on the presence of allergy: does allergy augment bacterial infection in the middle ear? Journal of otolaryngology—head & neck surgery. 2015;44(1):58.

40. Lu J-J, Perng C-L, Lee S-Y, Wan C-C. Use of PCR with universal primers and restriction endonuclease digestions for detection and identification of common bacterial pathogens in cerebrospinal fluid. Journal of clinical microbiology. 2000;38(6):2076. 10834956

41. Drinka P, Bonham P, Crnich CJ. Swab culture of purulent skin infection todetect infection or colonization with antibiotic-resistant bacteria. Journal of the American medical directors association. 2012;13(1):75–9. doi: 10.1016/j.jamda.2011.04.012 21621476

42. Mulu W, Abera B, Yimer M, Hailu T, Ayele H, Abate D. Bacterial agents and antibiotic resistance profiles of infections from different sites that occurred among patients at Debre Markos referral hospital, Ethiopia: a cross-sectional study. BMC Research Notes. 2017;10(1):254. doi: 10.1186/s13104-017-2584-y 28683780

43. Brook I. Microbiology of sinusitis. Proceedings of the American thoracic society. 2011;8(1):90–100. doi: 10.1513/pats.201006-038RN 21364226

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