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Predominance of Multidrug-Resistant Gram-Negative Bacteria on Contaminated Surfaces at a Tertiary Hospital in Tanzania: A Call to Strengthening Environmental Infection Prevention and Control Measures

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Abstract

The spreading of multidrug resistance (MDR) strains in the hospital settings via contaminated surfaces have been increasingly reported where Gram-negative bacteria have been implicated in causing most nosocomial infections. This study aimed to determine the rate of contamination with multi-resistant gram-negative bacteria in the hospital environment. A cross-sectional study was conducted at Muhimbili National Hospital paediatric department, between July and August 2020. Non-repetitive surface swab samples were collected from predefined surfaces and medical device surfaces, and cultured on MacConkey agar with and without antibiotics. Isolates were identified using biochemical test and tested for antibiotic susceptibility using the Kirby-Bauer disk diffusion method. The rate of hospital contamination with Gram-negative bacteria across the Pediatrics units was 30%, with a high rate observed in oncology units (34.8%) and the malnutrition/diarrhoea ward (32.1%). Sink/washing basin had the highest frequency of bacterial contamination (74.2%). We observed a high rate of ESBL (32.5%), with Acinetobacter baumannii, Klebsiella pneumoniae, and E. coli being the predominant ESBL-producing Gram-negative bacteria, while carbapenemase-producing Gram-negative bacteria was detected at 22.8%. Highest resistance rates (63–100%) were observed against ceftriaxone and trimethoprim-sulfamethoxazole. Up to 51% of the Gram-negative bacteria showed resistant to meropenem. MDR strains were detected in 61.4% of Gram-negative bacteria isolated. In conclusion, we observed a high rate of MDR bacteria contaminating hospital surfaces. The higher rate of MDR calls for a need to strengthen infectious prevention control measures, including cleaning practices in the hospital environment, to reduce the risk of transmission of resistant strains to patients and healthcare workers.

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Data Availability

All data generated or analysed during this study are included in this published article.

Code Availability

Not applicable.

Abbreviations

ATCC:

American Type Culture Collection

AMZ:

Aztreonam

CLSI:

Clinical and Laboratory Standards Institute

CN:

Gentamicin

CRO:

Ceftriaxone

CIP:

Ciprofloxacin

CI:

Confidence interval

ESBL:

Extended-spectrum beta-lactamase

IPC:

Infectious prevention and control

MEM:

Meropenem

mCIM:

Modified Carbapenem Inactivation Method

MNH:

Muhimbili National Hospital

MUHAS:

Muhimbili University of Health and Allied Sciences

MDR:

Multidrug resistance

NA:

Not applicable

PICU:

Intensive care unit

PRT:

Piperacillin-tazobactam

R3–R6:

Resistant to 3, 4, 5, or 6 classes of antimicrobials

SPSS:

Statistical Packages for Social Sciences

SXT:

Trimethoprim-sulfamethoxazole

WHO:

World Health Organization

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Acknowledgements

We would like to thank the staff at the bacteriology research laboratory at MUHAS, especially Mr. Lushona Mathias, for the technical assistance towards this work. We would also like to thank MUHAS and MNH management for allowing us to conduct this study.

Funding

This research did not receive any funding; the research was funded by authors.

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Authors and Affiliations

  1. School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. 65001, Dar Es Salaam, Tanzania

    Agricola Joachim, Joel Manyahi, Habiba Issa, Jackline Lwoga, Frank Msafiri & Mtebe Majigo

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  1. Agricola Joachim
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  2. Joel Manyahi
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Contributions

AJ conceived the study. AJ, HI and JL collected data and performed the laboratory investigations. AJ and MM performed analysis and interpreted the data. AJ drafted the manuscript. JM, FM and MM revised the manuscript. All authors read and approved the final manuscript.

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Correspondence to Agricola Joachim.

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Joachim, A., Manyahi, J., Issa, H. et al. Predominance of Multidrug-Resistant Gram-Negative Bacteria on Contaminated Surfaces at a Tertiary Hospital in Tanzania: A Call to Strengthening Environmental Infection Prevention and Control Measures. Curr Microbiol 80, 148 (2023). https://doi.org/10.1007/s00284-023-03254-8

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