Multidrug-Resistant Bloodstream Organism Infection At The Neonatal Intensive Care Unit In The Greater Accra Regional Hospital In Ghana

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Date

2022-03

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University of Ghana

Abstract

Abstract Background: Antimicrobial drugs since their inception have improved contemporary medicine. Blood stream infections (BSIs) are a significant source of morbidity and mortality among the neonatal population in hospitalized settings with a penchant for Low and middle-income countries (LMICs). Data on newborn BSIs showing Multidrug resistance (MDR) using a mixed technique approach are few. As a result, it has become critical to identify and analyze the scope of this hidden health problem in a vulnerable and at-risk population in order to raise awareness and prompt action. The general objective was to assess the multidrug resistant-organism infections in Neonatal Intensive care unit (NICU) in Greater Accra Regional Hospital in Ghana. Methods: The study was conducted using a mixed method research design at a tertiary level in a neonatal intensive care unit (NICU) in Greater Accra Regional Hospital (GARH), Ghana. All blood cultures taken for newborns admitted to the NICU within the period of 1st June 2020 to 31st May 2021were included. Multidrug resistance (MDR) in BSI rates were analysed, and the effect of antimicrobial resistance (AMR) on outcomes and duration of hospitalization were analysed. Participants in the qualitative study were Neonatal ICU nurses, Microbiologists, and Laboratory technicians. The sampling approach used for interviewing health workers was convenience sampling in view of the tight work scheduled of many of the qualified respondents. All interviews were conducted in the facility with prior notice to the participants. Data was analyzed into proportions as per total sample size. Analyzed data, together with interview findings, together forming quantitative and qualitative data, were compared with the secondary data extracted to answer the proposed research questions. P values <0.05 were considered significant. Results: Of 1,043 blood culture samples taken from neonates in the NICU, 195 cultured Multidrug resistant organisms (MDROs). Overall incidence of MDR BSI was 18.7% (195/1043). The predominantly isolated pathogenic organism was Klebsiella spp 31.2% (61/195) and Staphylococcus aureus 20.5% (40/195). Additionally, 38 coagulase negative Staphylococci were isolates. Among the Klebsiella spp resistance to ampicillin, cefotaxime and gentamicin was 72.1%, 39.3% and 52.4%, respectively, while carbapenem resistance was 10.4%. Mortality among neonates with MDR BSI was 26.2% (51/195). Results also indicated that knowledge of MDROs amongst Health care workers and control measures to curtail their development and spread were very general and lacked. Qualitative results also indicated that public education and sensitization at the community level as well as providing a framework and guidelines for antimicrobial stewardship at the facility level is a basic and urgent need in the management of MDR. Conclusion: This study corroborates existing literature, reiterating the urgent need for intervention. The empirical regimen in the setting of low- and middle-income countries such as Ghana is unlikely to lead to advancement substantial enough to improve outcomes associated with MDR BSI. The required improvement would require advancements in various medical fields including improvement in clinical microbiological services.

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MPH.

Keywords

Multidrug-Resistant, Organism Infection, Neonatal Intensive, Multidrug resistance

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