Multidrug-Resistant Bloodstream Organism Infection At The Neonatal Intensive Care Unit In The Greater Accra Regional Hospital In Ghana
Date
2022
Authors
Journal Title
Journal ISSN
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Publisher
University Of Ghana
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
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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.
Description
Mph.
Keywords
Multidrug-Resistant, Bloodstream, Organism Infection, Microbiologists, Ghana