Antibiotic resistance in aerobic bacterial isolates from infected diabetic foot ulcers in North Eastern Tanzania: an urgent call to establish a hospital antimicrobial stewardship committee

Authors

  • Ahmed Shabhay Department of General Surgery, Kilimanjaro Christian Medical University College, Moshi, Tanzania; Department of General Surgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Institute of Infectious Diseases and Research, Lugalo Military College of Medical Sciences (MCMS) and General Military Hospital (GMH), Dar es Salaam, Tanzania. http://orcid.org/0000-0001-9214-5415
  • Pius Horumpende Department of General Surgery, Kilimanjaro Christian Medical University College, Moshi, Tanzania; Institute of Infectious Diseases and Research, Lugalo Military College of Medical Sciences (MCMS) and General Military Hospital (GMH), Dar es Salaam, Tanzania; Department of Biochemistry and Molecular Biology, Kilimanjaro Christian Medical University College, Moshi, Tanzania; Kilimanjaro Christian Research Institute (KCRI) Moshi
  • Martin Mujuni Department of Internal Medicine, Kagera Regional and Consultant Hospital, Bukoba, Tanzania; Department of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
  • Edna Joy Munisi Department of Internal Medicine, Mount Meru Regional and Consultant Hospital, Arusha, Tanzania
  • Stephen Mshana Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences (CUHAS), Mwanza, Tanzania
  • Zarina Shabhay Department of Neuro-Surgery, Muhimbili Orthopedic Institute Dar es Salaam
  • Andrew Mganga Department of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
  • Kondo Chilonga Department of General Surgery, Kilimanjaro Christian Medical University College, Moshi, Tanzania; Department of General Surgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
  • David Msuya Department of General Surgery, Kilimanjaro Christian Medical University College, Moshi, Tanzania; Department of General Surgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
  • Jaffu O. Chilongola Department of Biochemistry and Molecular Biology, Kilimanjaro Christian Medical University College, Moshi, Tanzania; Kilimanjaro Christian Research Institute (KCRI) Moshi
  • Jeff Van Baal ZGT Academy, Hospital Group Twente, Almelo/Hengelo, The Netherlands; Cardiff University, Cardiff, Wales, UK
  • Samwel Chugulu Department of General Surgery, Kilimanjaro Christian Medical University College, Moshi, Tanzania; Department of General Surgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20213746

Keywords:

Antibiotic resistance, Diabetic foot ulcers, Multiple bacterial infection, Gram negative aerobes, Tanzania

Abstract

Background: Diabetic foot ulcers (DFU) is among major health problems which impact the socio economic burden globally. We aimed at assessing the susceptibility pattern of antimicrobials in DFU infections among patients admitted in the surgical department at Kilimanjaro Christian Medical Centre (KCMC).

Methods: This descriptive cross-sectional study was conducted from September 2018 through March 2019. Pus swabs were collected on the first day of admission by deep wound swabbing after irrigation with normal saline solution. Kirby-Bauer method was done according to the Clinical and Laboratory Standard Institute (CLSI) guidelines.

Results: Sixty diabetic ulcer patients had 62 bacterial isolates. Majority of the isolates were gram negative 49/62 (79.03%). The most common isolate was Escherichia coli 15/62 (24.19%) followed by Pseudomonas aeruginosa 14/62 (22.58%), Proteus mirabilis 8/62 (12.9%) and Staphylococcus aureus 5/62 (8.06%). Klebsiella pneumoniae, coagulase negative Staphylococcus, Proteus vulgaris, and Streptococcus pyogenes each contributed 4/62 (6.25%) isolates. Of the 49/62 (79.3%) gram negative isolates, 8/49 (16.33%) were mono resistant, 30/49 (61.22%) were multiresistant, and 11/49 (22.45%) were susceptible. Of the multi-resistant isolates, E. coli 12/15 (80.00%), and P. aeruginosa 7/14 (50.00%) were predominant. A total of 39/62 (62.90%) isolates in patients contributed to poorer outcomes including loss of body part. Patients with ulcers infected by P. aeruginosa 11/39 (28.21%) had the highest number of surgical removal of body parts followed by E. coli 8/39 (20.51%). Gram negative bacteria were highly susceptible to amikacin 91.18%, meropenem 93.33% and imipenem 95.24%. Isolates susceptibility to ceftriaxone was 32%.

Conclusions: Amikacin, meropenem and imipenem can be safely used as broad-spectrum antimicrobials in DFU. The standard of care remains culture and sensitivity of isolated microorganisms in combating diabetic foot ulcers infections.

Author Biography

Ahmed Shabhay, Department of General Surgery, Kilimanjaro Christian Medical University College, Moshi, Tanzania; Department of General Surgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Institute of Infectious Diseases and Research, Lugalo Military College of Medical Sciences (MCMS) and General Military Hospital (GMH), Dar es Salaam, Tanzania.

Head of Department of Surgery

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Published

2021-09-23

How to Cite

Shabhay, A., Horumpende, P., Mujuni, M., Munisi, E. J., Mshana, S., Shabhay, Z., Mganga, A., Chilonga, K., Msuya, D., Chilongola, J. O., Baal, J. V., & Chugulu, S. (2021). Antibiotic resistance in aerobic bacterial isolates from infected diabetic foot ulcers in North Eastern Tanzania: an urgent call to establish a hospital antimicrobial stewardship committee. International Journal of Basic & Clinical Pharmacology, 10(10), 1163–1169. https://doi.org/10.18203/2319-2003.ijbcp20213746

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Original Research Articles