1472. Antimicrobial Resistance in Uganda and the Urgent Need for Standardized Reporting and a National Surveillance Program
Session: Poster Abstract Session: Antimicrobial Stewardship: Pediatric and OPAT
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • Fujita_IDSAposter_100615_gray.pdf (1.2 MB)
  • Background: Antimicrobial resistance (AMR) has become an increasing concern worldwide. Despite the high burden of infectious diseases in sub-Saharan Africa, there is a paucity of data on local AMR patterns due to lack of surveillance, routine culture, and susceptibility testing, as well as widespread empiric antimicrobial therapy. Our aim was to determine the prevalent AMR patterns among culture isolates at Mulago National Referral Hospital and the Makerere Microbiology lab. 

    Methods: Positive blood culture isolates from children and adults from microbiology labs at Makerere University (n=346) and Mulago Hospital (n=117) were summarized into an antibiogram from June 2013 to October 2014.  Antibiotic susceptibility testing of positive cultures was performed according to CLSI guidelines. Isolates were categorized as “sensitive,” “intermediate,” and “resistant” based on disc diffusion diameter cut-off points. 

    Results: A total of 463 positive blood cultures were isolated from 215 children and 219 adults. Many of the samples from Makerere were from research studies rather than routine testing. Sex distribution was relatively equal (males 56%). The most common pathogens isolated were coagulase-negative Staphylococcus (n=108), Staphylococcus aureus (n=128), Echerichia coli (n= 47), and Klebsiella pneumonia (n=36), and other Enterobacteriae (n=17).  Of S. aureus, 38% were methicillin-resistant. E. coli was susceptible to ceftriaxone 33%, ciprofloxacin 39%, chloramphenicol 56%, piperacillin/tazobactam 80%, and imipenem 81%. Klebsiella pneumoniae was susceptible to ceftriaxone 15%, ciprofloxacin 23%, piperacillin/tazobactam 64%, and imipenem 80%. Susceptibility testing was not always performed. 

    Conclusion: Significant proportions of AMR exist in bacterial isolates identified in Kampala, Uganda and are consistent over time when compared to data from 2011-2012. Cost of testing, supply shortage, inability to confirm certain species (e.g. Acinetobacter) as pathogenic or contamination, and differentiation of community vs. hospital-acquired infections remain significant challenges. Systematic surveillance, microbiology lab strengthening, and standardized reporting in resource-limited settings will inform policy guidelines for the rationale use of antimicrobials in SSA.

    Ayako Wendy Fujita, B.S.1,2, Olive Mbabazi, MS3, Andrew Akampurira, BS3, CF Najjuka, MMed4, Charles Izale, MS5, David Meya, MMed6, David Boulware, MD, MPH2, Yukari Manabe, MD7 and Henry Kajumbula, MMed4, (1)Emory University School of Medicine, Atlanta, GA, (2)University of Minnesota, Minneapolis, MN, (3)Infectious Disease Institute, Kampala, Uganda, (4)Makerere University, Kampala, Uganda, (5)Department of Microbiology, Mulago Hospital, Kampala, Uganda, (6)Infectious Disease Institute, Makerere University, Kampala, Uganda, (7)Medicine, Johns Hopkins University, Baltimore, MD

    Disclosures:

    A. W. Fujita, None

    O. Mbabazi, None

    A. Akampurira, None

    C. Najjuka, None

    C. Izale, None

    D. Meya, None

    D. Boulware, None

    Y. Manabe, None

    H. Kajumbula, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.