Epidemiology of Antibiotic Resistance in Culture-positive Hospitalized Patients in Selected Hospitals in Khartoum, Sudan
Objective: To study the prevelence of antibiotic resistance and the prevalent bacterial isolates in hospitalized patients in Khartoum hospitals.
Materials & Methods: A cross-sectional prevalence study was carried out during the period of April–November 2015 in Khartoum; 226 bacterial cultures were included. Identification of isolates using standard biochemical tests and antibiotic susceptibilities were determined using disc diffusion method. Results were interpreted according to the standards of the British society of antimicrobial chemotherapy.
Results: Eight bacterial species were isolated: Staphylococcus aureus, Enterococcus
faecalis, Streptococcus spp., Klebsiella pneumoniae, Pseudomonas spp., Escherichia coli, Proteus spp., and Acinetobacter spp. S. aureus was the most prevalent, the majority of which were resistant to methicillin/oxacillin (MRSA). Cultures in our study were mainly from urine (36.7%), blood samples (37.2%), and wound cultures (19%). More than 90% of the tested isolates were resistant to cefuroxime; 54% and 73.8% of
Gram-positive and Gram-negative isolates, respectively, were resistant to ceftazidime. Furthermore, there was a high meropenem resistance among Gram-negative isolates tested. Multi-resistant Acinetobacter spp. as well as vancomycin-resistant S. aureus was isolated. Gram-negative isolates showed good susceptibilities to aminoglycosides as well as ciprofloxacin. However, the high resistance rate to these antibiotics was observed in Gram-positive isolates in these hospitals.
Conclusion: Methicillin-resistant S. aureus was the most prevalent organism. Gramnegative isolates showed good susceptibilities to aminoglycosides and ciprofloxacin. There were high resistance rates to cefuroxime, ceftazidime, and meropenem. Five vancomycin-resistant S. aureus were identified.
 Ibrahim, M. E., Bilal, N. E., and Hamid, M. E. (2012). Increased multi-drug resistant Escherichia coli from hospitals in Khartoum state, Sudan. African Health Science, vol. 12, no. 3, pp. 368–375.
 Luce, E. (2010). Plastic and reconstructive surgery, in Koneman’s Color Atlas and Textbook of Diagnostic Microbiology (sixth edition), vol. 125, pp. 414–415.
 Hall, G. S. (2013). Bailey & Scott’s diagnostic microbiology (thirteenth edition). Laboratory Medicine, vol. 44, no. 4, p. e138–e139.
 Howe, R. A. and Andrews, J. M. (2012). BSAC standardized disc susceptibility testing method (version 11). Journal of Antimicrobial Chemotherapy, vol. 67, pp. 2783–2784.
 Hudzicki, J. Kirby-Bauer disk diffusion susceptibility test protocol [Internet], pp. 1– 14. Retrieved from: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle: Kirby Bauer+Disk+Diffusion+Susceptibility+Test+Protocol#0.
 Shuman, E. K. and Chenoweth, C. E. (2010). Recognition and prevention of healthcare-associated urinary tract infections in the intensive care unit. Critical Care Medicine, vol. 38, no. 8, pp. S373–S379. Retrieved from: http://www.ncbi.nlm.nih. gov/pubmed/20647795.
 Bagshaw, S. M. and Laupland, K. B. (2006). Epidemiology of intensive care unitacquired urinary tract infections. Current Opinion in Infectious Diseases, vol. 19, no. 1, pp. 67–71.
 Wagenlehner, F. M. E., Cek, M., Naber, K. G., et al. (2012). Epidemiology, treatment and prevention of healthcare-associated urinary tract infections. World Journal of Urology, vol. 30, pp. 59–67.
 Page, D. B., Donnelly, J. P., and Wang, H. E. (2015). Community-, healthcare-, and hospital-acquired severe sepsis hospitalizations in the university health system consortium. Critical Care Medicine, vol. 43, no. 9, pp. 1945–1951. Retrieved from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=
 Young, P. Y. and Khadaroo, R. G. (2014). Surgical site infections. Surgical Clinics of North America, vol. 94, pp. 1245–1264.
 Owens, C. D. and Stoessel, K. (2008). Surgical site infections: epidemiology, microbiology and prevention. Journal of Hospital Infection, vol. 70, no. 2, pp. 3– 10.
 Davis, K. A., Stewart, J. J., Crouch, H. K., et al. (2004). Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clinical Infectious Diseases, vol. 39, no. 6, pp. 776–782.
 Gould, I. M. (2007). MRSA bacteraemia. International Journal of Antimicrobial Agents, vol. 30, no. 1, pp. 66–70.
 Richard, E. P. (2010). The silent epidemic: CA-MRSA and HA-MRSA. Journal of the American Academy of Orthopaedic Surgeons, pp. 2–4.
 Ahoyo, T. A., Bankolé, H. S., Adéoti, F. M., et al. (2014). Prevalence of nosocomial infections and anti-infective therapy in Benin: results of the first nationwide survey in 2012. Antimicrobial Resistance & Infection Control, vol. 3, no. 17, pp. 2–7. Retrieved from: http://download.springer.com/static/pdf/228/art%3A10.1186%2F2047-2994-3-
 A. M. and E. M. (2013). Antibiotic resistance. Medicine, vol. 41, no. 11, pp. 642–648. Retrieved from: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE= reference&D=emed11&NEWS=N&AN=2013695730.
 Stürenburg, E., Kühn, A., Mack, D., et al. (2004). A novel extended-spectrum β-lactamase CTX-M-23 with a P167T substitution in the active-site omega loop associated with ceftazidime resistance. Journal of Antimicrobial Chemotherapy, vol. 54, no. 2, pp. 406–409.
 Novais, Â., Cantón, R., Coque, T. M., et al. (2008). Mutational events in cefotaximase extended-spectrum? – lactamases of the CTX-M-1 cluster involved in ceftazidime resistance. Antimicrobial Agents and Chemotherapy, vol. 52, no. 7, pp. 2377–2382.
 Temkin, E., Adler, A., Lerner, A., et al. (2014). Carbapenem-resistant Enterobacteriaceae: Biology, epidemiology, and management. Annals of the New York Academy of Sciences, vol. 1323, no. 1, pp. 22–42.
 Falagas, M. E., Tansarli, G. S., Karageorgopoulos, D. E., et al. (2014). Deaths attributable to carbapenem-resistant Enterobacteriaceae infections. Emerging Infectious Diseases, vol. 20, no. 7, pp. 1170–1175.
 Lee, C. R., Cho, I. H., Jeong, B. C., et al. Strategies to minimize antibiotic resistance. International Journal of Environmental Research and Public Health, vol. 10, pp. 4274–4305.
 World Health Organization. (2014). The evolving threat of antimicrobial resistance: Options for action. Indian Journal of Medical Research, vol. 139, no. 1, pp. 182–183. Retrieved from: http://www.ijmr.org.in/article.asp?issn=0971-5916;year= 2014;volume=139;issue=1;spage=182;epage=183;aulast=Kap