BACKGROUND Available data on antibiotic resistance in sub-Saharan Africa is limited despite its increasing threat to global public health. As there is no previous study on antibiotic resistance in patients with clinical features of healthcare-associated infections (HAIs) in Sierra Leone, research is needed to inform public health policies. Our study aimed to assess antibiotic resistance rates from isolates in the urine and sputum samples of patients with clinical features of HAIs. METHODOLOGY We conducted a cross-sectional study of adult inpatients aged ≥18 years at Connaught Hospital, an urban tertiary care hospital in Freetown between February and June 2018. RESULTS Over the course of the study, we enrolled 164 patients. Risk factors for HAIs were previous antibiotic use (93.3%), comorbidities (58.5%) and age (≥65 years) (23.9%). Of the 164 samples, 89.6% were urine. Bacterial growth was recorded in 58.8% of cultured specimens; the type of specimen was an independent predictor of bacterial growth (p < 0.021). The most common isolates were Escherichia coli and Klebsiella pneumoniae; 29.2% and 19.0% in urine samples and 18.8% and 31.3% in sputum samples, respectively. The overall resistance rates were 58% for all extended-spectrum beta-lactamase (ESBL)-producing organisms, 13.4% for carbapenem-resistant non-lactose fermenting gram-negative bacilli, 8.7% for carbapenem-resistant Acinetobacter baumannii (CRAB) and 1.3% for carbapenem-resistant Enterobacteriaceae (CRE). There were no carbapenem-resistant P. aeruginosa (CRPA) isolates but all Staphylococcus aureus isolates were methicillin-resistant S. aureus. CONCLUSION We demonstrated a high prevalence rate of ESBL-producing organisms which are a significant burden at the main tertiary hospital in Sierra Leone. Urgent action is needed to strengthen microbiological diagnostic infrastructure, initiate surveillance on antibiotic resistance and develop and implement policy framework on antibiotic stewardship.

中文翻译：

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塞拉利昂城市三级医院中具有医疗保健相关感染临床特征的患者的抗生素耐药性：一项横断面研究。

背景技术尽管撒哈拉以南非洲地区对全球公共卫生的威胁越来越大，但有关抗生素抗药性的可用数据仍然有限。由于之前在塞拉利昂尚无有关具有医疗保健相关感染（HAIs）临床特征的患者对抗生素耐药性的研究，因此需要进行研究以告知公共卫生政策。我们的研究旨在评估具有HAIs临床特征的患者尿液和痰液样本中分离株的抗生素耐药率。方法论我们于2018年2月至2018年6月间在弗里敦市区三级医院Connaught医院对≥18岁的成人住院患者进行了横断面研究。结果在研究过程中，我们招募了164例患者。HAIs的危险因素是以前使用抗生素（93.3％），合并症（58.5％）和年龄（≥65岁）（23.9％）。在164个样本中，有89.6％是尿液。58.8％的培养标本记录了细菌的生长；标本的类型是细菌生长的独立预测因子（p <0.021）。最常见的分离株是大肠埃希菌和肺炎克雷伯菌。尿液样本分别为29.2％和19.0％，痰液样本分别为18.8％和31.3％。所有产生超广谱β-内酰胺酶（ESBL）的生物的总耐药率分别为58％，耐碳青霉烯的非乳糖发酵革兰氏阴性杆菌的13.4％，耐碳青霉烯的鲍曼不动杆菌（CRAB）的8.7％耐碳青霉烯的肠杆菌科（CRE）的％。没有耐碳青霉烯的铜绿假单胞菌（CRPA）分离株，但所有金黄色葡萄球菌的分离株均为耐甲氧西林的金黄色葡萄球菌。结论我们证明了产生ESBL的生物体的高流行率，这在塞拉利昂的主要三级医院中是沉重的负担。需要采取紧急行动，以加强微生物诊断基础设施，启动对抗生素耐药性的监测，并制定和实施抗生素管理政策框架。