Antimicrobial Resistance in Hospitals north-western Nicaragua

Abstract

In recent years, an increase in the incidence of Antimicrobial Resistance (AMR) has been observed among pathogens that cause primarily hospital-acquired infections, as well as in the community. Antimicrobial resistance is a global public health problem, mainly driven by the use and misuse of antibiotics. The phenomenon of antimicrobial resistance is a priority research area at the Center for Research on Infectious Diseases. As part of its activities, a study was conducted in three Northwestern hospitals (León, Chinandega, and Estelí) with the objective of determining the antimicrobial resistance or susceptibility profile of aerobic bacteria isolated from patients treated in these hospitals during the period from May 2003 to May 2006. The study included 1,181 strains of aerobic bacteria, and the Kirby-Bauer method, following NCCLS recommendations, was used to determine the resistance profile. The most frequently studied bacterial species were Staphylococcus aureus (385 strains), E. coli (209 strains), Pseudomonas spp. (180 strains), followed by a smaller number of strains of Shigella spp., Group A beta-hemolytic Streptococci, and other Gram-negative bacilli, mainly obtained from biological samples of skin and soft tissue infections, neonatal bacteremia, urinary tract infections, and pharyngotonsillitis. The results were as follows: Penicillin was the least effective drug against S. aureus; a significant percentage, greater than 25%, were resistant to Methicillin, particularly strains from Estelí. However, these antibiotics were highly effective against Streptococci, and no resistance to Vancomycin was observed. Regarding Gram-negative bacteria, T. sulfa was the least effective antimicrobial against E. coli isolated from urine cultures, with a similar percentage in all three hospitals, as well as against Klebsiella spp. and other Gram-negative bacteria, except Pseudomonas spp., for which analysis is not indicated. Pseudomonas spp. was resistant primarily to Chloramphenicol and Ceftriaxone in Estelí, and to Ceftriaxone and Gentamicin in León and Chinandega. The results of this study highlight the importance of the problem and offer the medical community the opportunity to use the data to adjust treatment guidelines and help modify risk behaviors that promote antimicrobial resistance.