Article Type : Research Article
Authors : Ahmed MA, Abdelgader LMA, Mahjaf GM, Gorish BMT, and Abdelmula W IY
Keywords : Nosocomial infections; Laboratory infections; Staphylococcus aureus; Shendi; Sudan
Background:
Laboratory infections can be classified as occupational and nosocomial
infections. Laboratory-related infections are generally recognized as a
potential risk for clinical laboratory workers. Some types of bacteria can
survive longer on dry surfaces and more on wet surfaces can infect other places
and environments.
Objective:
To detect common bacterial pathogens in various medical laboratories in Shendi
City.
Materials
and Methods: A cross-sectional analytical study was conducted in Shendi City
from August to December 2021. This study included 17 laboratories and 50 samples
collected by wet exchange from various locations including laboratory surfaces,
microscopes, centrifuges, CBC devices, staining racks, and CBC devices.
Results:
This study included Staphylococcus aureus 11 (22%), Staphylococcus epidermidis
10 (20%), Escherichia coli 1 (2%), Klebsiella pneumonia 9 (18%), and
Pseudomonas aeruginosa 2 (4%). Significant growth of pathogenic bacteria was
shown. Among all the organisms isolated, there is moderate resistance to
antibiotics, some bacteria are very resistant, others are resistant, and some
organisms are resistant to some they were highly sensitive to the substance and
resistant to other antibacterial agents. Bacterial isolates (39.4%) were
resistant to Amoclane, 12 (36.4%) were resistant to gentamicin, and 11 (33.3%)
were resistant to Ciprofloxacin and Imipenem.
Conclusions: At the
end of this study, pathogen contamination was found on laboratory surfaces and
equipment (approximately 66% of exchanged items contained pathogens), dry
surfaces may use these organisms as a source of laboratory infection.
Working
with pathogenic microorganisms requires good laboratory practices, risk
assessments, and bio safety/bio security measures to ensure the safety of
personnel, communities, and the environment from accidental or intentional
infection. . Occupational infections of laboratory personnel, called laboratory
infections (LAI), have been described in the scientific literature since 1897.
Accidental or exposure events leading to LAI may include inhalation of
infectious aerosols or contact with mucous membranes, droplets, contacts,
spills, or transmission via per cutaneous routes (bites, cuts, accidental
self-inoculation). However, in many of his LAI cases, the actual cause often
remains unknown or uncertain [1].
Nosocomial infections, also called "nosocomial infections", can be
defined as infections that occur in patients in hospitals or other healthcare
facilities where the infection was absent or latent at the time of admission.
These include nosocomial but post-discharge infections and occupational
infections among facility staff (WHO, 2002). Nosocomial infections (NIs) are
known worldwide and, despite scientific and technological health advances, are a major concern, especially in
developing countries, due to limited resources. Remains an issue [3]. Healthcare-associated infections
(HAIs) are an important cause of inpatient morbidity and mortality. The
severity of infection depends on the characteristics of the microorganisms
involved and the frequency of resistant pathogens in hospital settings [2]. Several recent studies suggest
that environmental contamination plays an important role in nosocomial
infections with multidrug-resistant bacteria (MDROs), viruses, mycobacteria,
and fungi [4]. A caring
environment consists of the three elements of a building or space used for
patient care. Devices are used to support patient care or to safely operate
buildings and spaces. People, including staff, patients, and visitors. Some pathogens
can persist in the environment for long periods and serve as vehicles for
transmission and spread in hospital settings. Cross-infection of these
pathogens can occur through the hands of healthcare workers, directly by
contact with patients, or indirectly by touching environmental surfaces. Less
commonly, direct contact with contaminated environmental surfaces can lead to
patient colonization [4]. The
role played by medical devices and work surfaces in transmitting these
organisms inevitably contributes to increased mortality, morbidity, and
antibiotic resistance [3]. The
emergence of multidrug-resistant bacteria has exacerbated this problem,
especially in resource-poor countries, as a result of overuse, abuse, and
inadequate antimicrobial management policies in healthcare systems.
Broad-spectrum and first-line antibiotics are widely used and resistance is
exacerbated due to the lack of hospital antimicrobial teams and strict
adherence to treatment guidelines. This resistance results in longer hospital
stays and a total economic burden due to treatment with correspondingly higher
morbidity and mortality [3]. The
implementation of surface microbiological controls in healthcare facilities is
part of the policy to prevent nosocomial infections. Preventive and corrective
actions can be implemented with a better understanding of microbial ecology,
demonstrating that monitoring the hospital environment is an essential
component in controlling nosocomial infections. Such microbiological monitoring
can measure the risk of infection by identifying infectious bacteria and
comparing local data with data from other institutions [5].
Study
Design
This
is an analytical cross-sectional study aimed at determining the types of
pathogenic bacteria found in the laboratory setting and their susceptibility to
antibiotics.
Study
area
A medical research institute in Shendi, Nile State,
Sudan.
Study
Population
Medical laboratories at the Shendi Local Market.
Inclusion
Criteria
All surfaces and equipment.
Sampling
All surfaces and equipment are included in the sample.
Data
collection tools
Data were collected from the results of actual
bacterial cultures of the collected samples.
Collection
of Samples
Contaminated swab samples from surfaces and equipment
were collected with saline-soaked swabs, after which the samples were
transferred to the Shendi University Microbiology Laboratory as soon as
possible in approximately 30 min.
Culturing of samples
All samples were cultured on MacConkey agar and blood
agar and subculture to obtain pure microorganisms.
Antimicrobial susceptibility
testing
Isolated
bacteria were tested for antimicrobial susceptibility using the standard
Kirby-Bauer disc diffusion method. Gram-positive bacteria are tested for
susceptibility to Co-amoxiclav, ceftriaxone, ciprofloxacin, and gentamicin;
gram-negative bacteria are susceptible to Co-amoxiclav, Ceftriaxone,
Ciprofloxacin, Gentamicin, and Imipenem was tested.
Data analysis
Data were manually analyzed and presented in tables.
Ethical Approval and
Consent
Not applicable
In this study, 50 swabs samples have been amassed from
different sites in the laboratories inclusive of surfaces, microscopes,
centrifuges, staining racks, and CBC devices, The percentage of a pathogenic
microorganism comes as follows: the table surfaces confirmed a relatively
infected location of approximately 11 (92%) of swabbed surfaces incorporate
pathogenic microorganism, approximately 9 (89%) of centrifuges incorporate
pathogenic microorganism, 4 (67%) of CBC gadgets incorporate pathogenic
microorganism, 10 (56%) of microscopes are infected with the aid of using a
pathogenic microorganism, the racks which can be used for staining display the
decrease wide variety of pathogens approximately 14% only. 8 samples of the
amassed 50 samples confirmed no increase in microorganisms. From the isolated
microorganism, 9 cultures confirmed the natural increase of gram-high-quality
bacilli (18% of all cultures incorporate increase), in keeping with gram stain
and colonial morphology, it changed into Bacillus species, additionally.
Table
1:
The Percentage of gram-positive and gram-negative among isolated bacteria.
Age group |
Frequency |
Percent % |
Gram positive cocci |
21 |
42% |
Gram negative bacilli |
12 |
24% |
Gram positive bacilli |
09 |
18% |
Gram positive bacilli mixed with other
species |
20 |
40% |
No growth |
08 |
16% |
Total |
62 |
100.0 |
Table
2:
The isolated bacteria according to site of sample collection.
Type |
MIC |
STR |
CEN |
DS |
CBC |
No growth |
5 |
1 |
0 |
0 |
2 |
S. aureus |
3 |
0 |
3 |
3 |
2 |
S. epidermidis |
2 |
1 |
3 |
3 |
1 |
E.coli |
1 |
0 |
0 |
0 |
0 |
K. pneumoniae |
3 |
0 |
2 |
3 |
1 |
P. aeuroginosa |
0 |
0 |
0 |
2 |
0 |
Bacillus spp |
10 |
4 |
8 |
4 |
3 |
Table
3: The
percentage of isolated bacterial species.
Type |
No |
Percent
% |
S .aureus |
11 |
22% |
S. epidermidis |
10 |
20% |
E.coli |
01 |
02% |
K. pneumoniae |
00 |
18% |
P. aeuroginosa |
02 |
04% |
Total |
33 |
100% |
Table
4:
Sensitivity of Staphylococcus aureus to antibiotics.
Antibiotics |
Sensitive |
Resistant |
Co-amoxiclav |
7 (63.6%) |
4 (36.4%) |
Ceftriaxone |
3 (27.3%) |
8 (72.2%) |
Ciprofloxacin |
4 (36.4%) |
7(63.6%) |
Gentamycin |
9 (81.8%) |
2 (18.2%) |
Table
5:
Sensitivity of S. epidermidis to antibiotics.
Antibiotics |
Sensitive |
Resistant |
Co-amoxiclav |
5 (50%) |
5 (50%) |
Ceftriaxone |
2 (20%) |
8 (80%) |
Ciprofloxacin |
3 (30%) |
7 (70%) |
Gentamycin |
4 (40%) |
6 (60%) |
Table
6:
Sensitivity of E.coli to antibiotics
Antibiotics |
Sensitive |
Resistant |
Co-amoxiclav |
0 |
1(100%) |
Ceftriaxone |
0 |
1(100%) |
Ciprofloxacin |
0 |
1(100%) |
Gentamycin |
0 |
1(100%) |
Imipenem |
0 |
1(100%) |
Table
7:
Sensitivity of K. pneumoniae to antibiotics.
Antibiotics |
Sensitive |
Resistant |
Co-amoxiclav |
5 (55.6%) |
4 (44.4%) |
Ceftriaxone |
1 (11.1%) |
8 (88.9%) |
Ciprofloxacin |
5 (55.6%) |
4 (44.4%) |
Gentamycin |
4 (44.4%) |
5 (55.6%) |
Imipenem |
6 (66.7%) |
3 (33.3%) |
Table
8:
Sensitivity of P. aeuroginosa to antibiotics.
Antibiotics |
Sensitive |
Resistant |
Co-amoxiclav |
1 (50%) |
1 (50%) |
Ceftriaxone |
0 |
2 (100%) |
Ciprofloxacin |
0 |
2 (100%) |
Gentamycin |
1 (50%) |
1 (50%) |
Imipenem |
0 |
2 (100%) |
Table
9:
The Amount of resistant bacteria among all isolated organisms of to
antibiotics.
Antibiotics |
Resistant |
Co-amoxiclav |
13 (39.4%) |
Ceftriaxone |
15 (45.4%) |
Ciprofloxacin |
11 (33.3%) |
Gentamycin |
12 (36.4%) |
Imipenem (Gram negative) |
4 (33.3%) |
Bacillus species changed into determined blended with
the different pathogenic microorganism in lots of cultures, the Gram-positive
cocci have been 21 microorganisms (42% of all isolated microorganism), 12
microorganisms have been Gram-negative bacilli (24%) (Table 1). The species of
these bacteria according to the site of sample collection were showed in the
(Table 2). The isolated Gram-positive cocci encompass Staphylococcus aureus 11
(22% of all isolated microorganisms), Staphylococcus epidermidis 10 (20%), the
Gram-negative bacilli encompass Klebsiella pneumonia 9 (18%), Escherichia coli
1 (2%), Pseudomonas aeuroginosa 2 (4%) (Table 3). The result of antimicrobial
susceptibility changed into proven in tables from (Table 4-9).
This study was conducted from August to December
2021 to detect bacterial contamination found in laboratories. It was conducted
in Shendi City. This study included 17 laboratories and the number of samples
collected was 50 samples collected from different locations, including
laboratory surfaces, microscopes, centrifuges, staining racks, and CBC
machines. This study showed that there was significant growth of pathogenic
bacteria other bacteria accounted for (40%) of all isolated pathogenic
bacteria; included. 10 Staphylococcus epidermidis (20%), 1 Escherichia coli (2%), 9 Klebsiella pneumoniae (18%), 2 Pseudomonas
aeuroginosa (4%). Antimicrobial susceptibility did not affect the Bacillus spp,
so it was not pathogenic. Staphylococcus aureus showed the highest percentage.
This is consistent with Ivan Sserwadda In 2018 and his colleagues found that:
75.4% of contaminant bacteria in post-operative wards are Staphylococcus aureus
[3]. Also, he agrees with Laila Chaoui and her colleagues in 2019 [2]. Other prevalent
bacteria include coagulase-negative staphylococci and Klebsiella pneumonia.
This finding is agreement with Ivan's. Serwadda and Laila Chaoui [3].
Considering antimicrobial susceptibility and antibiotic resistance, the
antibiotics tested in this study were imipenem for Gram-negative bacteria only
and coamoxilab, ceftriaxone, and ciprofloxacin for both Gram-negative and
Gram-positive bacteria, and gentamicin. Among all organisms isolated, there was
moderate resistance to antibiotics, some bacteria are highly resistant, others
are susceptible, and some organisms are highly susceptible to certain types of
antibiotics and resistant to other antibacterial agents. Ceftriaxone has a high
rate of resistance, with approximately 15 (45.4%) of the isolates resistant to
this antibiotic indicated by Amoclane and 13 (39.4%) of the isolates resistant
to Amoclane, 12 (36.4%) bacteria are resistant. are resistant to gentamicin and
11 (33.3%) bacteria are resistant to ciprofloxacin and imipenem. The high
resistance to ceftriaxone and amoclane indicates that these antibiotics are
frequently prescribed by doctors in our country without testing the
antimicrobial susceptibility to these antibiotics, or without shedding the
prescribed dose. It has been suggested that this is due to patients using
unreasonably large amounts. I oppose the use of these antibiotics. Among the
isolated bacteria, only one sample showed growth of Escherichia coli (100%)
resistant to all antibiotics, and two samples had Pseudomonas aeruginosa with
high antibiotic resistance and susceptibility to Amoclane. K. pneumoniae showed
the highest resistant to Ceftriaxone, about 8 (88.9%) of isolated bacteria and
highly susceptible to Imipenem, while staphylococcus epdermids showed the
highest resistant to Ciprofloxacin, about 7 bacteria (70%) followed by S.
aureus, about 7 bacteria (63.6%) and 9 bacteria (82%) of S. aureus susceptible
to Gentamycin, Staphylococcus epidermidis show proportionally high resistant to
almost all antibiotics, than other isolated bacteria and have proportionally
low sensitivity.
At the end of this study, contaminating pathogenic
bacteria were found on laboratory surfaces and equipment, and the bacterial
species isolated were Staphylococcus aureus, Staphylococcus epidermidis, Escherichia
coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Some of these bacteria
are multi-drug resistant and most of them can survive on dry surfaces for long
periods. Due to poor personal hygiene, laboratory workers can become infected
with these organisms and pass them on to patients, colleagues, the community,
and others. Laboratory workers and other healthcare workers may also
hand-infect these organisms in other areas of the healthcare center, such as
patient wards and intensive care units, where susceptible populations are
found. , which can lead to the spread of these microbes. Lack of infection
control programs and regular surveillance of laboratory infections may also act
as pathways to the spread of nosocomial infections. Improper cleaning and
disinfection of laboratory surfaces and equipment can lead to high levels of
laboratory contamination.
The authors are thankful to the Department of
Microbiology, Faculty of Medical Laboratory Sciences, Shendi University,
Shendi, Sudan, for their support during the study period.
The budget for this study was from personal
contributions from the authors, with no external funding.
The author has affirmed that there are no
conflicting interests.