title: Antimicrobial resistance in pathogens causing nosocomial infections in surgery and intensive care units of two hospitals in Antananarivo, Madagascar.
abstract: BACKGROUND
  In developing countries, knowledge of antimicrobial resistance patterns is essential to define empirical therapy.
  
  
  METHODS
  All the surgery and intensive care wards of two hospitals in Antananarivo were included to study the antimicrobial susceptibility of the pathogenic bacteria causing nosocomial infections. A repeated cross-sectional survey was conducted between September 2006 and March 2008, one day per week. Isolates were identified using classical methods, and resistance to antibiotics was assessed according to the recommendations of the Antibiogram Committee of the French Microbiology Society.
  
  
  RESULTS
  Clinical specimens from 706 from 651 patients were collected. Of the 533 bacterial pathogens, 46.7% were Enterobacteriaceae, 19.3% were Staphylococcus aureus, and 19.1% were pathogens from the hospital environment (Pseudomonas aeruginosa and Acinetobacter baumannii).Frequencies of resistance were high, particularly in Enterobacteriaceae; however, the rate of Staphylococcus aureus isolates resistant to oxacillin (13.6 %) was moderate and all these isolates were susceptible to glycopeptids. The percentages of isolates susceptible to ceftazidim were 81.8% for E. coli, 60.9% for Klebsiella, and 52.5% for Enterobacter spp. Resistance to third-generation cephalosporins was due to extended spectrum betalactamases (ESBL). Multivariate analysis showed that diabetes (adjusted OR: 3.9) and use of an invasive procedures (adjusted OR: 3.5) were independent risk factors for resistance to third-generation cephalosporins.
  
  
  CONCLUSIONS
  A nationwide surveillance programme is needed to monitor the microbial trends and antimicrobial resistance in Madagascar.
authors.affiliation: Institut Pasteur de Madagascar. frederique@pasteur.mg
authors.forename: Frédérique
authors.initials: F
authors.lastname: Randrianirina
authors.forename: Laetitia
authors.initials: L
authors.lastname: Vaillant
authors.forename: Charles Emile
authors.initials: CE
authors.lastname: Ramarokoto
authors.forename: Armand
authors.initials: A
authors.lastname: Rakotoarijaona
authors.forename: Mamy Lalatiana
authors.initials: ML
authors.lastname: Andriamanarivo
authors.forename: Henri Claude
authors.initials: HC
authors.lastname: Razafimahandry
authors.forename: Jules
authors.initials: J
authors.lastname: Randrianomenjanahary
authors.forename: Jean Roger
authors.initials: JR
authors.lastname: Raveloson
authors.forename: Elisoa Ratsima
authors.initials: ER
authors.lastname: Hariniana
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Carod
authors.forename: Antoine
authors.initials: A
authors.lastname: Talarmin
authors.forename: Vincent
authors.initials: V
authors.lastname: Richard
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology*; D001419:Bacteria / Q000187:drug effects*; D001424:Bacterial Infections / Q000382:microbiology*; D003422:Critical Care; D003428:Cross Infection / Q000382:microbiology*; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial; D018432:Drug Resistance, Multiple; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008270:Madagascar; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors
chemical_list: D000890:Anti-Infective Agents