title: Five-Year Antimicrobial Susceptibility Trends Among Bacterial Isolates from a Tertiary Health-Care Facility in Kigali, Rwanda.
abstract: Antimicrobial resistance (AMR) is a global public health threat. There is limited information from Rwanda on AMR trends. This longitudinal study aimed to describe temporal trends of antibiotic susceptibility among common bacteria. We collated the antimicrobial susceptibility results of bacteria cultured from clinical specimens collected from inpatients and outpatients and submitted to the microbiology laboratory at King Faisal Hospital, Kigali, Rwanda, from January 1, 2009, to December 31, 2013. Differences in antimicrobial susceptibility between the first and fifth year of the study for each bacterial species was assessed using χ2test. Of 5,296 isolates collected, 46.7% were Escherichia coli, 18.4% were Klebsiella spp., 5.9% were Acinetobacter spp., 7.1% were Pseudomonas spp., 11.7% were Staphylococcus aureus, and 10.3% were Enterococcus spp. Colistin and imipenem had greatest activity against gram-negative bacteria. Acinetobacter spp. showed the greatest resistance profile to antimicrobials tested, relative to other gram-negative bacteria. Vancomycin retained excellent activity against S. aureus and Enterococcus species (average susceptibility was 100% and 99.4%, respectively). Trend analysis determined that resistance to imipenem increased significantly among Klebsiella, E. coli, Pseudomonas, and Acinetobacter isolates; there was also rising resistance to colistin among E. coli and Pseudomonas species. Only E. coli demonstrated increased resistance to gentamicin. For gram-positive pathogens, vancomycin susceptibility increased over time for Enterococcus species, but was unchanged for S. aureus Our data suggest that resistance to imipenem and colistin are rising among gram-negative bacteria in Rwanda. Proper infection control practices and antimicrobial stewardship will be important to address this emerging threat.
authors: Department of Public Health, Philadelphia, Pennsylvania.
authors: Makeda
authors: M
authors: Carroll
authors: Department of Microbiology, SMBT Institute of Medical Science and Research Center, Nashik, India.|King Faisal Hospital, Kigali, Rwanda.
authors: Ashok
authors: A
authors: Rangaiahagari
authors: King Faisal Hospital, Kigali, Rwanda.
authors: Emmanuel
authors: E
authors: Musabeyezu
authors: Fellowship of Postgraduate Medicine, London, United Kingdom.
authors: Donald
authors: D
authors: Singer
authors: Yale AIDS Program, Section of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut. onyema.ogbuagu@yale.edu.
authors: Onyema
authors: O
authors: Ogbuagu
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D006801:Humans; D017053:Infection Control; D012432:Rwanda / Q000453:epidemiology; D062606:Tertiary Care Centers
chemical_list: D000900:Anti-Bacterial Agents