A five year assessment of the emerging sensitivity patterns of the top six pathogenic bacterial isolates at the University Teaching Hospital (UTH) in Lusaka
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The effect of microbial resistance to antibiotics is growing at a very fast rate all over the world. One of the main reasons for this is the frequency of use of drugs for the treatment of common ailments, some of which may not even require antibiotics. Therefore, there is selective pressure resulting from drug-over use, misuse by patients due to poor health education, use of poor quality drugs because of failure by community members to afford the cost of high efficacy drugs have among other factors contributed to high Anti-Microbial Resistance. Coupled with this is the poor health-seeking behaviour of patients in poor communities who would rather share drugs meant for one patient because they cannot afford the cost. The irrational prescribing habits of clinicians have also been cited as being contributors to high Anti-Microbial Resistance. The University Teaching Hospital in Lusaka serves as the largest referral hospital in Zambia and therefore is affected by all the factors stated above.Consequently, the problem of AMR is prominent.This study was therefore carried out to explore the pattern of resistance of pathogenic microorganisms commonly isolated at the hospital against the prescribed classes of drugs. An assessment of which microorganism was most resistant over the entire period was done. In addition, the study identified which, among the antimicrobials tested over the five year period performed the least with respect to microbial sensitivity profiles. In order to carry out this study, a retrospective compilation of the data of antibiotic sensitivity testing at UTH was undertaken to cover a five year period stretching from June 2001 to June 2006. Data was entered in the same format used for reporting results (Resistance, Intermediate and Sensitive) and analysed for frequency of each per organism per year. Data was carried out first by using the EPi Data entry programme. Subsequently, data was exported for final analysis to the Statistical Package for Social Sciences (SPSS). Pearson's Chi square statistics were used in arriving at the associations between the effect of the various drugs and the microbial response as the basis for hypothesis testing. The results of this study showed that there has been a significant change in the way microorganisms are responding to the various antimicrobials over time (p<0.05). In addition, the most used drug groups, like chloramphenicol and penicillins at UTH were most affected by the problem of AMR (p=0.001 in each case). Microorganisms, however remained highly sensitive to quinolone drugs especially ciprofloxacin and norfloxacin with over 80% organisms testing sensitive. On the other hand, the penicillin group of antibiotics had the worst performance over the entire period of five years. They had a combined failure of 3197 isolates resisting their action. This represented a total of 73.2% resistance. Klebsiella was the single most resistant organism against all classes of drugs used, although it was prominently sensitive to the action of ciprofloxacin. Recognising that the problem of AMR is gradually increasing at the UTH, this study has proposed several interventions. Some of these include the need to uphold and promote the prudent use of antibiotics especially in human beings and revising or amending the policy on use of antimicrobials as growth promoters in animals. The other interventions should take into consideration the need to launch campaigns in communities on the safe and effective use of all medicines including antimicrobials, in similar ways that HIV/AIDS campaigns are done and to institute into routine work the aspects of continuous drug efficacy monitoring.