Abstract

CHARACTERIZATION OF BACTERIAL INFECTIONS AND ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF PERITONITIS POST CAESAREAN IN GYNECOLOGY AND OBSTETRIC DEPARTMENT AT UNIVERSITY TEACHING HOSPITAL OF KIGALI, RWANDA

Musabyumuremyi Celestin*, Arpita Sharma, Nyirigira John, Nkubana Theoneste, Uwamariya Chantal, Iradukunda Patrick, Musanabaganwa Clarisse and Mazarati Jean Baptiste

Abstract

Introduction: Peritonitis post- caesarean infections are the second cause of maternal mortality next to postpartum hemorrhage and most of bacteria responsible for those infections are antibiotics resistances which are public health concern. Objective: The aim of this study is to determine the risk factors to peritonitis post-cesarean infections; bacteria profile; pattern of their antibacterial susceptibilities and the genes that are involved in Extended Spectrum Beta Lactamase production for Gram negative bacteria. Methodology: This study was a prospective and descriptive study conducted from October 2017 to November 2018 at University Teaching Hospital of Kigali in gynecology and obstetric department with peritonitis post caesarean section whereby a total sample of 196 participants has been recruited using convenience sampling method. The samples culture, bacteria isolation, identification and antibacterial susceptibilities were performed according to CLSI. ESBL production for Gram negative bacteria were phenotypically identified with combination disc and genotypically by PCR. The data were entered in SPSS version 22 and statistically analyzed to determine the associated factors using Chi square test. Results: Out of 196 samples performed, 181samples were culture positives (92.3%). Higher proportion of bacterial isolates were Gram-negative than Gram-positive bacteria 126 (69.6%). Klebsilla pneumonia accounted for 30.9% and was the most isolated pathogen. Imipenem was sensitive to all Gram negative bacteria while erythromycin for Staphylococcus aureus. 44 Gram negative bacteria (34.9%) were confirmed phenotypically as ESBL positive. The coding genes identified are: TEM accounted for 20 (45.5%), CTX- M1 for 14 (31.8%), CTX- M2 for 4 (9%); and for OXA 6(13.6%). Concerning the isolated genes of ESBL; K.pneumonia had TEM (5), CTX- M1 (10), CTX- M2 (1), and OXA (1); E.coli TEM (8) CTX- M1 (3), CTX- M2 (2) and OXA ( 3); Acinetobator baumanii TEM (3), CTX- M1 (1), CTX- M2 (1 and OXA (1); Pseudomonas aeroginosa TEM (3) CTX- M1 (8), and OXA 1, Proteus mirabilis TEM (1). Conclusion: High rate of antibiotic resistance has been observed in this study therefore routine screening of ESBLs production should be enhanced and also the diagnostic capacity of laboratory professionals for the detection and surveillance of antibiotic resistance should be strengthened.

Keywords: Bacterial Infection Antimicrobial Susceptibility Peritonitis Caesarean.