High prevalence of multidrug-resistant bacteria on patient medical file surfaces at five critical care units in Kampala, Uganda: an explanatory sequential mixed-methods study.

Abstract

Introduction: Intensive care units (ICUs) and high-dependency units (HDUs) care for critically ill patients, many of whom have multi-drug-resistant (MDR) bacteria. We investigated the prevalence and distribution of MDR bacteria on the surfaces of patient medical files in three ICUs and two HDUs in Kampala.

Method: We conducted a cross-sectional study that used simple random sampling to select patient medical files through unique codes recorded in a health information electronic system. MDR was defined as laboratory confirmation of the WHO priority pathogens following the 33rd edition of the Clinical Laboratory Standards Institute on Antimicrobial Susceptibility testing guidelines for antibiotic susceptibility interpretation. Quantitative data was descriptively analyzed, while qualitative was thematically analyzed.

Results: Six of 33 files (18.2%) had MDR bacteria on their surfaces. Contamination was significantly associated with the type of medical diagnosis (p=0.014) and the file storage location (p=0.010). The MDR pathogens identified were Fastidious Acinetobacter (5/33; 15.2%) and methicillin-resistant Staphylococcus aureus (1/33; 3%).

Conclusion: Nearly one in five patient medical files in ICUs and HDUs were contaminated with MDR bacteria. Most contaminated files belonged to patients treated with aminoglycoside or glycopeptide-based regimens.