Research Article ISSN 2639-9458

Microbiology & Infectious Diseases

Bacterial Ecology and Bacterial Resistance Profile to Antibiotics in the

Department of Medicine and Urology of the BSS University Hospital of Kati
Hamsatou CISSE1, Youba SANGARE1, Abdramane TRAORE1, Nagou TOLO1, Amadou KASSOGUE3,
Djeneba DIAGNE1, Cheick Oumar SANOGO2, Boureima KODIO4, Abdoulaye Mamadou TRAORE5,
Garan DABO6, Ghislain PODA7, Brehima GUINDO8 and Daouda Kassoum MINTA5*
1
Department of General Medicine CHU "Professor Bocar Sidy
Sall" of Kati.

2
Traumatology Department CHU "Professor Bocar Sidy Sall"
of Kati.

3
Department of Urology, CHU "CHU Professor Bocar Sidy
Sall" of Kati. *
Correspondence:
Professor. Daouda Kassoum MINTA, Department of Infectious
4
Primum NOCERE Clinic. Diseases, Point G University Hospital, Bamako, Mali, Tel: +223
66844762 /+223 75090209, E-mail: minta_daouda@yahoo.fr.
Department of infectious diseases, CHU du Point G, Bamako,
5

Mali. Received: 07 Jan 2024; Accepted: 15 Feb 2024; Published: 22 Feb 2024

Department of Medicine « CHU « l'hôpital du Mali » Bamako.

6

Mali.

7
National Institute of Public Health, Bamako, Mali.

8
National Institute of Public Health, Bacteriology Laboratory.

Citation: Hamsatou C, Youba S, Abdramane T, et al. Bacterial Ecology and Bacterial Resistance Profile to Antibiotics in the Department
of Medicine and Urology of the BSS University Hospital of Kati. Microbiol Infect Dis. 2024; 8(1): 1-7.

ABSTRACT
Background: The emergence and spread of antibiotic resistance is a major public health threat. Worldwide, one of the main causes
remains the unreasonable use of antibiotics.

Objective: To map bacterial infections and the resistances profile of antibacterials at Kati University Hospital.

Methodology: Transversal analytical study with prospective collection over a period of 20 months in the department of general
medicine and urology of the BSS University Hospital of Kati.

Results: 102 patients participated in this study with an average age of 55.5 years. Almost a quarter (72.5%) of participants were men.
Less than half were patients aged 60 years. The biologics examined involved urine (78.4 %), pus (16%), blood (12.7%), stool (2%)
samples. The main germs isolated were: Escherichia coli (52.9%); Klebsiella pneumonia (14.5%); Staphylococcus aureus (9.9%);
Acinetobacter baumannii and Enteroccocus faecium (4.9%). The level of resistance of Escherichia coli and Klebsiella pneumoniae
was high to ampicillin, amoxicillin-clavulanic acid; cotrimoxazole; moderately elevated to C3G, and fluoroquinolones with relative
sensitivity to aminoglycosides. Imifpenem, Amikacin, Ertapenème were the most active antibiotics. Staphylococci were resistant
to penicillin, with ciprofloxacin and oxacillin. Thus, Acinetobacter baumannii had a high level of resistance to C3G, Ticarcillin,
Cotrimoxazole and Piperacillin-tazobactam. Enteroccocus faecium had strong resistance to Cotrimoxazole and Ciprofloxacin.

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 Approximately, 51% of isolated bacteria were multi-resistant. HIV infection; antibiotic therapy; a long stay in a healthcare setting is
a risk of acquiring multidrug resistance. This relationship is statistically significant with a p value of p<0.00respectively 5

Conclusion: The level of resistance recorded should serve as an alert for the implementation and application of prevention strategies
for BMR. The resistance profile determined will be used to better guide the rational prescription of antibiotic therapy in our hospital.

Keywords profile and write the determinants associated with the emergence
Bacterial ecology, Antibacterial resistance profile, CHU BSS Kati. of antibacterial resistance.

Introduction Methodology
The discovery of antibiotics was considered the most important It is analytical cross-sectional study using a prospective collection
and astonishing of the twentieth century. Their introduction into method over a period of 20 months (January 2019 to August2020)
clinical care practice is one of the interventions that has addressed in the Department of General Medicine and urologsurgery within
not only infectious disease control challenges with millions of lives the University Hospital Center “Professor Bocar Sidy Sall" (CHU-
saved but also a revolutionized practice [1]. However, according BSS) by Kati. Our study site is located about fifteen km from the
to the WHO, a serious and growing threat to global health is capital of the country and approved for the care of patients referred
deteriorating the effectiveness of these therapeutic molecules, due from different levels of the country's health pyramid or from those
to the increase in antibiotic resistance in community care settings who have come for routine consultations by personal decision.
and the environment concomitant with their use [2]. This Bacterial
Resistance to Antibiotics, defined here as the ability of bacteria Study Population Characteristics
to survive in concentrations of antibiotics that usually inhibit/ Adult patients admitted to hospitalization following referral from a
kill others of the same species "Antimicrobial resistance may not health facility of lower technical platform level or equivalent level,
seem as urgent as a pandemic, but it is just as dangerous" [3]. The having been exposed to antibiotic therapy or not; or patients who
European Antibiotic Resistance Surveillance Network (EARSS) have made an individual decision of outpatient consultation prior
reports about 50% of Escherichia coli strains were resistant to hospitalization.
to ampicillin in France, as globally in all AERSS participating
countries [4]. Eligibility
Eligibility for the study concerned exhaustively all patients
It affects 500,000 people with suspected bacterial infections in 22 admitted to hospitalization with clinical signs in favor of an
countries and according to the same source, more than 700,000 infectious syndrome who had benefited from a collection of
deaths worldwide result each year from antimicrobial-resistant pathological products for etiological research purposes and whose
infections based on OMS, more than the number of deaths caused bacterial etiology documented is combined with an antibiogram
by cancer by 2050 [5]. over the entire study period.

In the United States, resistance to ATBs is responsible for more Data collection and analysis
than 23,000 deaths and a direct societal cost of $20 billion, and an Data collection is carried out by pre-trained and field-tested survey
indirect cost of $35 billion. It is noted during 400,000 infections personnel. The data is collected on pre-established individual
responsible per year with at least 25,000 deaths [5,6]. records and entered on Access version 2016. The variables studied
include sociodemographic, clinical, biological bacteriological
In Africa, this phenomenon of resistance is poorly evaluated; data variables. The premium IMB SPSS Statistics 21 software was
show a strong spread of multidrug-resistant bacteria in the various used for the analysis. The proportions were compared by the chi-
countries of West Africa [6]. The lack of national epidemiological square test and Fisher's exact test. A p-value ≤ 0.05 was considered
data on Bactriean resistance and of national reference on BMR are a statistically significant difference.
a handicap to the implementation of BMR prevention strategies
[1]. Plot work in the context of the LCRMs reports a high Ethical aspects
frequency of multidrug-resistant enterobacteriaceae among others, The protocol of this study was submitted to the administrative
64.3% of E coli and 34.5% of Klebsiella pneumonia [1,5]. Within managers of the CHU " Professor Bocar Sidy Sall" of Kati. After
other hospitals in the country, ours would not be immune to the approval, patients' voluntary, voluntary and informed consent
emergence of antibacterial resistance. It is necessary to take stock was sought prior to inclusion. All patients have an identification
of the issue of the profile of antibacterial resistance, with regard number that will allow them to remain anonymous. The files are
to abusive and unregulated prescription; The absence of a local closed in a safe and kept for a period of 5 years.
repository; the frequency of invasive procedures and the long stay
of patients in a care setting. Results
Socio-demographic characteristics of participants
Our objective was to do bacterial infectious etiological research of During the study period, we collected 840 hospitalizations, 102
cases; determine the frequency of the current bacterial resistance patients meeting our inclusion criteria or 12.14% of patients. Most

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 Figure 1: Sample portion taken.

Figure 2: Distribution by wearing of medical equipment.

Figure 3: Type of germs isolated.

Figure 4: Proportion of different multidrug-resistant bacteria in isolates.

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Table 1: Proportion of germs isolated by body fluids.
Bacterium Blood (%) Urine (%) Stool (%) Pus (%) Total
Escherichia Coli 3 46 1 4 54
Klebsiella pneumoniae 2 12 0 0 14
Staphylococcus aureus 2 4 0 1 7
Streptococcus hemolyticus 2 0 0 0 2
Streptococcus epidermis 1 0 0 0 1
Enterrococcus faecium 0 5 0 0 5
Enterococcus faecalis 0 1 0 0 1
Pseudomonas aerguinosa 0 4 0 0 4
Acinetobacter baumani 0 5 0 0 5
Enterobacter sp 0 2 0 0 2
Morganella morganii 0 1 0 0 1
Salmonella spp 0 0 1 0 1
Proteus mirabilis 0 1 0 0 1
Sphingomonas 0 1 0 0 1
Raoultella ornithinolytica 0 1 0 0 1
Proteus penneri 0 1 0 0 1
Streptoccocus spp 0 0 0 1 1
Total 10 84 2 6 102

Table 2: Profile resistance Escherichia coli to antibacterial. Table 3: Resistance profile of Klebsiella pneumoniae.
Sensitive Resistant Total Sensitive Resistant Total
Antibiotic Antibiotic
n% n% n% n% n% n%
Ampicillin 2 (3,7) 48 (88,9) 50 (92,6) Ampicillin 0 11 (78,6) 11 (78,6)
Amoxi-Ac clavulanic 7 (13) 44 (81,5) 51 (94,5) Amoxi-Ac clavulanic 7 (21,4) 10 (71,4) 13 (92,8)
Ticarcillin 3 (5,6) 39 (72,2) 42 (77,8) Ticarcillin 0 11 (78,6) 11 (78,6)
Piperacillin-Tazobactam 7 (13) 32 (59,3) 39 (72,3) Piperacillin -Tazobactam 3 (21,4) 7 (50) 10 (100)
Cefotaxime 10 (18,5) 39 (72,2) 49 (90,7) Cefotaxime 4 (28,6) 7 (50) 11 (78,6)
Ceftazidime 8 (14,8) 38 (70,4) 46 (85,2) Ceftazidime 3 (21,4) 8 (57,1) 11 (78,6)
Ertapenem 40 (74,1) 5 (9,4) 45 (83,3) Ertapenem 9 (64,3) 1 (7,1) 10 (74,4)
Imipenem 45 (83,3) 2 (3,7) 47 (87) Imipenem 11 (78,4) 2 (14,3) 13 (92,8)
Amikacin 41 (75,9) 9 (16,7) 50 (92,6) Amikacin 12 (85,7) 0 12 (85,7)
Gentamicin 27 (50) 20 (37) 47 (87) Gentamicin 3 (21,4) 8 (57,1) 11 (78,6)
Ciprofloxacin 8 (14,8) 42 (64,6) 50 (92,6) Tobramycin 4 (28,6) 8 (57,1) 12 (85,7)
Ofloxacin 4 (7,4) 40 (74,1) 44 (81,5) Ciprofloxacin 4 (28,6) 10 (74,4) 14 (100)
Ofloxacin 3 (21,4) 9 (64,3) 12 (85,7)

Table 4: Isolation of bacterial resistance by previous exposure to antibiotic therapy.

Risk factors related to bacterial resistance
95% C.I. for EXP (B) P-value
Exp (B) Lower Upper
HIV 10,009 3,644 27,493 ,000
Step
ATB ,214 ,095 ,479 ,000
Constant ,746 ,593

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of our patients were male and aged 60 years and older with a mean The evolution was favorable in patients without BMR carriers, a
of 55.5 years, a standard deviation of 18, 21 years. More than half frequency of 73.1%. The difference was statistically significant
of our study population, or 60.8%, had a notion of prior exposure (P<0.05).
to an antibiotic. The wearing of a noted medical equipment was the
peripheral venous catheter in 98% patient and the bladder soundin Discussion
86% (Figure 1). The emergence of bacterial resistance with different mechanisms
presents a public health problem, as is the case in this study
Sampling process conducted in patients admitted to hospitalization in both
In the 102 subjects collected during the study, the majority departments. The main objective of this study was to investigate
biologics were urine (78.4%), Purulent (16%), blood (12.7%), bacterial infections and the antibiotic resistance profile. During
stool (2%) samples that were tested. the implementation of this study, some limitations were identified,
including:
E coli is the germ most found in both departments with a greater • The difference between susceptibility testing is that the
frequency in the urology department or 53% followed by 14.3% of samples were not processed in the same laboratory.
Klebsiella pneumonia and Staphylococcus aureus in 7% of cases. • Completeness of data.
• The low participation rate due to lack of financial means for
Results of Susceptibility Testing of Priority Germs the realization of biological examinations.
Bacterial resistance to antibacterial antibiotics has increased to
alarming proportions in view of our analysis. Despite these limitations, this study retains its originality, which
 Escherichia coli: most E. coli strains had developed stronger lies in its prospective and multi-service nature thus taking a picture
resistance in more than > 60% to ampicillin (88.9%); of the situation of isolated bacteria and their level of sensitivity to
Amoxicillin-clavulanic acid (81.5%); Ofloxacin (74.1%); antibiotics.
Ticarcillin (72.2%). About 40% of the strains were resistant
to Cefotaxime Ceftazidime. Ertapenem, Imipenem Amikacin During our study period, 102 patients meeting our inclusion
remain active on most strains (only 16% resistance recorded criteria or 12.14% of patients were registered. Most of our patients
to amikacin). were male aged 60 years and older with an average age of 55.5
 Klebsiella pneumoniae: 74.4% were resistant to Ciprofloxacin years. This predominance of the elderly and the male sex could be
and Tobramycin. All strains tested were sensitive to Amikacin, explained by the fact that 2/3 of our patients were collected in the
7.1% were resistant to Ertapenem and 14.3% to Imopenem. urology department.
 Acinetobacter baumannii: The combination piperacillin-
tazobactam, Ceftazidime and Cotrimoxazole were the most Bacterial infection can occur at any age; but it is more common in
resistant molecules at 60% each. They were all sensitive to the elderly because of a decreased immune system, bladder atony,
Amikacin, the lowest resistance rate was with imipenem 20%. and the presence of comorbidities. In an earlier study conducted in
 Staphylococcus aureus had developed a higher resistance Bamako, the results showed that the infection was more common in
to Cotrimoxazole with 57.1% and 42.9% resistance to women than in men, so he reports in his observation, that the urinary
benzylpenicillin, ciprofloxacin, oxacillin and gentamicin. tract infection was not related to age but patients aged 60 years and
 Enteroccocus spp had developed resistance to vancomycin and older were the most affected with and a frequency of 69.23%. The
erythromycin (20%); amoxi-clavulanic acid, Cotrimoxazole same findings were made in Morocco by Saadoun who in his series
and Ciprofloxacin (40%). also reports that urinary tract infection affects all age groups with a
predominance of the age group of 60 years and over (35%), followed
Multidrug-resistant bacteria (MDR) and associated factors by that between 41-60 years (33%) [7]. Indeed, in the elderly, there
Multidrug-resistant bacteria accounted for 51% of the germs is a decrease in the immune defenses of the urinary tract due to
isolated in our series; ESBL production has been observed in changes in the urinary tract, especially the bladder and genital tract.
Enterobacteriaceae (E. coli and K. pneumoniae). BSLE production These changes vary by gender [8]. Of the 102 samples collected
was isolated from E. coli with a frequency of 73.1% (38 out of during the study period, they were mainly urine samples (78.4%)
54 strains isolated) followed by15;4% of K. pneumoniae Several followed by blood samples (12.7%), purulent samples (6.9%).
determinants or factors including HIV infection (40%), previous Urinary tract infection is the most common bacterial infection in
use of antibiotic therapy (79%) have been identified associated the world. This predominance could be explained using bladder
with the emergence of resistance cases but also the duration of catheters by the majority of our patients (86%). In addition to bladder
hospitalization in a healthcare setting, the average of which was catheterization, almost all of our patients had undergone peripheral
13.32 days. HIV-infected patients are ten times more likely to venous catheterization (98.6%) which would be responsible for a
have antibiotic resistance to [RR 10,009; 95% C.I. 3.644-27.493] probable increase in the rate of bacteraemia. In Morocco, Mortaji
However, we did not find a statistically significant relationship had reported in his series that bronchopulmonary infections occupy
between the use of a bladder catheter and theplacement of a the first place with a rate of 47%; infections related to blood cultures
peripheral venous catheter. (primary or secondary bacteremia from another site e.g. urinary tract

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or catheter) with a rate of about 23%; urinary tract infections with a found a susceptibility to fosfomycin and nitrofurantoin greater
rate of about 16%; infections related to pus and miscellaneous with than 98%, a resistance to cephalosporins less than 5% and a
a rate of about 9%. Note his study took place in an intensive care susceptibility to ciprofloxacin less than 90% but this varied
unit. For genital swabs, there was a low diagnostic orientation and according to age and sex. It ranged from about 85% in women
demand is generally low at the level of national hospitals, which are over 65 to 95% in women aged 15 to 65 and about 82% in men.
the last resort for patients after repeated failures of antibiotic therapy.
Imopenem and Amikacin were the most active molecules on BGN
E coli is the germ most found in both departments (medicine especially E. coli and Klebsiella pneumoniae with a low resistance
and urology) with a greater frequency in the urology department rate (less than 20%). These molecules are less used in therapeutics
explaining its presence in most urine samples in this series or 53% by their cost, their limited accessibility and the rational use of
followed by Klebsiella pneumonia 14.3% and Staphylococcus these molecules is mandatory in order to avoid the emergence
aureus in 7% of cases. Gram-negative bacilli are mainly responsible of carbapenemase-producing E. coli strains. Multidrug-resistant
for urinary tract infections, hence a significant proportion of E coli bacteria are a major public health problem, they accounted for
and Klebsiella pneumoniae in our series. This rate is identical to more than half of the germs isolated in our series or 51%. They
that of Takilt et al. in Algeria in 2014, had found Escherichia coli were mainly dominated by enterobacteriaceae (E. coli and
51.94%, Klebsiella 14.56%, Staphylococcus aureus 2.91% [10]. Klebsiella pneumoniae) producing ESBL respectively Escherichia
In Bamako, Coulibaly reports having isolated mostly in order of coli with a frequency of 73.1% or 38 strains out of 54 isolated
frequency Escherichia coli and Klebsiella pneumoniae in 57.75% strains followed by Klebsiella pneumoniae or 15.4%.
and 22.54% of BGN; a codominance of Staphylococcus aureus and
coagulase-negative Staphylococcus in 27.59% of GC (+) each [11]. In France Chervet reported a prevalence of ESBL-secreting
On the other hand, our figures are lower than those of Saadoun in bacteria at 4.2% among Enterobacteriaceae, 5.1% among
Morocco, which had found E. coli with a frequency of 69% followed Escherichia coli and 3% among Klebsiella sp [7], Our figures are
by Klebsiella spp (18%) [7]. Similarly in Paris, Chervet in his study higher than in the literature with a prevalence of ESBL-secreting
on urinary tract infections in the city, reported that most of the urine E. coli at 1.7% between 2003 and 2006 in the Aresc study [14],
analyzed was therefore positive for Eschericha coli (69.4% in the to 1.2% in 2007-2008 in the Ecosens II study [15] and to 3% in
general population, 74.0% in women and 50.1% in men) [12]. 2011 in the AFORCOPI-Bio study [16] which confirms that the
prevalence of ESBL-secreting E. coli is increasing in community-
Analysis of the susceptibility test revealed that the majority of E. coli acquired urinary tract infections.
strains Coli had a stronger resistance in more than 70% to penicillins
(ampicillin), fluoroquinolones (Ofloxacin, ciprofloxacin) and ESBL-producing Enterobacteriaceae are responsible for most
amoxi cillin-clavulanic acid. This rate is significantly higher than nosocomial infections, as approximately all of our patients had
undergone bladder catheterization and PVC; In addition, we did not
that of Takilt et al in Algeria in 2014, reported resistance to E. coli.
find a statistically significant relationship between the wearing of a
in 13.19% of the Penicillin family, Klebsiella pneumoniae was
bladder catheter, the peripheral venous catheter and the occurrence
resistant to amoxi-clavulanic acid, amoxicillin, and Ofloxacin. On
of resistance. However, several other factors were associated with
the other hand, in his study Staphylococcus aureus was practically
this resistance with a statistically significant relationship p<0.05.
sensitive to all antibiotics tested, except for Ofloxacin. [10],
These include HIV infection which was present in 40%, the notion
Saadoun in Morocco noted resistance of E. coli to amoxicillin in
of antibiotic intake prior to hospitalization in 79% of cases but also
64%, although this molecule is not currently recommended for
the duration of hospitalization.
probabilistic treatment of community urinary tract infections [16],
44% to amoxi cillin-clavulanic acid, 36% to ciprofloxacin [7].
Conclusion
Multi-bacterial resistance appears to be expanding in our
In our study about 50% of the strains of Klebsiella pneumoniae
hospital. A framework for consultation between practitioners
were resistant to the different classes of antibiotics tested (C3G,
and in collaboration with microbiologists would better guide the
Fluoroquinolone, aminoglycosides). This rate is significantly prescriptions of anti-infectives.
lower than that of Saadoun, which had found strains of Klebsiella
pneumoniae resistant to third generation cephalosporins (C3G)
22%, aminoglycosides 27% and Ciprofloxacin 42.7% [7]. The References
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© 2024 Hamsatou CISSE, et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License

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