Understanding Laboratory Methods and Their Impact on Antimicrobial Resistance Surveillance, at Muhimbili National Hospital, Dar es Salaam, Tanzania

Peter Nyasulu, Mabula Kasubi, Respicious Boniface, Jill Murray

Department of Microbiology, Central Pathology Laboratory, Muhimbili National Hospital, Dar es Salaam, Tanzania.
Department of Public Health, School of Health Sciences, Monash University, Ruimsig, South Africa;School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Muhimbili Orthopaedic Institute, Muhimbili National Hospital, Dar es Salaam, Tanzania.
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

DOI: 10.4236/aim.2014.41007                

Abstract

The study sought to describe laboratory methods and blood culture procedures and their impact on antimicrobial resistance surveillance among nosocomial bacteria. We conducted a systematic audit of blood culture procedures and practices in the Department of Microbiology, Central Pathology Laboratory at Muhimbili National Hospital, between 19^th and 23^rd March 2012. A total of 25 -30 blood culture specimens were received each day as an indication of low volumes of blood culturing at this site. More blood culture requests came from the neonatal unit of the hospital, and were performed manually with high culture negative specimens. The laboratory performed antibiotic susceptibility testing as per the CLSI guidelines. No vancomycin resistance was ever reported at this site. All blood culture results were entered into the JEEVA laboratory information system, where results could be accessed by clinicians in the wards and data could be retrieved to assess patterns of antimicrobial resistance. Blood culture data entry system lacked quality control checks hence numerous errors and missing data were observed. Our results support the relevance of having improved laboratory procedures and good quality blood culture since surveillance of antimicrobial resistance primarily depends on good laboratory procedures, good quality and reliable blood culture data. This would essentially minimise imprecise estimates of rates of antimicrobial resistance at this hospital.

Keywords

Antimicrobial Resistance; Microbiology; Surveillance; Laboratory; Tanzania

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Muhimbili National Hospital. http://www.mnh.or.tz (Accessed March 30 2013)
[2]	United Republic of Tanzania, Prime Minister’s Office, “Regional Administration and Local Government. Strategic Plan for 2010/11-2012/2013.”
[3]	MNH, “Directorate of Clinical Support Services Profile.” http://www.mnh.or.tz/index.php/directorates/clinical-services (Accessed March 30 2013)
[4]	United Republic of Tanzania, Ministry of Health and Social Welfare, “National Health Laboratory Strategic Plan, 2009-2015. p. ix-52p.”
[5]	T. Mazzulli, “Vancomycin Resistant Staphylococcus aureas (VRSA). Canadian Antimicrobial Resistance Alliance.” http://www.can-r.com/mediaResources/VRSA.pdf (Accessed November 10 2013)
[6]	P. C. Applebaum, “The Emergence of Vancomycin-Intermediate nd Vancomycin-resIstant Staphylococcus aureus,” Clinical Microbiology and Infection, Vol. 12, No. S1, 2006, pp. 16-23. http://dx.doi.org/10.1111/j.1469-0691.2006.01344.x
[7]	Clinical and Laboratory Standards Institute, “Performance Standards for Antimicrobial Susceptibility Testing. Twentieth Information Supplement,” Wayne, PA.
[8]	“Jeeva (‘Life’) Informatics Solutions.” http://www.jeevadx.com/ (Accessed October 31 2013)
[9]	WHO, “Surveillance of Antimicrobial Resistance.” http://www.who.int/drugresistance/surveillance/en/ (Accessed November 11 2013)
[10]	WHO, “Manual for the Laboratory Identification and Antimicrobial Susceptibility Testing of Bacterial Pathogens of Public Health Importance in the Developing World,” 2003. http://www.who.int/csr/resources/publications/drugresist/en/IAMRmanual.pdf
[11]	WHONET, “Microbiology Laboratory Database Software [Computer Programme],” World Health Organisation, and Boston (MA): WHO Collaborating Centre for Surveillance of Antimicrobial Resistance, Microbiology Laboratory, Brigham and Women’s Hospital, Geneva, 1999.
[12]	WHO, “The WHO Global Strategy for Containment of Antimicrobial Resistance.” http://www.who.int/csr/resources/publications/drugresist/en/EGlobal_Strat.pdf (Accessed November 11 2013)