Superbugs-related prolonged admissions in three tertiary hospitals, Kano State, Nigeria

Introduction Superbugs are pathogenic micro-organism and especially a bacterium that has developed resistance to the medications normally used against it. As the superbug family increases, the need for appropriate diagnostic, treatment, prevention and control strategies cannot be over emphasized. Therefore, this work determined the distribution of superbug bacteria among patients on prolonged hospital admissions in three tertiary hospitals of Kano state, Nigeria. Methods A descriptive cross sectional study was undertaken among 401 patients from medical, surgery, orthopedic and burn centre wards in a three tertiary hospitals in Kano state. A sample collected comprises wound/pus, urine, urine catheter and nasal intubation and were analysed using standard microbiological methods for Acinetobacter spp and other related nosocomial bacterial pathogens. Antibiotic susceptibility testing was done using Kirby-Bauer disc diffusion method. Results One hundred and thirty eight (138) isolates were recovered, from the studied participants. More than 80% of the nosocomial infections (NIs) were caused by Gram-negative bacteria, predominantly Escherichia coli, Klebseilla spp, Proteus spp, Pseudomona spp and Acinetobacter spp. In-vitro antibiotic susceptibility test revealed that acinetobacter were 100% resistant to amoxicillin, co-trimoxazole, perfloxacin and imipenem. Conclusion Superbugs (Acinetobacter species) significantly contributed to delayed hospital admissions through observed 100% resistance to used antibiotics. The healthcare managers of these hospitals and the ministry of health need to take measures against this resistant bacteria (Acinetobacter spp) especially on prescribing antibiotics that showed 100% resistant from these studied hospitals.


Introduction
Antimicrobial resistant poses one of the most pressing public health threats worldwide [1]. The emergence of resistant strains of hospital pathogens has presented a challenge in the provision of good quality of in-patient care. Inappropriate use of antibiotics in the hospital is largely responsible for this problem [2]. Bacterial infections caused by multidrug-resistant (MDR) bacteria are a growing threat worldwide [3]. They are a major cause of morbidity and mortality in developing countries including Nigeria. Antimicrobial resistance (AMR) is a major problem in both hospital and community acquired infections [4,5]. Several intrinsic factors such as point mutation, gene amplification and extrinsic factors like horizontal transfer of resistant gene between bacteria within and across species by transposes, integrins or plasmids have been postulated for the development of resistance, which cannot be reduced once developed even by restricting the antibiotic usage. Social factors such as demographic changes, poor hygienic practices and overcrowding have been enumerated for the emergence of AMR [6]. Infections caused by resistant bacteria adversely affect treatment outcomes, costs, disease spread and duration of illnesses, posing a serious challenge to the future chemotherapies [5,7]. In addition to this, the battle between bacteria and their susceptibility to drugs is yet problematic among public, researchers, clinicians and drug companies who are looking for effective drugs [7]. Global burden of antimicrobial resistant (AMR) is still unknown due the lack of comprehensive data from some part of the world especially African countries including Nigeria [1]. But literature has shown that, the burden is at alarming red. For

Results
A total of four hundred and one patients participated in the study.  (Table 4).

Discussion
More than 80% of the nosocomial infections (NIs) were caused by the Gram-negative bacteria (GNB

Conclusion
Present study determined the superbugs-related prolonged admissions in three tertiary hospitals, Kano state, Nigeria. The results showed that, Acinetobacter spp and other related nosocomial bacterial pathogens were 0-100% resistant to the antibiotics tested.
There is need for the management of the three studied hospitals to take measures especially in antibiotics prescription by reviewing guideline to avoid prescribing antibiotics that showed 100% resistance to this bacteria.
What is known about this topic  Presence of some nosocomial bacterial pathogens from the three studied hospitals;  Antibiotic resistant profile of some nosocomial bacterial pathogens from the three studied hospitals.
Page number not for citation purposes 5 What this study adds  Presence of Acinetobacter spp associated with other nosocomial bacterial pathogens from the three studied hospitals;  Antibiotic resistant profile of Acinetobacter spp associated with bacterial nosocomial pathogens from the three studied hospitals.

Competing interests
The authors declare no competing interests.

Authors' contributions
Alkali Bashir, Iliyasu Garba, Abdurrazak Kibiya and Muhammad Hassan Abubakar conducted the laboratory work of this study. The first mentioned authors and Adamu Almustapha Aliero, Ibrahim Ntulume, Faruku Sarkinfada and Agwu Ezera contributed equally to its content apart from the laboratory part. All authors read and approved the final version of this manuscript before submission.

Acknowledgments
We would like to thank the management of the three studied hospitals for granting us permission to carry out this study. Study participants for participating in this study. Finally the staff of the microbiology laboratories for their kind support during this study.