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Background: It is well documented that inappropriate use of antimicrobials is the major driver of antimicrobial resistance. To combat this, antibiotic stewardship has been demonstrated to reduce antibiotic usage, decrease the prevalence of resistance, lead to significant economic gains and better patients' outcomes. In Nigeria, antimicrobial guidelines for critically ill patients in intensive care units (ICUs), with infections are scarce. We set out to develop antimicrobial guidelines for this category of patients., Methods: A committee of 12 experts, consisting of Clinical Microbiologists, Intensivists, Infectious Disease Physicians, Surgeons, and Anesthesiologists, collaborated to develop guidelines for managing infections in critically ill patients in Nigerian ICUs. The guidelines were based on evidence from published data and local prospective antibiograms from three ICUs in Lagos, Nigeria. The committee considered the availability of appropriate antimicrobial drugs in hospital formularies. Proposed recommendations were approved by consensus agreement among committee members., Results: Candida albicans and Pseudomonas aeruginosa were the most common microorganisms isolated from the 3 ICUs, followed by Klebsiella pneumoniae, Acinetobacter baumannii, and Escherichia coli. Targeted therapy is recognized as the best approach in patient management. Based on various antibiograms and publications from different hospitals across the country, amikacin is recommended as the most effective empiric antibiotic against Enterobacterales and A. baumannii, while colistin and polymixin B showed high efficacy against all bacteria. Amoxicillin-clavulanate or ceftriaxone was recommended as the first-choice drug for community-acquired (CA) CA-pneumonia while piperacillin-tazobactam + amikacin was recommended as first choice for the treatment of healthcare-associated (HA) HA-pneumonia. For ventilatorassociated pneumonia (VAP), the consensus for the drug of first choice was agreed as meropenem. Amoxycillin-clavulanate +clindamycin was the consensus choice for CAskin and soft tissue infection (SSIS) and piperacillin-tazobactam + metronidazole ±vancomycin for HA-SSIS. Ceftriaxone-tazobactam or piperacillin-tazobactam + gentamicin was consensus for CA-blood stream infections (BSI) with first choice+regimen for HA-BSI being meropenem/piperacillin-tazobactam +amikacin +fluconazole. For community-acquired urinary tract infection (UTI), first choice antibiotic was ciprofloxacin or ceftriaxone with a catheter-associated UTI (CAUTI) regimen of first choice being meropenem + fluconazole., Conclusion: Data from a multicenter three ICU surveillance and antibiograms and publications from different hospitals in the country was used to produce this evidence-based Nigerian-specific antimicrobial treatment guidelines of critically ill patients in ICUs by a group of experts from different specialties in Nigeria. The implementation of this guideline will facilitate learning, continuous improvement of stewardship activities and provide a baseline for updating of guidelines to reflect evolving antibiotic needs., Competing Interests: The Authors declare that no competing interest exists., (Copyright © 2023 by West African Journal of Medicine.)

Background: Hand washing is the single most important means of preventing hospital acquired infections, but requires for effectiveness, a constant supply of running water and proper facilities. Most developing countries do not have constant running water facilities, so alternate methods have been developed and used in clinics and hospitals., Objective: To compare and validate alternate methods of hand washing developed for use in Nigeria., Methods: The hands of 12 volunteers were pre-contaminated with known isolates of Klebsiella pneumoniae, Escherichia coli and Pseudomonas aeruginosa. The volunteers washed their hands as described by Ayliffe. The hands and equipment were cultured pre- and post-contamination and post-hand washing. The water used for the hand wash was also cultured pre-hand washing to control for water-based contamination. Each method was evaluated three times and various parts of the equipment were cultured to determine the areas contaminated by the hands during the hand wash., Results: "Elbow-way" was shown to be the best and the gold standard Sink and Tap for promoting an effective hand washing, as there was no evidence of post-contamination. The worst was the single-bowl method in which the hands of all the 12 (100%) volunteers were contaminated from the bowl, followed by the two-bowl initiative 10 (83%) and the bucket and bowl 9 (75%)., Conclusion: The bucket and bowl as well as the single-bowl methods most commonly used in hospitals result in gross contamination of the bowls and bucket and are therefore unsafe and should be discouraged. The elbow way on the other hand appears to be an easy and safe alternative in situations where there is no running water.

Objectives: To obtain general information on soap use and soap bacterial flora, and to assess the risk of transmission of organisms from contaminated soap to patients., Design: Descriptive study., Setting: Three hospitals in an urban area of Lagos, Nigeria. A teaching (761 bed) hospital, a general hospital (a 51 bed secondary healthcare facility) and a private hospital (a 30 bed private community with a surgical specialty)., Results: Bar soaps were much more commonly used than liquid soaps. Out of the thirty six bar soaps and their receptacles studied, 19 (52.8%) were found wet, nine (25%) dry, five (13.9%) very dry, and three (8.3%) in a pool of water. A total of 39% soaps and 75% of receptacles were contaminated. Thirty three percent of the dry soaps and 68.4% of the wet soaps were contaminated. None of the very dry soaps and all in a pool of water were contaminated. The bacteria isolated from soaps included Pseudomonas aeruginosa (89.5%) and Klebsiella pneumoniae (10.5%), while Pseudomonas aeruginosa (70.6%), Klebsiella pneumoniae (14.7%), Staphylococcus aureus (11.8%) and Serratia marcescens (2.9%) were isolated from the receptacles. The antibiogram showed that the Pseudomonas aeruginosa isolated from the soaps and their containers (sinks) were distinct from those obtained from colonised or infected wounds. The soap contamination rates correlated with the conditions in which the soaps were kept., Conclusion: The type of soap containers in particular, played a vital role in keeping the soap dry or wet. In all the hospitals studied, the policies on soap use, if any, were not in agreement with the recommended guidelines. The healthcare workers need to be re-educated on these guidelines.

A prospective study to determine the causative agents of catheter-related bacteriuria was carried out on 99 patients with median age of 55 years, on admission in the Oncology, Paediatric Surgery and Obstetric and Gynaecology wards of the Lagos University Teaching Hospital. There was significant bacteriuria in seventy-one (72%) of the 99 urine samples. All catheter urine samples were contaminated by day 5 Gram-negative bacilli were predominant (89.3%) of which Pseudomonas aeruginosa (26.2%) was the most common, while Escherichia coli and Enterobacter aerogenes accounted for 15.5% each, closely followed by Proteus mirabilis (14.3%) and Klebsiella pneumoniae (9.5%). The Gram positive isolates Enterococcus faecalis (8.3%) and Staphylococcus saprophyticus (2.4%) made up only 10.7% of isolates. Most of the isolates from catheterised patients were resistant to the common antibiotics such as ampicillin, cotrimoxazole, gentamicin and ceftriaxone with high susceptibility to ofloxacin and ceftazidime though the isolates of Enterococcus faecalis was also resistant to ofloxacin. However, isolates of S. saprophyticus were still susceptible to the penicillins and tetracycline.

In vitro susceptibility of several strains of six different species of clinical facultative pathogens involved in nosocomial infections in our hospital was investigated by a series of disc diffusion, broth dilution and Chequerboard titration testing. With disc diffusion method all the test strains, except Streptococcus pyogenes, were resistant to penicillin. 46% of the Klebsiella aerogenes and 73% of the Pseudomonas strains were generally resistant to cefotaxime. The minimum inhibitory concentration (MIC) of the antibiotics correlated well with the results of the disc diffusion tests. Synergistic effects were demonstrated by various combinations of gentamicin, ampicillin, clindamycin, colistin, cefoxitin, and ceftriazone against resistant strains of S. aureus, Pseudomonas aeruginosa, Escherichia coli and Klebsiella aerogenes. Against S. aureus the effect of gentamicin/clindamycin demonstrated indifference. The need for stringent caution is strongly advocated in the selection of combination therapy for serious infections caused by some hospital bacterial strains particularly in acute care units. The clinical microbiologist should be consulted at all times during the process of selection of an appropriate combined therapy for expert guidance.