Bacterial Isolates and Their Antimicrobial Susceptibility Patterns of Wound Infections among Inpatients and Outpatients Attending the University of Gondar Referral Hospital, Northwest Ethiopia

Antibiotic Resistance Profiles and MLST Typing of Staphylococcus Aureus Clone Associated with Skin and Soft Tissue Infections in a Hospital of China

Objective

To analyze the antibiotic resistance profile, virulence genes, and molecular typing of Staphylococcus aureus (S. aureus) strains isolated in skin and soft tissue infections at the First Affiliated Hospital, Gannan Medical University, to better understand the molecular epidemiological characteristics of S. aureus.

Methods

In 2023, 65 S. aureus strains were isolated from patients with skin and soft tissue infections. Strain identification and susceptibility tests were performed using VITEK 2 and gram-positive bacteria identification cards. DNA was extracted using a DNA extraction kit, and all genes were amplified using polymerase chain reaction. Multilocus sequence typing (MLST) was used for molecular typing.

Results

In this study, of the 65 S. aureus strains were tested for their susceptibility to 16 antibiotics, the highest resistance rate to penicillin G was 95.4%. None of the staphylococcal isolates showed resistance to ceftaroline, daptomycin, linezolid, tigecycline, teicoplanin, or vancomycin. fnbA was the most prevalent virulence gene (100%) in S. aureus strains isolated in skin and soft tissue infections, followed by arcA (98.5%). Statistical analyses showed that the resistance rates of methicillin-resistant S. aureus isolates to various antibiotics were significantly higher than those of methicillin-susceptible S. aureus isolates. Fifty sequence types (STs), including 44 new ones, were identified by MLST.

Conclusion

In this study, the high resistance rate to penicillin G and the high carrying rate of virulence gene fnbA and arcA of S.aureus were determine, and 44 new STs were identified, which may be associated with the geographical location of southern Jiangxi and local trends in antibiotic use. The study of the clonal lineage and evolutionary relationships of S. aureus in these regions may help in understanding the molecular epidemiology and provide the experimental basis for pathogenic bacteria prevention and treatment.

One-Pot Synthesis of Silver/Zirconium Nanoparticles Using Sargassum tenerrimum for the Evaluation of Their Antibacterial and Antioxidant Activities

INTRODUCTION

The global health threat posed by worldwide antimicrobial resistance necessitated immediate multisectoral action by the scientific community to achieve sustainable development goals. Silver and zirconium nanoparticles (Ag/ZrO-NPs), known for their antimicrobial properties, have the potential to combat pathogens effectively, making them versatile for various applications across different fields.

OBJECTIVE

 This study aims to synthesize and characterize Sargassum tenerimum-mediated Ag/ZrO-NPs and evaluate their antioxidant and antibacterial efficacy against multidrug resistant (MDR) pathogens.

METHODOLOGY

The synthesis of Ag/ZrO-NPs using the one-pot green synthesis method was conducted and followed by using characterization techniques, namely, UV-visible spectroscopy (UV-vis), Fourier transform infrared spectroscopy (FT-IR), field emission scanning electron microscopy (FE-SEM), X-ray diffraction analysis (XRD), and energy-dispersive X-ray analysis (EDX). The antibacterial activity was assessed using the agar well diffusion method, and antioxidant activity was determined using the DPPH(2,2-diphenyl-1-picrylhydrazyl) method. Statistical analysis was analyzed using the IBM SPSS Statistics for Windows, version 21.0 (released 2012, IBM Corp., Armonk, NY).

RESULTS

The green-synthesized Ag/ZrO-NPs exhibited a color change from dark brown to creamy white, indicating the successful reduction of the nanoparticles. UV-analysis peaks were observed at 310-330 nm, while the FT-IR analysis showed the peaks at various wavelengths, such as 648.9 cm-1 (alkyne C-H bond), 1041.14 cm-1 (aliphatic fluoro compounds, C-F stretch), 1382.54 cm-1 (dimethyl -CH3), 1589.6 cm-1 (primary amine, N-H bond), and 3353.8 cm-1 (aliphatic secondary amine, N-H stretch). The crystallinity of the nanoparticles was determined to be 59.5%, while the remaining 40.5% exhibited an amorphous structure. The SEM image revealed the spherically agglomerated structure of the nano-ranged size Ag/ZrO-NPs. The EDX analysis indicated the presence of elemental compositions Zr (16.2%), Ag (18.8%), and C (28.7%) in the green-synthesized Ag/ZrO-NPs. These nanoparticles demonstrated significant antibacterial activity against Pseudomonas aeruginosa, Enterococcus faecalis, and Methicillin-resistant Staphylococcus aureus (MRSA). The moderate antibacterial activity against E. coli showed thesignificant antioxidant activity in a dose-dependent manner.

CONCLUSION

The green-synthesized Ag/ZrO-NPs showed notable antibacterial and antioxidant activity. In future aspects, it may be used as a potential drug after completion of in-vivo and in-vitro studies.

Prevalence and antimicrobial susceptibility profile of bacteria isolated from the hands of housemaids in Jimma City, Ethiopia

Introduction

Bacterial pathogens continue to be a major cause of foodborne gastroenteritis in humans and remain a public health problem. Housemaids operating inside a kitchen could be the source of infection and may transmit disease-inflicting pathogens through contaminated hands.

Objective

This study aimed to assess the prevalence and antimicrobial susceptibility profile of bacteria isolated from the hands of housemaids in Jimma City, Ethiopia.

Methods

A laboratory-based cross-sectional study was employed among 234 housemaids. Hand swab samples from the dominant hand of the study participants were collected under sterile conditions following standard operating procedures. Then, in the laboratory, the swabs were inoculated aseptically using streak-plating methods on the growth media, such as mannitol salt agar [Staphylococcus aureus and coagulase-negative staphylococci], MacConkey agar [Klebsiella species and Proteus species], salmonella-shigella agar [Salmonella species and Shigella species], and eosin methylene blue agar [Escherichia coli (E. coli)]. In addition, a set of biochemical tests was applied to examine bacterial species. Data were double-entered into EpiData version 3.1 and then exported to the Statistical Package for Social Science (SPSS) version 26 for further analysis. Descriptive analyses were summarized using frequency and percentage.

Results

The proportion of housemaids' hands containing one or more positive bacterial isolates was 72% (95% CI: 66.2, 77.8). The dominant bacterial isolates were Staphylococcus aureus (31.6%), Escherichia coli (21.3%), Salmonella species (1.3%), Shigella species (6.7%), Klebsiella species (23.1%) and Proteus species (14.7%). Fingernail status (AOR =15.31, 95% CI: 10.372, 22.595) and the removal of a watch, ring, and bracelet during hand washing (AOR = 20.844, 95% CI: 2.190, 9.842) were significantly associated with the prevalence of bacterial isolation. Most Staphylococcus aureus isolates were susceptible to chloramphenicol (98.6%). Escherichia coli isolates were susceptible to tetracycline (75%), ceftriaxone (79.2%), chloramphenicol (87.5%), and ceftazidime (77.1%). Eighty percent of isolated Shigella species were susceptible to chloramphenicol and gentamicin respectively. In addition, Klebsiella and Proteus species exhibited high susceptibility to chloramphenicol. However, their isolates showed resistance against a number of the tested antimicrobials. Staphylococcus aureus isolates (28.2%) were resistance to tetracycline. Moreover, One-quarter of Escherichia coli isolates were resistance to tetracycline, ceftriaxone, chloramphenicol, and ceftazidime. Whereas 46.7% and 48.5% of isolated Shigella species and Proteus species were resistance to tetracycline and ceftriaxone.

Conclusion

The hands of housemaids are important potential sources of pathogenic bacteria that would result in the potential risk of foodborne diseases. Most bacteria isolates were resistant to tetracycline, ceftriaxone, and ceftazidime. Therefore, practicing good hand hygiene helps to prevent and control the spread of antimicrobial-resistant microbes.

Effects of Silybum marianum L. Seed Extracts on Multi Drug Resistant (MDR) Bacteria

Wound infections became a great challenge, especially after the emergence of bacterial resistance to commonly used antibiotics. Medicinal plants can be the source of alternative antibacterial agents effective against multi drug resistant (MDR) bacteria. This research aimed to evaluate the effectiveness of different Silybum marianum seed extracts in fighting MDR bacteria that infect wounds. First, thirty purified bacterial cultures obtained from superficial, infected wounds were subjected to antibiotic sensitivity tests. The selected MDR isolates were then used to test the antimicrobial effects of different S. marianum seed extracts. The most potent extract was evaluated for its impact on the ultrastructure of the cells of sensitive bacterial isolates using transmission electron microscopy (TEM). The bioactive ingredients of this extract were analyzed by means of gas chromatography-mass spectroscopy (GC-MS). Then, in-silico absorption, distribution, metabolism, excretion, and toxicity (ADMET) properties were predicted for the main components. The results indicated that four out of 30 bacterial isolates were considered MDR bacteria. Primary morphological features of colonies, secondary (automatic) identification using the Biomerieux Vitek 2 System, and 16S rRNA sequencing of the four isolates confirmed that they represent Staphylococcus aureus, Stenotrophomonas maltophilia, Klebsiella pneumoniae, and Escherichia coli. Among different extracts of S. marianum seeds, ethanol extract showed the strongest inhibitory effect on both Gram-positive and Gram-negative bacteria, with minimum inhibitory concentration (MIC) values between 9.375 and 1.172 mg/mL. However, at concentrations four times higher, this extract was unable to kill bacterial cells, indicating that it had a bacteriostatic effect on the tested MDR strains. TEM revealed denaturation and distorted cell ultrastructure in S. aureus and S. maltophilia after exposure to ethanol extract. In addition, GC-MS analysis of the ethanol extract identified nine compounds known to have important biological activities, and ADMET analysis showed good drug-likeness for two of these compounds. Consequently, S. marianum seeds could be a good source of alternative bacteriostatic agents effective against MDR bacterial strains that cause wound infections.

Application of parametric survival analysis to women patients with breast cancer at Jimma University Medical Center

Public health systems in both industrialized and undeveloped countries continue to struggle with the worldwide problem of breast cancer. In sub-Saharan African countries, notably Ethiopia, it is the form of cancer that strikes women the most commonly. Despite the extreme difficulties, the causes of mortality in Ethiopia have not yet been identified. In addition, little study has been done in this area. Therefore, the major objective of this analysis was to pinpoint the factors that were most responsible for the decreased life expectancy of breast cancer patients at the University of Jimma Medical Center. 552 women who had been treated for breast cancer at Jimma University Medical Center between October 2018 and December 2022 were included in this study, which used a retrospective cohort study design and five-year follow-up data. The most frequent and widely used test for comparing the probability of survival curves between several categorical independent variables was the log-rank test. Next, semi-parametric methods for multivariable analysis using the Cox proportional hazards model were used. Furthermore, a parametric strategy that includes fully parametric survival models better achieves the goal of the analysis. Among covariate, age of patient (ϕ = 254.06; 95% CI (3.95, 7.13), P-value = 0.000), patient live in urban (ϕ = 0.84; 95% CI (-0.35,-0.00), P-value = 0.047), preexisting comorbidity (ϕ = 2.46; 95% CI (0.39, 1.41), P-value = 0.001), overweight women cancer patient (ϕ = 0.05; 95% CI(-4.41,-1.57), P-value = 0.000, positive Axillary Node status cancer patient (ϕ = 0.04; 95% CI(-4.45,-1.88), P-value = 0.000), both surgery and chemotropic baseline treatment patient (ϕ = 0.53; 95% CI(-1.12,-0.16), P-value = 0.009) significantly affected the survival of women breast cancer. Age of breast cancer patient, patient education level, place of residence, marital status, pre-existing comorbidity, axillary node status, estrogen receptor, tumor size, body mass index at diagnosis, stage of cancer, and baseline treatment were found to have a significant effect on time to survive for women with breast cancer at the University of Jimma Medical Center, Oromia region, Ethiopia. However, the covariate histologic grade, number of positive lymph nodes involved, and type of hormone used were insignificant to the survival of breast cancer patients.

Antimicrobial resistance pattern of Klebsiella isolated from various clinical samples in Ethiopia: a systematic review and meta-analysis

BACKGROUND

The burden of Klebsiella drug resistance to antimicrobials is a major public health concern worldwide; particularly the problem is severe in developing countries including Ethiopia. Therefore, the aim of this systematic review and meta-analysis is to establish the pooled estimate of Klebsiella drug resistance; and antimicrobial-specific resistance pattern among Klebsiella clinical isoaltes in Ethiopia.

METHODS

Articles were searched from PubMed, Google Scholar, and Science direct and grey literature from 2009 to 2019. Four authors have independently extracted data on the prevalence and antimicrobial resistance pattern of the isolates. Statistical analysis was conducted by using Open meta-analyst (version 3.13) and Comprehensive meta-analysis (version 3.3). The main outcome measures were the overall Klebsiella resistance; and drug-specific resistance patterns. A random-effects model was used to determine the pooled resistance prevalence with 95% confidence interval (CI), and significant heterogeneity was considered at p < 0.1; and I2 > 50% using DerSimonian and Laird method. In addition, subgroup analyses were conducted to improve the outcome.

RESULT

We obtained 174 potentially relevant studies through searching electronic databases, and finally, 35 eligible studies were included for meta-analysis. A total of 13,269 study samples participated, from which 1017 Klebsiella species were isolated. The overall Klebsiella resistance in Ethiopia was found to stand at 53.75% (95% CI: 48.35-58.94%). Based on the subgroup analyses; the highest (64.39%); and lowest (46.16%) values were seen in Southern Nations, Nationalities, and Peoples of Ethiopia; and Tigray regions respectively; and the highest Klebsiella resistance was reported to ampicillin (90.56%), followed by amoxicillin (76.01%) and trimethoprim-sulfamethoxazole (66.91%). A relatively low level of resistance rate was observed to amikacin (16.74%) and cefoxitin (29.73%).

CONCLUSION

The pooled Klebsiella resistance was found to be considerably high (53.75%) to most of the essential antibiotics in Ethiopia. Klebsiella was highly resistant to ampicillin and amoxicillin but relatively lower to amikacin. Therefore, appropriate interventional strategies need to be taken to address the emerging resistance of Klebsiella species.

High frequency and molecular characterization of ESBL-producing Enterobacteriaceae isolated from wound infections in North Lebanon

BACKGROUND

Extended-spectrum beta-lactamases producing Enterobacteriaceae (ESBL-PE) represent a major problem in wound infections. Here, we investigated the prevalence and molecular characterization of ESBL-PE associated with wound infections in North Lebanon.

RESEARCH DESIGN AND METHODS

A total of 103 non-duplicated E. coli and K. pneumoniae strains isolated from 103 patients with wound infections, were collected from seven hospitals in North Lebanon. ESBL-producing isolates were detected using a double-disk synergy test. In addition, multiplex polymerase chain reaction (PCR) was used for the molecular detection of ESBLs genes.

RESULTS

E. coli was the predominant bacteria (77.6%), followed by K. pneumoniae (22.3%). The overall prevalence of ESBL-PE was 49%, with a significantly higher rate among females and elderly patients. K. pneumoniae was the common MDR and ESBL-producer bacteria (86.95% and 52.17%) compared to E. coli (77.5% and 47.5%). Most of the isolated ESBL producers harbored multiple resistant genes (88%), where blaCTX-M was the most predominant gene (92%), followed by blaTEM (86%), blaSHV (64%), and blaOXA genes (28%).

CONCLUSIONS

This is the first data on the ESBL-PE prevalence associated with wound infections in Lebanon, showing the emergence of multidrug-resistant ESBL-PE, the dominance of multiple gene producers, and the widespread dissemination of blaCTX-M and blaTEM genes.

Prevalence and resistance profile of bacteria isolated from wound infections among a group of patients in upper Egypt: a descriptive cross-sectional study

AIM

This cross-sectional survey aimed to identify aerobic bacteria, antimicrobial resistance, and multi-drug resistance profiles of bacteria isolated from different wound infections among a group of Egyptian patients.

RESULTS

Of 120 positive samples, 170 isolates were identified. Polymicrobial infections were determined in 55% of samples. The dominant Gram-positive isolated strains were Staphylococcus aureus, especially from wound infections because of accidents (71.8%). Piperacillin, methicillin, ampicillin/sulbactam, and amoxicillin/clavulanic acid were all highly resistant to S. aureus and Coagulase-negative Staphylococci. The prevalence of methicillin-resistant S. aureus in wound infections was 89.9%. S. aureus showed superior sensitivity to vancomycin (85.3%) and linezolid (81.3%). The highest prevalence of Gram-negative isolates was for Pseudomonas aeruginosa (40%), which was highly sensitive to ciprofloxacin (79.2%) and highly resistant to levofloxacin (83.3%). Several isolates revealed a multi-drug resistance profile (52.4%). The overall MDR rate of Gram-positive and Gram-negative isolates were 50% and 54.9%, respectively.

CONCLUSION

The prevalence of MRSA isolated from various wound infections and MDR is a warning issue in Upper Egypt. It should implement a health education strategy and hygiene measures to prevent the spread of wound infection-causing organisms in the community.

Bacterial isolates and their antimicrobial susceptibility profile of superficial and deep-seated skin and soft tissue infections

Background

Skin and soft tissue infections (SSTIs) are caused by microbial invasion of healthy or damaged skin. SSTIs are difficult to manage and contribute to chronicity and emergence of antimicrobial resistance.

Objectives

To ascertain the prevalence of bacteria causing SSTIs and their antimicrobial susceptibility patterns.

Methods

A prospective study between November 2020 and May 2021. A total of 447 samples from SSTIs were analyzed.

Results

A total of 347 samples revealed mono-bacterial growth, of which 67% were male. SSTIs are common among patients aged 21-50 years with the dominance (78%) of gram-negative rods (GNRs). Escherichia coli (36%), Klebsiella spp. (22%), Staphylococcus aureus (16%), and Pseudomonas aeruginosa (11%) were predominant organisms. GNRs were highly resistant (>65%) to ciprofloxacin and trimethoprim-sulfamethoxazole. For injectable antibiotics, the highest resistance was determined against ceftriaxone, and the least resistance was determined against amikacin. Resistance against carbapenem was the highest among P. aeruginosa (53%) and Klebsiella spp. (32%). S. aureus showed the highest resistance against ciprofloxacin, and the least resistance was determined against clindamycin. Of 57 S. aureus isolates, 86% isolates were methicillin-resistant Staphylococcus aureus (MRSA). All isolates of P. aeruginosa and S. aureus were sensitive to polymyxin B and vancomycin, respectively. The prevalence of multidrug-resistant E. coli and Klebsiella spp. was higher among deep-seated SSTIs (dSSTIs).

Conclusions

The predominant etiology of SSTIs is GNR. Currently, there is very high resistance against oral antibiotics. Antimicrobial resistance against carbapenem has also increased. Moreover, there is a high frequency of MRSA. MDR E. coli and Klebsiella spp. isolates are frequently involved in dSSTIs.

Contribution to the Personalized Management of the Nosocomial Infections: A New Paradigm Regarding the Influence of the Community Microbial Environment on the Incidence of the Healthcare-Associated Infections (HAI) in Emergency Hospital Surgical Departments

Background: The management of acute surgical pathology implies not only the diagnosis-treatment sequence but also an important preventive component. In the surgical hospital department, wound infection is one of the most frequent complications which must be managed both in a preventive and a personalized manner. To achieve this goal, several factors of negative local evolution, contributing to the slowdown of the healing processes, such as the colonization and contamination of the wounds, need to be emphasized and controlled from the first moment. In this context, knowing the bacteriological status at admission ensures the distinction between the colonization and infection processes and could help to manage in an efficient way the fight against bacterial pathogen infections from the beginning. Methods: A prospective study was performed for 21 months on 973 patients hospitalized as emergencies in the Plastic and Reconstructive Surgery Department within the Emergency University County Hospital of Brasov, Romania. We analyzed the bacteriological profile of the patients from admission to discharge and the bidirectional and cyclic microorganism dynamics both in the hospital and the community microbial environment. Results: Of the 973 samples collected at admission, 702 were positive, with 17 bacterial species and one fungal, with a predominance of Gram-positive cocci at 74,85%. The most frequently isolated strains were Staphylococcus species (86.51% of the Gram-positive/64.7% of the total isolated strains), while Klebsiella at 8.16% and Pseudomonas aeruginosa species at 5.63% were mainly emphasized in the case of Gram-negative bacilli. Two to seven pathogens were introduced after admission, suggesting that the community microbial environment is in a process of evolution and enrichment with hospital pathogens. Conclusions: The high level of positive bacteriological samples and the complex associations of the pathogens found at the admission bacteriological screening sustain the new idea that the pathogenic microorganisms existing in the community microbial environment have started to increasingly influence the hospital microbial environment, in contrast with the previous consideration, which emphasized only the unidirectional relationship between hospital infections and the changing bacteriological characteristics of the community environment. This modified paradigm must become the basis of a new personalized approach to the management of nosocomial infections.

Bacteriological profile of wound swab and their antibiogram pattern in a tertiary care hospital, Saudi Arabia

OBJECTIVES

To assess the microbial profile of wound infection and their antibiogram pattern.

METHODS

A retrospective study was carried out at King Abdulaziz University Hospital, Jeddah Saudi Arabia between December 2021 and July 2022 comprising data related to demographic, microbial profile and antibiotic sensitivity pattern of wound infection-suspected cases.

RESULTS

A total of 305 wound swabs were collected; of which 56.1% showed microbial growth. Among 187 microbial isolates, 62% were gram-negative bacteria, 30.5% were gram-positive bacteria and 7.5% were fungi. Staphylococcus aureus was the prevailing isolates 17.1%, followed by Klebsiella pneumoniae and Pseudomonas aeruginosa, each with 13.9% and Escherichia coli with 12.8 %. Providencia sp with 0.1% was the least isolated bacteria. Out of 173 bacterial isolates, 46.8% were sensitive to antimicrobial agents tested, while 53.2% were resistant to one and more drug tested. Of these isolates, 22% were found to be the MDR bacteria. The highest MDR percentages was noted among Acinetobacter baumannii (70%) followed by Klebsiella pneumoniae (53.9%), Escherichia coli (25%) and Pseudomonas aeruginosa (19.2%) and the least by (12.5%) by Staphylococcus aureus. CONCLUSION: The microbial isolation rates from wound infection was high, with Staphylococcus aureus being the most prevalent. Considerable antimicrobial resistance rate to the commonly used antibiotics was discovered. Thus, regular monitoring of microbial profile and their antimicrobial sensitivity pattern in the study region in attempt to contain antimicrobial resistance is highly recommended.

The potential for the double risk of rabies and antimicrobial resistance in a high rabies endemic setting: detection of antibiotic resistance in bacterial isolates from infected dog bite wounds in Uganda

BACKGROUND

Post-exposure treatment for dog bites in humans aims at alleviating the risk of rabies and promoting wound healing. Wound healing may be complicated by bacteria. This study identified the different bacteria and their antibiotic susceptibilities in infected dog bite wounds (DBWs) in Uganda.

METHODS

A cross-sectional study was conducted among 376 dog bite patients. Wound swabs from patients with infected DBWs were collected and inoculated into recommended media. They were cultured for both aerobic and anaerobic bacteria. All isolated bacteria were identified based on colony characteristics, gram stain, and standard biochemical tests. Molecular identification was performed for strains that were resistant to three or more antibiotics. Antibiotic susceptibility testing was conducted using the disc diffusion method following the modified Kirby-Bauer method. The data were analysed using Stata version 15 software.

RESULTS

Approximately half of the patients (52.9%, 199/376) presented with infected wounds. Majority of the swabs (84.4%, 168/199) were culture positive, and yielded a total of 768 isolates where about half (52.9%, 406/768) were gram positive bacteria, and about two-thirds (64.6%, 496/768) were recovered from category II wounds. Among the gram positive bacteria, 339 (83.5%) were aerobes where Staphylococcus aureus (103, 30.4%), Coagulase-negative staphylococci (68, 20.1%), and Corynebacterium spp (33, 9.7%) had the highest prevalence. For the 362 Gram negative isolates, 217 (59.9%) were aerobes and the commonest isolates were P. maltocida (64, 29.5%), Capnocytophaga canimorsus (36, 16.6%) and P. canis (26, 12.0%). Gram-positive isolates were resistant to metronidazole (93.6%), oxacillin (68.5%), ceftriaxone (14.6%) and amoxicillin/clavulanic acid (14.0%). Gram negative isolates were resistant to metronidazole (100%), ampicillin (30.7%), oxacillin (29.3%), and doxycycline (22.9%). Multidrug resistance was in 105 (29.0%) and 121/406 (29.8%) of the gram-negative and gram-positive isolates, respectively. All gram-positive isolates were susceptible to vancomycin and ciprofloxacin.

CONCLUSIONS

Infection rates of DBWs in Uganda are high and the dominant bacterial isolates are Staphylococcus aureus, Pasteurella spps, and Capnocytophaga canimorsus. Multidrug resistance to commonly used antibiotics is high. The recommendation in the Uganda Clinical Guidelines to use metronidazole in the management of DBWs should be reviewed. DBWs should be enlisted for routine antimicrobial resistance surveillance and rational use of antimicrobial agents should be promoted.

New Amorphous Hydrogels with Proliferative Properties as Potential Tools in Wound Healing

The study and discovery of bioactive compounds and new formulations as potential tools for promoting the repair of dermoepidermal tissue in wound healing is of continuing interest. We have developed a new formulation of amorphous hydrogel based on sodium alginate (NaAlg); type I collagen, isolated by the authors from silver carp tails (COL); glycerol (Gli); Aloe vera gel powder (AV); and silver nanoparticles obtained by green synthesis with aqueous Cinnamomum verum extract (AgNPs@CIN) and vitamin C, respectively. The gel texture of the amorphous hydrogels was achieved by the addition of Aloe vera, demonstrated by a rheological analysis. The evaluations of the cytotoxicity and cell proliferation capacity of the experimental amorphous hydrogels were performed against human foreskin fibroblast Hs27 cells (CRL-1634-ATCC). The developed gel formulations did not show a cytotoxic effect. The hydrogel variant containing AgNPs@CIN in a concentration of 8 µg Ag/gel formulation and hydrogel variant with vitamin C had proliferative activity. In addition, the antibacterial activity of the hydrogels was evaluated against S. aureus ATCC 6538, Ps. aeruginosa ATCC 27853, and E. coli ATCC 25922. The results demonstrated that the gel variant based on AgNPs@CIN in a concentration of 95 µg Ag/gel formulation and the hydrogel based on vitamin C show antibacterial activity. Therefore, the developed hydrogels with AgNPs@CIN and vitamin C could be promising alternatives in wound healing.

Virulence genes distributed among Staphylococcus aureus causing wound infections and their correlation to antibiotic resistance

Background

Staphylococcus aureus causes many human infections, including wound infections, and its pathogenicity is mainly influenced by several virulence factors.

Aim

This study aimed to detect virulence genes (hla, sea, icaA, and fnbA) in S. aureus isolated from different wound infections among Egyptian patients admitted to Minia University Hospital. This study also aimed to investigate the prevalence of these genes in methicillin-resistant S. aureus (MRSA), methicillin-susceptible S. aureus (MSSA), and vancomycin-resistant S. aureus isolates and the resistance and sensitivity to different antibiotic classes.

Methods

A cross-sectional study was carried out from November 2019 to September 2021. Standard biochemical and microbiological tests revealed 59 S. aureus isolates. The Kirby-Bauer disc diffusion method was used to determine antibiotic susceptibility. DNA was extracted using a DNA extraction kit, and polymerase chain reaction was used to amplify all genes.

Results

A total of 59 S. aureus isolates were detected from 51 wound samples. MRSA isolates accounted for 91.5%, whereas MSSA isolates accounted for 8.5%. The multidrug resistance (MDR) percentage in S. aureus isolates was 54.2%. S. aureus showed high sensitivity pattern against vancomycin, linezolid, and chloramphenicol. However, a high resistance pattern was observed against oxacillin and piperacillin. sea was the most predominant gene (72.9%), followed by icaA (49.2%), hla (37.3%), and fnbA (13.6%). sea was the commonest virulence gene among MRSA isolates (72.2%), and a significant difference in the distribution of icaA was found. However, sea and icaA were the commonest genes among MSSA isolates (79.9%). The highest distribution of sea was found among ciprofloxacin-resistant isolates (95.2%).

Conclusion

The incidence of infections caused by MDR S. aureus significantly increased with MRSA prevalence. sea is the most predominant virulence factor among antibiotic-resistant strains with a significant correlation to piperacillin, gentamicin, and levofloxacin.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-022-07624-8.

Evaluation of Dermal Toxicity and Wound Healing Activity of Cnestis ferruginea Vahl ex DC

Cnestisferruginea is a tropical plant, which is traditionally used in the treatment and management of various conditions including skin infections and wounds. The aim of this study was to investigate the dermal toxicity and wound healing potential of C. ferruginea. Ten millimeter full-thickness mucosal wounds were created on the dorsal midportion of the Sprague Dawley rats. Wounds were treated with 10, 5, and 2.5% w/w aqueous creams, prepared from the methanol extract of the root bark of C. ferruginea (CFM). The wound tissues were harvested on day 21 for histology studies. Compared with the untreated group, 10, 5, and 2.5% w/w CFM-treated wounds significantly reduced the wound size over the study period ( $P<0.0001$ ). Tissue histology revealed a healed wound with well-regenerated collagen and skin appendages with no pus cells. A skin irritation test was conducted on CFM, as well as the dermal toxicity of CFM was determined in the repeated dose and acute dermal toxicity bioassays. These tests revealed that CFM showed no toxic effect on the skin and showed that CFM was not a skin irritant. C. ferruginea exhibited wound healing activity, which gives credence to its folkloric use.

Time to Death and Its Determinant Factors Among Patients With Chronic Heart Failure in Northwest Ethiopia: A Retrospective Study at Selected Referral Hospitals

Background

Heart failure (HF) is a major health problem that affects patients and healthcare systems worldwide. It is the leading cause of morbidity and death and negatively impacts the quality of life, healthcare costs, and longevity. However, the causes of death were not well defined. This study aimed to identify the determinants of death among patients with HF in the Amhara Region, Northwest Ethiopia.

Methods

A multicenter retrospective cohort study was conducted on 285 patients in the age group 15 years or older under follow-up from 1 January 2015 to 31 December 2019. Descriptive analyses were summarized using the Kaplan–Meier survival curve and the log-rank test. Then, the Cox-proportional hazard regression model was employed to estimate the hazard of death up to 5 years after they were admitted to the HF department to follow up on their treatment.

Results

Out of 285 patients with HF, 93(32.6%) of the respondents were dying within 5 years of follow-up. Anemia was the common comorbid disease (30.5%), and valvular heart disease was the most common etiology (33.7%) of chronic heart failure in this study. This study showed a significant mortality difference between hospitals. HF patients with hypertension [adjusted hazard ratio (AHR): 3.5076, 95% confidence interval (CI): 1.43, 8.60], anemia (AHR: 2.85, 95% 1.61, 5.03), pneumonia (AHR: 2.02, 95% 1.20, 3.39), chronic kidney disease (2.23, CI: 1.31, 3.77), and diabetes mellitus (AHR: 2.42, 95% CI: 1.43, 4.09) were at a higher risk of death. Moreover, patients with symptoms listed in the New York Heart Association Class (III and IV), Ischemic Heart Disease and unknown etiologies, men (AHR: 2.76, 95%:1.59, 4.78), and those with a high pulse rate (AHR: 1.02, 95%:1.00, 1.04) were at a higher risk of death.

Conclusion

There was a mortality difference between hospitals. This study has revealed that HF patients with anemia, diabetes mellitus, pneumonia, hypertension, chronic kidney disease, HF etiologies, severe New York Heart Association Class (III and IV), men, and high pulse rate were the main factors associated with death. Health professionals could give more attention to patients whose pulse rate is high, men, and a patient who had comorbidities in the ward.

Distal and/or Proximal Joint Stiffness Among Post-Fracture Patients Treated in University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia

Background

Methods

Results

Conclusion

Antimicrobial susceptibility profiles of clinically important bacterial pathogens at the Kamuzu Central Hospital in Lilongwe, Malawi

BACKGROUND

The aim of this prospective study was to ascertain antimicrobial resistance (AMR) in clinical bacterial pathogens from in-hospital adult patients at a tertiary hospital in Lilongwe, Malawi.

METHODS

Clinical specimens (blood culture, pus, urine and cerebrospinal fluid) collected during June to December 2017 were examined for bacterial growth in standard aerobic conditions. One specimen per patient was included. Antimicrobial susceptibility testing (AST) was performed using the disk diffusion method and interpreted according to EUCAST guidelines.

RESULTS

A total of 694 specimens were collected during the study period, of which 336 (48%) specimen yielded visible bacterial growth. Of the 336 specimens, a total of 411 phenotypically different isolates were recovered. Of the 411 isolates, 84 isolates (20%) were excluded and the remaining 327 (80%) were further characterised. The characterised isolates were identified as ESKAPE pathogens (n=195/327; 60%), Escherichia coli (n=92/327; 28%), Proteus mirabilis (n=33/327; 10) or Salmonella spp. (n=7/327; 2%) and were included for further analysis. The excluded isolates (n=84) comprised of coagulase-negative staphylococci (n=25), streptococci (n=33), and low-prevalence Gram-negative bacilli (n=26). E. coli (n=92; 28%) and S. aureus (n=86; 26%) were the most dominant species. A multidrug resistant (MDR) extended spectrum β- lactamase (ESBL)-positive phenotype was detected in Klebsiella pneumoniae (n=20/29; 69%) and E. coli (n=49/92; 53%). One third of the Pseudomonas aeruginosa isolates were resistant to meropenem (MEM), but did not appear to be carbapenemase-producers. Methicillin resistant Staphylococcus aureus (MRSA) was molecularly confirmed in 10.5% of S. aureus (n=9/86).

CONCLUSION

The high proportion of the MDR ESBL-phenotype in clinical isolates of Enterobacterales, strongly limits antimicrobial treatment options and has consequences for empirical and targeted antimicrobial treatment as well as clinical microbiology services and hospital infection control. There is need for a continuous surveillance and an antimicrobial stewardship (AMS) program to contain and prevent the spread of AMR.

Microbial Species Isolated from Infected Wounds and Antimicrobial Resistance Analysis: Data Emerging from a Three-Years Retrospective Study

The antimicrobial resistance is a topic of global interest in the treatment of wound infections. The goal of this retrospective study was both the identification of the microorganisms responsible for wound infections and the determination of their drug susceptibility pattern. The study was performed from 2017 to 2019 and included 239 patients. Thirty-four species were isolated by culture methods and identified and analysed for their susceptibility patterns to antimicrobials through the Walk Away automated system. The presence of one species was the most frequent condition (75.3%), whereas a co-infection was detected in 24.7% of samples. The most common species were Gram-negative (57.9%), amongst which the most prevalent were Pseudomonas aeruginosa (40.2%), Escherichia coli (20.7%), Proteus mirabilis (11.2%), and Acinetobacter baumannii/haemolyticus (9.5%). Gram-positive bacteria were observed in 36.6%, Staphylococcus aureus (79.4%) being the most predominant species. At least one resistance to antibiotics was detected in 88.2% of isolates, while a multi-drug-resistance versus no less than 6 antimicrobials was detected in 29.2% of isolates. Although multi-drug resistant species and co-infections were observed, those were less frequently observed at the wound site. These conditions make the microorganisms eradication more difficult. The detection of a polymicrobial infection and multi-drug resistant microorganisms followed by a proper therapeutic treatment would lead to the resolution of the infection, promoting wound healing and the limitation of the spread of antibiotic resistance.

Antimicrobial Resistance Profile of Bacterial Isolates Identified from Surgical Site Infections at a Referral Hospital, Northwest Ethiopia

Background

Surgical wound infections (SWI) remain as a major source of postoperative illness that increases the time of hospital stay and health care related costs globally. On top of this, the emergence and spread of drug-resistant pathogens continue to challenge the proper management of surgical wound infections.

Methods

A hospital based cross-sectional study was conducted at Felege Hiwot Referral Hospital (FHRH). A total of 165 study participants were included. Socio-demographic data were collected using a pre-tested structured questionnaire. Isolates were identified by conventional bacteriological technique and antimicrobial susceptibility test was performed using the Kirby-Bauer disc diffusion method.

Results

Among 165 study participants, 98 (59.4%) were males. The overall prevalence of culture confirmed surgical wound infection was 115 (69.7%). A total of 125 bacteria isolates were identified among which, Staphylococcus aureus was predominant followed by Pseudomonas aeruginosa and Klebsiella species with a proportion of 31 (24.8%), 26 (20.8%) and 17 (13.6%), respectively. Majority (80.8%) of the isolates were found multidrug resistant (MDR). Dirty wound and duration of hospital stay were found significantly associated with culture confirmed surgical wound infections.

Conclusions

S. aureus, P. aeruginosa and Klebsiella species were the most common isolates identified from surgical wound sites. Most of these pathogens were found MDR. Therefore, regular surveillance on the types of bacterial isolates and their drug resistance pattern should be considered.

Prevalence of multidrug-resistant bacteria in Ethiopia: a systematic review and meta-analysis

OBJECTIVES

Multidrug-resistant (MDR) bacteria are a significant public-health threat worldwide, especially in low- and middle-income countries. Comprehensive data are important to understand the magnitude of multidrug resistance (MDR), however these are not available in Ethiopia.

METHODS

Five electronic databases and grey literature of Addis Ababa University Repository were searched for data regarding the prevalence of MDR bacteria in Ethiopia. OpenMetaAnalyst R1.3 was used for analysis using a random-effects model to determine the effect size. Heterogeneity among articles was checked using the inconsistency index (I²). Funnel plot was used to check for publication bias. The quality of each article was checked using the Newcastle-Ottawa checklist adapted for cross-sectional studies.

RESULTS

Through database searching, 2094 articles were identified, of which 37 fulfilled the study inclusion criteria. This review comprises 6856 bacteria, of which 4949 isolates were MDR. The overall pooled prevalence of MDR was 70.5% (95% CI 64.9-76.1%), with considerable heterogeneity (I² = 97.48%, P < 0.001). Funnel plot revealed no publication bias. Sidama (81.7%) had the highest MDR and Tigray (51.1%) the lowest. The greatest source of MDR was from multiple sites of infection (MSI) (76.8%); the least was from bloodstream infections (62.9%). MDR was higher in studies conducted on hospital-acquired infections (72.1%) compared with both hospital- and community-acquired infections (69.8%).

CONCLUSION

Our study indicates a high prevalence of MDR in Ethiopia. Sidama region, MSI and hospital-acquired infections showed the highest MDR in subgroup analysis. Regional hospitals should implement infection prevention and proper use of antibiotics in the community.

Bacterial profile and their antimicrobial susceptibility patterns in patients admitted at MaddaWalabu University Goba Referral Hospital, Ethiopia: a cross sectional study

BACKGROUND

Hospital acquired infections (HAIs) are one of the global concerns in resource limited settings. The aim of the study was to determine bacteria profile and their antimicrobial susceptibility patterns among patients admitted at surgical and medical wards.

METHODS

A hospital based cross-sectional study was conducted from November 2016 to July 2017 in MaddaWalabu University Goba Referral Hospital. Urine and wound swabs were processed and standard disk diffusion test was done to assess susceptibility pattern. Association among variables was determined by Chi-square test.

RESULTS

Among 207 patients enrolled, 24.6% developed HAI, of which, 62.7% and 37.3% were from surgical and medical wards, respectively. The male to female ratio was 1.5:1. The age ranged from 19 to 74 years with a mean of 41.65(±16.48) years. A total 62 bacteria were isolated in which majority of the isolates were gram negative bacteria. Most isolates were resistance to most of the antibiotics tested but sensitive to Ceftriaxone, Norfloxacin and Ciprofloxacin.

CONCLUSION

Due to the presence of high level drug resistant bacteria, empirical treatment to HAI may not be effective. Therefore, treatment should be based on the result of culture and sensitivity.

Wounds, Antimicrobial Resistance and Challenges of Implementing a Surveillance System in Myanmar: A Mixed-Methods Study

Wound infections with drug-resistant bacteria lead to higher mortality and morbidity and increased healthcare costs. We aimed to describe the spectrum of bacterial pathogens, isolated from wound cultures in Yangon General Hospital in 2018, and their antimicrobial resistance (AMR) patterns and to understand the challenges in implementing an AMR surveillance system in Myanmar. We conducted a concurrent mixed-methods study involving analysis of surveillance data and in-depth interviews with nine key personnel involved in AMR surveillance. Of 1418 wound specimens processed, 822 (58%) were culture-positive. The most common Gram-positive bacteria were coagulase-negative staphylococci (23.3%) and Staphylococcus aureus (15.1%). Among Gram-negative bacteria, Escherichia coli (12.5%) and Pseudomonas aeruginosa (10.1%) were common. Staphylococcus aureus isolates were resistant to penicillin (98%), oxacillin (70%) and tetracycline (66%). Escherichia coli showed resistance to ampicillin (98%). Lack of dedicated and trained staff (microbiologist, technician, data entry operator), lack of computers at sentinel sites and non-uniform and non-standardized data capture formats were the major challenges in implementing AMR surveillance. These challenges need to be addressed urgently. We also recommend periodic analysis and sharing of antibiograms at every hospital to inform the treatment regimens used in wound management.

Assessment of Functional Limitation and Associated Factors in Adults with Following Lower Limb Fractures, Gondar, Ethiopia in 2020: Prospective Cross-Sectional Study

Background

Lower limb fractures account for approximately one-third of all fractures. Lower limb fracture complications are one of the major reasons for hospital stays and have high impact on rehabilitation services. Functional limitations with lower extremities fractures are related to decreased functional mobility, the need for long term use of assistive devices, lack of independence, and the long term need for assistive care. This study aimed to assess the functional limitation and identify the possible predictors among lower limb fracture patients by using the Lower Extremity Functional Scale (LEFS).

Methods

A prospective institutional-based cross-sectional study was conducted from July to October 30/2020, at University of Gondar, comprehensive specialized hospital. The data of 226 participants were collected through face-to-face interviews, patient record review and by physical examination with simple random sampling techniques. Binary logistic regression was used to identify predictors of functional limitation among lower limb fracture with SPSS 25. The strength of the association was present by adjusted odds ratios (OR).

Results

One hundred and eighty-two (n = 182 (80.5%): 95% CI (74.8 to 85.8) patients with following lower limb fracture have functional limitation. Level of education (AOR =5.50; 95% CI: 1.707–17.742), presence of hospitalized complication AOR=3.26; 95% CI (1.147–9.294), severity of pain AOR=3.19; 95% CI (1.399–7.259), duration of onset AOR=9.512; 95% CI (3.585–25.237), knee flexion limitation AOR=7.13; 95% CI (1.926–26.368) were the independent risk factors for functional limitation.

Conclusion

The magnitude of functional limitation in following lower limb fracture individual was considerably high in study setup. Level of education, presence of hospitalized complication, severity of pain, duration of onset, knee flexion limitation were the independent risk factors for functional limitation.

Phenotypic Detection of Carbapenem-Resistant Gram-Negative Bacilli from a Clinical Specimen in Sidama, Ethiopia: A Cross-Sectional Study

BACKGROUND

Carbapenem-resistant gram-negative bacteria are an emergent source of both community-acquired and healthcare-associated infection that poses a substantial hazard to public health. This study aimed to conclude the magnitude of carbapenem resistance gram-negative bacteria from a clinical specimen at Hawassa University Comprehensive Specialized Hospital.

METHODS

A hospital-based cross-sectional study was accompanied from February 13 to June 7, 2020, in which consecutive patients with 103 gram-negative bacteria were encompassed. The isolates included were 54 urine, 17 blood, 17 pusses, 4 cerebrospinal fluid (CSF), 3 aspirates, 3 effusions, 2 stools, 2 ear discharges, and 1 nasal swab. A semi-structured questionnaire was used to gather socio-demographic data from the attendant and clinical data from the patient's chart. Patients admitted in any wards and visited outpatients department were included for the study if gram-negative bacteria was identified for those who accepted the consent. A routine manual culture, Gram's staining and biochemical tests used to identify the bacteria. Antibiotic susceptibility was determined for twelve antibiotics including cotrimoxazole, ceftazidime, meropenem, gentamycin, chloramphenicol, ampicillin, ciprofloxacin, cefotaxime, cefuroxime, nitrofurantoin, piperacillin-tazobactam, and amikacin using the Kirby-Bauer disc diffusion method. Modified carbapenem inactivation (mCIM) method was used to determine carbapenem resistance using meropenem disk as per the recommendation of Clinical and Laboratory Standards Institute guideline. Statistical package for social science software version 21 was used for data entry and analysis. The odds ratio at 95% confidence interval (CI) and p-value <0.05 were taken as a statistically significant association.

RESULTS

Generally, 111 gram-negative bacteria were identified from 103 patients. Of 111 isolates, thirteen isolates (nine resistance and four intermediates) were identified in disk diffusion testing for meropenem. Of this, 10 isolates were carbapenemases producer with the overall rates of 9% in the Modified carbapenem inactivation method (mCIM). Pseudomonas spp. 3 (30.0%), E. coli, K. pneumonia, Acinetobacter spp. each two (20.0%), and K. oxytoca 1 (10.0%) were identified as carbapenemases positive. The rates of the multidrug, extensive, pan drug were 86.5, 43.3, and 1.8, respectively. Ampicillin 94 (97.9%), followed by cefuroxime 52 (91.2%), cefotaxime 94 (88.7%), cotrimoxazole 58 (88.1%), ceftazidime 40 (83.3%), ciprofloxacin 47 (77.1%), nitrofurantoin 35 (70.0%), gentamycin 71 (65.7%), with high level of resistance. However, piperacillin-tazobactam 41 (48.8%), chloramphenicol 25 (47.2%), meropenem 13 (11.7%), and amikacin 9 (8.5%) were with low rates of resistance. In this study, there were no variables statically associated with carbapenem resistance that is p > 0.05.

CONCLUSION

Our study showed that carbapenem-resistant gram-negative bacilli are 9% in the study area. Our finding signposts that ampicillin, cefuroxime, cefotaxime, cotrimoxazole, ceftazidime, ciprofloxacin, nitrofurantoin, and gentamycin with a high rate of resistance >50%. However, piperacillin-tazobactam, chloramphenicol, meropenem, and amikacin were at low rates of resistance. Therefore, a measure should be taken to contain carbapenem resistance gram-negative bacteria in the study area. Further, study with better method needs to be conducted to conclude the real scenario of carbapenem resistance.

Gram-Negative Bacteria Isolates and Their Antibiotic-Resistance Patterns in Patients with Wound Infection in Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND

Antibiotic resistance (ABR) restricts the armamentarium of health-care providers against infectious diseases due to the emergence of multidrug resistance (MDR), especially in Gram-negative bacteria. This study aimed to determine pooled estimates of Gram-negative bacteria, their resistance profiles, and rates of MDR in patients with wound infection in Ethiopia.

METHODS

Electronic databases such as PubMed/MEDLINE, EMBASE, Science Direct, Web of Science, and Google Scholar were searched. Original articles, available online from 1988 to 2020, addressing the prevalence and resistance patterns of Gram-negative bacteria in patients with wound infection and written in English were screened. The data were extracted using a format prepared in Microsoft Excel and exported to STATA 14.0 for the outcome analyses.

RESULTS

The data of 15,647 wound samples, from 36 studies conducted in 5 regions of the country, were pooled. The overall pooled estimate of Gram-negative bacteria was 59% [95% CI: 52-65%, I2 = 96.41%, p < 0.001]. The pooled estimate of Escherichia colirecovered from isolates of 5205 wound samples was 17% [95% CI: 14-20%], followed by Pseudomonas aeruginosa, 11% [95% CI: 9-14%], Klebsiella pneumonia, 11% [95% CI: 9-13%], Proteus mirabilis, 8% [95% CI: 6-10%], Acinetobacter species, 4% [95% CI: 2-6%], Enterobacter species, 4% [95% CI: 3-5%], and Citrobacter species, 3% [95% CI: 2-4%]. Multidrug resistance prevalence estimates of E. coli, K. pneumonia, P. aeruginosa, P. mirabilis, Citrobacter species, Enterobacter species and Acinetobacter species were 76% [95% CI: 66-86%], 84% [95% CI: 78-91%], 66% [95% CI:43-88%], 83% [95% CI:75-91%], 87% [95% CI:78-96%], 68% [95% CI:50-87%] and 71% [95% CI:46-96%], respectively.

CONCLUSION

There was high resistance in Gram-negative bacteria from wound specimens to commonly used antibiotics in Ethiopia. The data warrant the need of regular epidemiological surveillance of antimicrobial resistance and implementation of an efficient infection control program.

Elevated Level of Imipenem-Resistant Gram-Negative Bacteria Isolated from Patients Attending Health Centers in North Gondar, Ethiopia

Background

The frequent identification of resistant bacteria in hospitals constantly presents antimicrobial therapy with a challenge. Imipenem, once considered an extremely powerful antibiotic against multidrug-resistant bacterial infections, is losing its effectiveness. Its use in empirical therapy with inadequate or nonexistent antimicrobial stewardship programs has further triggered bacterial resistance in low-income countries. Therefore, this study aimed at identifying imipenem-resistant Gram-negative bacteria from patients who were referred to health centers in North Gondar, Ethiopia.

Methods

A total of 153 sputum samples were used to isolate Gram-negative bacteria. The isolates, which were resistant to imipenem, were identified by standard biochemical tests and 16S rRNA sequencing. The Kirby-Bauer disk diffusion method was used to determine the sensitivity or resistance of the isolate to diverse antimicrobial agents.

Results

The study identified 79 imipenem-resistant bacterial isolates from eight genera with clinically relevant microorganisms, including Acinetobacter baumannii (20.77%), Klebsiella pneumoniae (19.48%), Pseudomonas aeruginosa (16.88%), and Serratia marcescens (14.28%). Overall, imipenem-resistant bacterial isolates were detected in 31 samples (20.26%). Additionally, a remarkably high level of resistance to most antibiotics was observed among isolates of Klebsiella pneumoniae and Acinetobacter baumannii. Gentamycin is the most active antibiotic against many of the isolates, while β-lactams appear to be less effective.

Conclusion

The study indicated that many Gram-negative bacteria were resistant to imipenem with parallel resistances to other antimicrobials. Hence, the prescription of imipenem within the region should be according to the antibiotic resistance profiles of the multi-drug resistant bacteria.

Antimicrobial susceptibility of bacteria isolated from the infected wounds of patients with lymphoedema in East Wollega, Ethiopia

BACKGROUND

Lymphoedema is caused by dysfunction of the lymphatic system resulting in accumulation of high-protein content fluid in the interstitial space. To date, the bacteria associated with wound infections of patients with lower limb lymphoedema in Ethiopia have not been studied. This study identified pathogenic bacteria involved in wound infection and assessed antimicrobial susceptibility patterns in patients with lymphoedema in Ethiopia.

METHODS

Swab samples were collected from the wounds of patients with lymphoedema and cultured using standard microbiological techniques. Micro-organisms were identified by colony morphology followed by identification and antimicrobial susceptibility testing using the automated VITEK 2 COMPACT Microbial Detection System.

RESULTS

Swabs were collected from 103 patients and 84 were culture positive: 44 (52.4%) culture-positive samples showed polymicrobial growth and 40 (47.6%) grew single bacterial isolates. In total, 134 isolates were obtained, of which 26 gram-negative and 12 gram-positive bacterial species were identified. A total of 28/63 (44.4%) gram-negative isolates and 3/57 (5.3%) gram-positive isolates were multiple drug resistant. There was no resistance to ciprofloxacin, moxifloxacin or gentamycin among gram-negative or gram-positive bacteria.

CONCLUSION

In this study, many infections were polymicrobial and showed multiple drug resistance. Fluoroquinolones and gentamycin, however, seemed to be effective against bacterial wound infection in this setting.

Prevalence of Vancomycin resistant enterococci (VRE) in Ethiopia: a systematic review and meta-analysis

Background

The emergence of Vancomycin resistant enterococci (VRE) poses a major public health problem since it was first reported. Although the rising rates of VRE infections are being reported elsewhere in the worldwide; there is limited national pooled data in Ethiopia. Therefore, this study was aimed to estimate the pooled prevalence of VRE and antimicrobial resistance profiles of enterococci in Ethiopia.

Methods

Literature search was done at PubMed, EMBASE, Google scholar, African Journals online (AJOL) and Addis Ababa University repository following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Both published and unpublished studies reporting the prevalence of VRE until June 30, 2019 were included. Data were extracted using Microsoft Excel and copied to Comprehensive Meta-analysis (CMA 2.0) for analysis. Pooled estimate of VRE was computed using the random effects model and the 95% CIs. The level of heterogeneity was assessed using Cochran’s Q and I² tests. Publication bias was checked by visual inspection of funnel plots and Begg’s and/or Egger’s test.

Results

Twenty studies fulfilled the eligibility criteria and found with relevant data. A total of 831 enterococci and 71 VRE isolates were included in the analysis. The pooled prevalence of VRE was 14.8% (95% CI; 8.7–24.3; I² = 74.05%; P <  0.001). Compared to vancomycin resistance, enterococci had higher rate of resistance to Penicillin (60.7%), Amoxicillin (56.5%), Doxycycline (55.1%) and Tetracycline (53.7%). Relatively low rate of resistance was found for Daptomycin and Linezolid with a pooled estimate of 3.2% (95% CI, 0.5–19.7%) and 9.9% (95% CI, 2.8–29.0%); respectively. The overall pooled multidrug resistance (MDR) rate of enterococci was 60.0% (95% CI, 42.9–75.0%).

Conclusion

The prevalence of VRE and drug resistant enterococci are on the rise in Ethiopia. Enterococcal isolates showed resistance to one or more of the commonly prescribed drugs in different or the same drug lines. Multidrug resistant (MDR) enterococci were also found. Although the rates were low, the emergence of resistance to Daptomycin and Linezolid is an alarm for searching new ways for the treatment and control of VRE infections. Adherence to antimicrobial stewardship, comprehensive testing and ongoing monitoring of VRE infections in the health care settings are required.

Incidence and Bacterial Etiologies of Surgical Site Infections in a Public Hospital, Addis Ababa, Ethiopia

Background:

Surgical Site Infections (SSIs) are among the frequently reported healthcare-acquired infections worldwide. Successful treatment of SSIs is affected by the continuous evolvement of drug-resistant microbes. This study investigated the incidence of SSIs, identifying the major etiologic agents and their drug resistance patterns in Yekatit 12 Hospital, Ethiopia.

Methods:

A cross-sectional study was conducted on 649 patients who underwent surgery at Yekatit 12 hospital from April 2016 to April 2017. Socio-demographic and clinical data were collected from each patient on admission. After surgery, they were followed for SSI occurrence. SSI was initially diagnosed by a senior surgeon based on standard clinical criteria and then confirmed by culture. Isolates were tested for drug resistance according to the clinical and laboratory standards institute guideline.

Results:

Of the 649 study participants, 56% were females. Their age ranged from 9 months to 88 years with a median age of 37 years. The incidence of culture-confirmed SSI was 10.2% (66/649) where 73 isolates were recovered. About two-third of the isolates were Gram-positive bacteria. Staphylococcus aureus was the most frequently isolated (27/73, 37%) followed by Coagulase-negative staphylococci (18/73, 24.7%), Escherichia coli (11/73, 15.1%) and Klebsiella species (10/73, 13.7%). About 89% and 44% of S. aureus isolates were resistant to penicillin and trimethoprim-sulfamethoxazole, respectively. MRSA constituted 11% of the S. aureus isolates. All the Gram-negative isolates were resistant to ampicillin and trimethoprim-sulfamethoxazole but susceptible to amikacin and meropenem. Klebsiella species showed 70-100% resistance to ceftazidime, cefuroxime, augmentin, chloramphenicol, ciprofloxacin, cefepime and gentamicin. About 82% of E. coli isolates were resistant for chloramphenicol, cefepime, ceftazidime, augmentin, cefuroxime and 64% for gentamicin and ciprofloxacin.

Conclusion:

The incidence of surgical site infection in Yekatit 12 hospital is 10.2%. Most of the SSIs were due to Gram-positive bacteria. Gram-negative isolates showed high resistance to the most commonly prescribed drugs. No resistance was found for meropenem indicating the absence of carbapenem-resistant bacteria. SSI treatments should be guided by culture and drug resistance test. Better infection prevention practices and continuous surveillance of antimicrobial resistance in the hospital are recommended for better patient care.

Biofilm formation and antibiotic resistance in meticillin-resistant and meticillin-sensitive Staphylococcus aureus isolated from burns

OBJECTIVE

To investigate the relationship between biofilm formation and antibiotic resistance patterns in meticillin-resistant and meticillin-sensitive Staphylococcus aureus, isolated from burns.

METHODS

In a cross-sectional study, pus/wound swab samples were obtained from burns. Presence of Staphylococcus aureus was confirmed, and biofilm formation-related icaABCDR and eta, etb genes were detected by polymerase chain reaction. Biofilm formation assay was assessed using the microtiter plate method. Antibiotic resistance was performed using the disk diffusion method and minimum inhibitory concentration.

RESULTS

A total of 95 patients with burns were recruited. Of the 95 wounds swabbed, Staphylococcus aureus was identified in 50 (62.5%), and 47 (94%) isolates capable of producing biofilm. Biofilm production levels were classed as 'strong' (n=29; 58%), 'moderate' (n=11; 22%), 'weak' (n=7; 14%) and 'non-biofilm forming' (n=3; 6%). There was an almost even split between isolates identified as meticillin-resistant Staphylococcus aureus (MRSA), n=24 (48%), and meticillin-sensitive Staphylococcus aureus (MSSA) n=26 (52%). The prevalence of the icaA, icaB, icaC, icaD and icaR genes among the studied isolates were 96%, 80%, 80%, 96% and 84%, respectively. The prevalence of eta and etb genes in isolates were 84% and 92%, respectively.

CONCLUSION

Biofilm producing isolates of Staphylococcus aureus showed greater multidrug resistance than non-biofilm producers. In our study, a high rate of biofilm formation and antimicrobial drug resistance was seen. Our results highlight the alarming levels of antimicrobial resistance among MRSA strains and important data about the prevalence of eta and etb genes in Staphylococcus aureus strains isolated from burn patients in this study.

The increasing threat of silver-resistance in clinical isolates from wounds and burns

Purpose

The widespread use of silver-containing compounds has led to emergence of silver-resistant bacteria. Few studies are available on the detectability of plasmid-mediated silver-resistance in developing countries. Therefore, we aimed to detect silver-resistance in isolates from wounds and burns, and to genetically characterize plasmid-mediated silver-resistance genes (sil genes).

Methods

One hundred and fifty clinical isolates were obtained from burns and wounds. They were identified using the suitable Analytical Profile Index and MicroScan identification systems. Their antimicrobial susceptibility was tested by the disk diffusion and broth microdilution methods. Their silver nitrate (AgNO₃) minimum inhibitory concentration (MIC) was determined using the broth macrodilution method. The presence of different sil genes on plasmids extracted from silver-resistant isolates and the replicon types of the extracted plasmids were investigated using polymerase chain reaction (PCR). The ability of these plasmids to impart silver-resistance was tested by transformation.

Results

All except two isolates were multidrug-resistant. Nineteen silver-resistant bacterial isolates (12.6%) were detected; with AgNO₃ MIC ≥512 µg/mL. They were identified as Klebsiella pneumoniae (n=7), Staphylococcus aureus (n=4), Escherichia coli (n=2), Enterobacter cloacae (n=2), Pseudomonas aeruginosa (n=2) and Acinetobacter baumannii (n=2). PCR revealed the presence of different sil genes on the extracted plasmids. Plasmid transformation resulted in the transfer of silver-resistance to the resulting transformants. The extracted plasmids had different replicon types.

Conclusion

Plasmid-mediated silver-resistance was detected for the first time, in clinical P. aeruginosa, A. baumannii and S. aureus isolates; in addition to its detection in K. pneumoniae, E. coli and Enterobacter cloacae. Therefore, strict monitoring on the use of silver compounds in medical settings is required; with implementation of an approved standardized method for silver-resistance detection.

Microbial epidemiology and antimicrobial resistance patterns of wound infection in Ethiopia: a meta-analysis of laboratory-based cross-sectional studies

BACKGROUND

Wound infections are responsible for significant human morbidity and mortality worldwide. Specifically, surgical site infections are the third most commonly reported nosocomial infections accounting approximately a quarter of such infections. This systematic review and meta-analysis is, therefore, aimed to determine microbial profiles cultured from wound samples and their antimicrobial resistance patterns in Ethiopia.

METHODS

Literature search was carried out through visiting electronic databases and indexing services including PubMed, MEDLINE, EMBASE, CINAHL, and Google Scholar. Original records, available online from 2000 to 2018, addressing the research question and written in English were identified and screened. The relevant data were extracted from included studies using a format prepared in Microsoft Excel and exported to STATA 15.0 software for analyses of outcome measures and subgrouping. Der-Simonian-Laird's random effects model was applied for pooled estimation of outcome measures at 95% confidence level. Comprehensive meta-analysis version-3 software was used for assessing publication bias across studies. The study protocol is registered on PROSPERO with reference number ID: CRD42019117638.

RESULTS

A total of 21 studies with 4284 wound samples, 3012 positive wound cultures and 3598 bacterial isolates were included for systematic review and meta-analysis. The pooled culture positivity was found to be 70.0% (95% CI: 61, 79%). Regarding the bacterial isolates recovered, the pooled prevalence of S. aureus was 36% (95% CI: 29, 42%), from which 49% were methicillin resistant strains. The pooled estimate of E. coli isolates was about 13% (95% CI: 10, 16%) followed by P. aeruginosa, 9% (95% CI: 6, 12%), K. pneumoniae, 9% (95% CI: 6, 11%) and P. mirabilis, 8% (95% CI: 5, 11%). Compared to other antimicrobials, S. aureus has showed lower estimates of resistance against ciprofloxacin, 12% (95% CI: 8, 16%) and gentamicin, 13% (95% CI: 8, 18%). E. coli isolates exhibited the highest point estimate of resistance towards ampicillin (P = 84%; 95% CI: 76, 91%). Gentamicin and ciprofloxacin showed relatively lower estimates of resistance with pooled prevalence being 24% (95% CI: 16, 33%) and 27% (95% CI: 16, 37%), respectively. Likewise, P. aeruginosa showed the lowest pooled estimates of resistance against ciprofloxacin (P = 16%; 95% CI: 9, 24%).

CONCLUSION

Generally, the wound culture positivity was found very high indicating the likelihood of poly-microbial contamination. S. aureus is by far the most common bacterial isolate recovered from wound infection. The high estimate of resistance was observed among β-lactam antibiotics in all bacterial isolates. Ciprofloxacin and gentamicin were relatively effective in treating wound infections with poly-microbial etiology.

High Burden of Antimicrobial Resistance among Bacteria Causing Pyogenic Wound Infections at a Tertiary Care Hospital in Kathmandu, Nepal

Pyogenic wound infections are one of the most common clinical entities caused and aggravated by the invasion of pathogenic organisms. Prompt and aggressive antimicrobial therapy is needed to reduce the burden and complications associated with these infections. In this study, we intended to investigate the common pathogens and their antimicrobial susceptibility patterns from the pyogenic wound infections at a tertiary care hospital in Kathmandu, Nepal. A laboratory based cross-sectional study was carried out among the pyogenic clinical specimens of the patients visiting Manmohan Memorial Teaching Hospital, Kathmandu, Nepal. Processing of clinical specimens and isolation and identification of bacterial pathogens were carried out using standard microbiological methods. Antimicrobial susceptibilities and resistant profiles were determined by following the standard guidelines of Clinical and Laboratory Standards Institute (CLSI). About 65% of the clinical specimens were positive for the bacterial growth and Gram positive bacteria (57.4%) were the leading pathogens among pyogenic wound infections. Staphylococcus aureus (412, 49.28%), Escherichia coli (136, 16.27%), Klebsiella spp. (88, 10.53%), and Pseudomonas spp. (44, 5.26%) were the common pathogens isolated. High level of drug resistance was observed among both Gram positive bacteria (51.9%) and Gram negative bacteria (48.7%). Gram positive isolates were resistant to ampicillin, ciprofloxacin, cotrimoxazole, erythromycin, and cloxacillin. Gram negative isolates were resistant to cephalosporins but were well susceptible to amikacin and imipenem. Pyogenic wound infections are common in our hospital and majority of them were associated with multidrug resistant bacteria. The detailed workup of the prevalent pathogens present in infected wounds and their resistance pattern is clearly pertinent to choosing the adequate treatment.