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Worku M, Molla T, Kasew D, Assefa M, Geteneh A, Aynalem M, Gizachew M, Biset S. Antibiogram of Bacteria Isolated from Bloodstream Infection-Suspected Patients at the University of Gondar Comprehensive Specialized Hospital in Northwest Ethiopia: A Retrospective Study. Int J Microbiol 2024; 2024:7624416. [PMID: 39015246 PMCID: PMC11250713 DOI: 10.1155/2024/7624416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/03/2024] [Accepted: 06/19/2024] [Indexed: 07/18/2024] Open
Abstract
Background Bacterial bloodstream infections (BSIs) are the leading cause of sepsis-related morbidity and mortality worldwide. The emergence and spread of antimicrobial resistance (AMR) in bacteria is also a growing global concern. As a result, data on bacterial profile and their antibiogram are essential for strategies to contain drug resistance, improve the quality of patient care, and strengthen health systems. Methods Retrospective data from bacteriological results of blood samples of BSI-suspected patients from 2018 to 2021 were collected using a data collection sheet. Standard bacteriological techniques were followed during sample collection, culture preparation, bacterial identification, and antibiotic susceptibility testing (AST). We used Epi Info version 7 to enter and clean the data and then exported it to SPSS version 26 for analysis. Logistic regression models were used to measure the association between variables. A p value <0.05 with a 95% confidence interval was considered as statistically significant. Result Of the total 2,795 blood culture records, 455 (16.3%) were culture positive for bacteria, with Klebsiella pneumoniae (26%) and Staphylococcus aureus (24.6%) being the leading isolates. The isolates were highly resistant to common antibiotics, with more than 80% of them being resistant to ceftriaxone and penicillin. Moreover, about 43% of isolates were multidrug resistant (MDR), with Klebsiella pneumoniae (65.5%), Acinetobacter species (56.7%), and Citrobacter species (53.8%) being the most common MDR isolates. Age and diagnosis year were significantly associated with the presence of bacterial BSIs (p value <0.05). Conclusion Bacterial BSI and AMR were growing concerns in the study area. Bacteremia was more common in children under the age of five, and it decreased as the patient's age increased. The alarming rate of AMR, such as MDR blood isolates, calls for periodic and continuous monitoring of antibiotic usage in the study area.
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Affiliation(s)
- Minichil Worku
- University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Tigist Molla
- University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Desie Kasew
- Department of Medical MicrobiologySchool of Biomedical and Laboratory SciencesCollege of Medicine and Health SciencesUniversity of Gondar, Gondar, Ethiopia
| | - Muluneh Assefa
- Department of Medical MicrobiologySchool of Biomedical and Laboratory SciencesCollege of Medicine and Health SciencesUniversity of Gondar, Gondar, Ethiopia
| | - Alene Geteneh
- Department of Medical Laboratory ScienceCollege of Health SciencesWoldia University, Woldia, Ethiopia
| | - Melak Aynalem
- Department of Hematology and ImmunohematologySchool of Biomedical and Laboratory SciencesCollege of Medicine and Health ScienceUniversity of Gondar, Gondar, Ethiopia
| | - Mucheye Gizachew
- Department of Medical MicrobiologySchool of Biomedical and Laboratory SciencesCollege of Medicine and Health SciencesUniversity of Gondar, Gondar, Ethiopia
| | - Sirak Biset
- Department of Medical MicrobiologySchool of Biomedical and Laboratory SciencesCollege of Medicine and Health SciencesUniversity of Gondar, Gondar, Ethiopia
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Rwigi D, Nyerere AK, Diakhate MM, Kariuki K, Tickell KD, Mutuma T, Tornberg SN, Soge OO, Walson JL, Singa B, Kariuki S, Pavlinac PB, Mogeni P. Phenotypic and molecular characterization of β-lactamase-producing Klebsiella species among children discharged from hospital in Western Kenya. BMC Microbiol 2024; 24:135. [PMID: 38654237 PMCID: PMC11040804 DOI: 10.1186/s12866-024-03284-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 03/31/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The emergence and spread of β-lactamase-producing Klebsiella spp. has been associated with a substantial healthcare burden resulting in therapeutic failures. We sought to describe the proportion of phenotypic resistance to commonly used antibiotics, characterize β-lactamase genes among isolates with antimicrobial resistance (AMR), and assess the correlates of phenotypic AMR in Klebsiella spp. isolated from stool or rectal swab samples collected from children being discharged from hospital. METHODS We conducted a cross-sectional study involving 245 children aged 1-59 months who were being discharged from hospitals in western Kenya between June 2016 and November 2019. Whole stool or rectal swab samples were collected and Klebsiella spp. isolated by standard microbiological culture. β-lactamase genes were detected by PCR whilst phenotypic antimicrobial susceptibility was determined using the disc diffusion technique following standard microbiology protocols. Descriptive analyses were used to characterize phenotypic AMR and carriage of β-lactamase-producing genes. The modified Poisson regression models were used to assess correlates of phenotypic beta-lactam resistance. RESULTS The prevalence of β-lactamase carriage among Klebsiella spp. isolates at hospital discharge was 62.9% (154/245). Antibiotic use during hospitalization (adjusted prevalence ratio [aPR] = 4.51; 95%CI: 1.79-11.4, p < 0.001), longer duration of hospitalization (aPR = 1.42; 95%CI: 1.14-1.77, p < 0.002), and access to treated water (aPR = 1.38; 95%CI: 1.12-1.71, p < 0.003), were significant predictors of phenotypically determined β-lactamase. All the 154 β-lactamase-producing Klebsiella spp. isolates had at least one genetic marker of β-lactam/third-generation cephalosporin resistance. The most prevalent genes were blaCTX-M 142/154 (92.2%,) and blaSHV 142/154 (92.2%,) followed by blaTEM 88/154 (57.1%,) and blaOXA 48/154 (31.2%,) respectively. CONCLUSION Carriage of β-lactamase producing Klebsiella spp. in stool is common among children discharged from hospital in western Kenya and is associated with longer duration of hospitalization, antibiotic use, and access to treated water. The findings emphasize the need for continued monitoring of antimicrobial susceptibility patterns to inform the development and implementation of appropriate treatment guidelines. In addition, we recommend measures beyond antimicrobial stewardship and infection control within hospitals, improved sanitation, and access to safe drinking water to mitigate the spread of β-lactamase-producing Klebsiella pathogens in these and similar settings.
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Affiliation(s)
- Doreen Rwigi
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
- Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya.
| | - Andrew K Nyerere
- Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Mame M Diakhate
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Kevin Kariuki
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Kirkby D Tickell
- Department of Global Health, University of Washington, Seattle, Washington, USA
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
| | - Timothy Mutuma
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | | | - Olusegun O Soge
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Judd L Walson
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
- The Childhood Acute Illness & Nutrition (CHAIN) Network, Nairobi, Kenya
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Benson Singa
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Samuel Kariuki
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
- Center for Microbiology Research (CMR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Patricia B Pavlinac
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Polycarp Mogeni
- Kenya Medical Research Institute (KEMRI), Nairobi, Kenya.
- Department of Global Health, University of Washington, Seattle, Washington, USA.
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Chelaru EC, Muntean AA, Hogea MO, Muntean MM, Popa MI, Popa GL. The Importance of Carbapenemase-Producing Enterobacterales in African Countries: Evolution and Current Burden. Antibiotics (Basel) 2024; 13:295. [PMID: 38666971 PMCID: PMC11047529 DOI: 10.3390/antibiotics13040295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 04/29/2024] Open
Abstract
Antimicrobial resistance (AMR) is a worldwide healthcare problem. Multidrug-resistant organisms (MDROs) can spread quickly owing to their resistance mechanisms. Although colonized individuals are crucial for MDRO dissemination, colonizing microbes can lead to symptomatic infections in carriers. Carbapenemase-producing Enterobacterales (CPE) are among the most important MDROs involved in colonizations and infections with severe outcomes. This review aimed to track down the first reports of CPE in Africa, describe their dissemination throughout African countries and summarize the current status of CRE and CPE data, highlighting current knowledge and limitations of reported data. Two database queries were undertaken using Medical Subject Headings (MeSH), employing relevant keywords to identify articles that had as their topics beta-lactamases, carbapenemases and carbapenem resistance pertaining to Africa or African regions and countries. The first information on CPE could be traced back to the mid-2000s, but data for many African countries were established after 2015-2018. Information is presented chronologically for each country. Although no clear conclusions could be drawn for some countries, it was observed that CPE infections and colonizations are present in most African countries and that carbapenem-resistance levels are rising. The most common CPE involved are Klebsiella pneumoniae and Escherichia coli, and the most prevalent carbapenemases are NDM-type and OXA-48-type enzymes. Prophylactic measures, such as screening, are required to combat this phenomenon.
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Affiliation(s)
- Edgar-Costin Chelaru
- Department of Microbiology II, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.-C.C.); (A.-A.M.); (M.-O.H.); (M.-M.M.)
| | - Andrei-Alexandru Muntean
- Department of Microbiology II, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.-C.C.); (A.-A.M.); (M.-O.H.); (M.-M.M.)
- Department of Microbiology, Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania
| | - Mihai-Octav Hogea
- Department of Microbiology II, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.-C.C.); (A.-A.M.); (M.-O.H.); (M.-M.M.)
| | - Mădălina-Maria Muntean
- Department of Microbiology II, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.-C.C.); (A.-A.M.); (M.-O.H.); (M.-M.M.)
| | - Mircea-Ioan Popa
- Department of Microbiology II, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (E.-C.C.); (A.-A.M.); (M.-O.H.); (M.-M.M.)
- Department of Microbiology, Cantacuzino National Military Medical Institute for Research and Development, 050096 Bucharest, Romania
| | - Gabriela-Loredana Popa
- Department of Microbiology, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Parasitic Disease Department, Colentina Clinical Hospital, 020125 Bucharest, Romania
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Sah RK, Dahal P, Parajuli R, Giri GR, Tuladhar E. Prevalence of blaCTX-M and blaTEM Genes in Cefotaxime-Resistant Escherichia coli Recovered from Tertiary Care at Central Nepal: A Descriptive Cross-Sectional Study. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2024; 2024:5517662. [PMID: 38226321 PMCID: PMC10789516 DOI: 10.1155/2024/5517662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/17/2024]
Abstract
Urinary tract infections (UTIs) are highly prevalent globally, and various antibiotics are employed for their treatment. However, the emergence of drug-resistant uropathogens towards these antibiotics causes a high rate of morbidity and mortality. This study was conducted at the Microbiology Laboratory of Grande International Hospital from November 2021 to May 2022 and aimed to assess the prevalence of UTI caused by Escherichia coli and their antibiotic susceptibility pattern with a focus on extended-spectrum beta-lactamases (ESBLs) and the prevalence of two genes (blaCTX-M and blaTEM) in cephalosporin-resistant E. coli. Altogether, 1050 urine samples were processed to obtain 165 isolates of E. coli. The isolates were identified by colony morphology and biochemical characteristics. Antimicrobial susceptibility tests (ASTs) were determined by the Kirby-Bauer disk diffusion method, and their ESBL enzymes were estimated by the combined disk method (CDM). Two ESBL genes (blaCTX-M and blaTEM) were investigated by polymerase chain reaction (PCR) in cefotaxime-resistant E. coli. Among the 1050 urine samples that were processed, 335 (31.9%) were culture-positive with 165 (49.2%) identified as E. coli. The age group ≥60 years (30.3%) had greater susceptibility to bacterial infections. AST revealed that meropenem was highly effective (95.7% susceptibility), while ampicillin showed the least sensitivity (42.4%). Among the E. coli isolates, 86 were multidrug resistant (MDR) and 10 were extensively drug resistant (XDR). Of these, 46 MDR (96%) and 2 XDR (4%) were ESBL producers. The prevalence of ESBL genes (blaCTX-M and blaTEM) was 49.3% and 54.8%, respectively. The overall accuracy of CDM as compared to PCR for the detection of the blaCTX-M gene was 55.26%. The prevalence of MDR E. coli harboring the blaCTX-M and blaTEM genes underscores the imperative role of ESBL testing in accurately identifying both beta-lactamase producers and nonproducers.
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Li L, Guan W, Fan Y, He Q, Guo D, Yuan A, Xing Q, Wang Y, Ma Z, Ni J, Chen J, Zhou Q, Zhong Y, Li J, Zhang H. Zinc/carbon nanomaterials inhibit antibiotic resistance genes by affecting quorum sensing and microbial community in cattle manure production. BIORESOURCE TECHNOLOGY 2023; 387:129648. [PMID: 37572887 DOI: 10.1016/j.biortech.2023.129648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/14/2023]
Abstract
This study used metagenomic sequencing to examine the effects of carbon-based zinc oxide nanoparticles (CZnONPs) and graphene-based zinc oxide nanoparticles (GZnONPs) on quorum sensing (QS), antibiotic resistance genes (ARGs) and microbial community changes during cattle manure production. The manure zinc content was significantly reduced in GZnONPs group. In the QS pathway, the autoinducer gene increases significantly in Control group, while the transporter and repressor genes experience a substantial increase in CZnONPs group. These results contributed to the significantly decreased the abundance of ARGs in GZnONPs group. The co-occurrence network analysis revealed a correlation between core ARGs and QS-related KEGG Orthology or ARGs' hosts, indicating that the selective pressure of zinc influences microbial QS, forming a unique ARG pattern in in vivo anaerobic fermentation. These findings suggest that implementing nutritional regulation in farming practices can serve as a preventive measure to mitigate the potential transmission of ARGs resulting from livestock waste.
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Affiliation(s)
- Lizhi Li
- College of Life Science and Resources and Environment, Yichun University, Yi Chun 336000, China
| | - Weikun Guan
- College of Life Science and Resources and Environment, Yichun University, Yi Chun 336000, China
| | - Yihao Fan
- College of Life Science and Resources and Environment, Yichun University, Yi Chun 336000, China
| | - Qin He
- College of Life Sciences, Nanchang Normal University, Nanchang 330032, China
| | - Dongsheng Guo
- College of Life Science and Resources and Environment, Yichun University, Yi Chun 336000, China
| | - An Yuan
- College of Life Science and Resources and Environment, Yichun University, Yi Chun 336000, China
| | - Qingfeng Xing
- College of Life Science and Resources and Environment, Yichun University, Yi Chun 336000, China
| | - Yang Wang
- College of Life Science and Resources and Environment, Yichun University, Yi Chun 336000, China
| | - Ziqin Ma
- College of Life Science and Resources and Environment, Yichun University, Yi Chun 336000, China
| | - Jian Ni
- College of Life Science and Resources and Environment, Yichun University, Yi Chun 336000, China
| | - Jia Chen
- College of Life Science and Resources and Environment, Yichun University, Yi Chun 336000, China
| | - Qilong Zhou
- College of Life Science and Resources and Environment, Yichun University, Yi Chun 336000, China
| | - Yuhong Zhong
- College of Life Science and Resources and Environment, Yichun University, Yi Chun 336000, China
| | - Jiating Li
- College of Life Science and Resources and Environment, Yichun University, Yi Chun 336000, China
| | - Haibo Zhang
- College of Life Science and Resources and Environment, Yichun University, Yi Chun 336000, China.
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Abayneh M, Zeynudin A, Tamrat R, Tadesse M, Tamirat A. Drug resistance and extended-spectrum β-lactamase (ESBLs) - producing Enterobacteriaceae, Acinetobacter and Pseudomonas species from the views of one-health approach in Ethiopia: a systematic review and meta-analysis. ONE HEALTH OUTLOOK 2023; 5:12. [PMID: 37697359 PMCID: PMC10496308 DOI: 10.1186/s42522-023-00088-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/10/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Although antimicrobial resistance (AMR) bacteria present a significant and ongoing public health challenge, its magnitude remains poorly understood, especially in many parts of the developing countries. Hence, this review was conducted to describe the current pooled prevalence of drug resistance, multidrug- resistance (MDR), and Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, Acinetobacter, and Pseudomonas species in humans, the environment, and animals or food of animal origin in Ethiopia. METHODS PubMed, Google Scholar, and other sources were searched for relevant articles as per the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. A critical appraisal for screening, eligibility, and inclusion in the meta-analysis was made based on the Joanna Briggs Institute's (JBI) essential appraisal tools. The meta-analysis was done on Statistical Software Package (STATA) version 17.0. RESULTS A total of 33 research articles were included in this systematic review and meta-analysis. Escherichia coli, Klebsiella species, Acinetobacter, and Pseudomonas species were the most frequently reported bacteria from two or more sources. More than 50% of Klebsiella species and 25% to 89% of Escherichia coli from two or more sources were resistant to all analysed antibiotics, except carbapenems. Fifty-five percent (55%) to 84% of Acinetobacter species and 33% to 79% of Pseudomonas species from human and environmental sources were resistant to all analyzed antibiotics. Carbapenem resistance was common in Acinetobacter and Pseudomonas species (38% to 64%) but uncommon in Enterobacteriaceae (19% to 44%). Acinetobacter species (92%), Klebsiella species (86%), and Pseudomonas species (79%) from human sources, and Proteus species (92%), and Acinetobacter species (83%), from environmental sources, were the common multidrug-resistant isolates. About 45% to 67% of E. coli, Klebsiella, Acinetobacter, and Pseudomonas species from human and environmental sources were ESBL producers. CONCLUSION Our review report concluded that there was a significant pooled prevalence of drug resistance, MDR, and ESBL-producing Enterobacteriaceae, Acinetobacter, and Pseudomonas species from two or more sources. Hence, our finding underlines the need for the implementation of integrated intervention approaches to address the gaps in reducing the emergence and spread of antibiotic- resistant bacteria.
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Affiliation(s)
- Mengistu Abayneh
- College of Medical and Health Science, Department of Medical Laboratory Sciences, Mizan-Tepi University, PO Box 260, Mizan-Aman, Ethiopia.
| | - Ahmed Zeynudin
- School of Medical Laboratory Sciences, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Rahel Tamrat
- School of Medical Laboratory Sciences, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Mulualem Tadesse
- School of Medical Laboratory Sciences, Faculty of Health Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Abraham Tamirat
- Faculity of Public Health, Department of Health, Behavior and Society, Jimma University, Jimma, Ethiopia
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Ibrahim ME. Risk factors in acquiring multidrug-resistant Klebsiella pneumoniae infections in a hospital setting in Saudi Arabia. Sci Rep 2023; 13:11626. [PMID: 37468757 DOI: 10.1038/s41598-023-38871-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/16/2023] [Indexed: 07/21/2023] Open
Abstract
Over the last decades, the prevalence of multidrug-resistant (MDR) Klebsiella pneumoniae in clinical settings has increased progressively. This study determined the prevalence and risk factors associated with MDR K. pneumoniae infection among hospitalized patients in a referral hospital located in southern Saudi Arabia. A prospective cross-sectional study was conducted in King Abdullah Hospital from April 2021 to March 2022. K. pneumoniae (n = 211) bacteria were recovered from clinical samples of adult patients and examined for antibiotic susceptibility. Univariate and multivariate logistic regressions were applied to determine the factors associated with MDR K. pneumoniae infection. MDR K. pneumoniae strains was found in 66.8% (142/211) of the patients. Among MDR K. pneumoniae, the highest resistance rate was determined for ampicillin (100%), cefuroxime (97.9%), ceftriaxone (94.3%), and aztreonam (92.2%). The lowest resistance rate was determined for colistin (16.3%), and tigecycline (6.4%). Further, the patients' gender, age group, intensive care unit (ICU) admission, invasive medical devices, and chronic illness were found to be significantly associated with MDR K. pneumoniae infection. The independent risk factors associated with MDR K. pneumoniae infection were the male gender (adjusted odds ratio [AOR] 2.107, 95% confidence interval CI 1.125‒3.945, p = 0.02), patients ≥ 65 years of age (AOR 1.905; CI 1.003‒3.616, p = 0.049), ICU admission (AOR 1.963; CI 1.033‒3.732, p = 0.04), diabetes (AOR 1.95; CI 1.02‒3.727, p = 0.043) and chronic obstructive pulmonary disease (AOR 7.172; CI 1.557‒33.032, p = 0.011). The study offered a vision of MDR K. pneumoniae infection in our setting and provided essential indications for further studies that may lead to the prevention and reduction of MDR bacteria.
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Affiliation(s)
- Mutasim E Ibrahim
- Department of Basic Medical Sciences (Microbiology Unit), College of Medicine, University of Bisha, P. O. Box 731, Bisha, 67614, Saudi Arabia.
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Moges F, Tamiru T, Amare A, Mengistu G, Eshetie S, Dagnew M, Feleke T, Gizachew M, Abebe W. Prevalence of Methicillin-Resistant Staphylococcus aureus and Multidrug-Resistant Strains from Patients Attending the Referral Hospitals of Amhara Regional State, Ethiopia. Int J Microbiol 2023; 2023:3848073. [PMID: 37384165 PMCID: PMC10299872 DOI: 10.1155/2023/3848073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/11/2023] [Accepted: 05/29/2023] [Indexed: 06/30/2023] Open
Abstract
Background Staphylococcus aureus (S. aureus) causes different types of human infections and can develop resistance to many antibiotics. There is a scarcity of data on the mecA gene and multidrug-resistant (MDR) strain distribution of this organism in developing countries, such as Ethiopia. This study investigated the presence of mecA gene and MDR profile of S. aureus among patients attending referral hospitals of Amhara regional state. Methods Of the total of 110 isolates collected from Amhara regional referral hospitals, 70 MDR isolates were further processed for isolation of S. aureus mecA gene. Genomic DNA was isolated using a Sigma-Aldrich genomic DNA isolation kit for Gram-positive bacteria. Amplification of S. aureus mecA gene was performed with the amplicon size of 533 bp. Antimicrobial susceptibility test including methicillin resistance was determined by the Kirby-Bauer disc diffusion method. Results The majority of the isolates were recovered from patients aged less than 5 years (51; 36.7%) and the least number of isolates was recorded in age group greater than 60 years (6; 4.3%). Most of the isolates were from blood (61; 43.9%), followed by wounds (45; 32.4%). A high resistance rate was observed in penicillin (81; 73.6%), followed by cotrimoxazole (78; 70.9%), ceftriaxone (76; 69%), erythromycin (66; 60%), and tetracycline (65; 59.1%). Phenotypically, considering cefoxitin as a surrogate marker, 38 (34.5%) of the isolates were methicillin-resistant. The overall MDR isolates were 80 (72.7%). The PCR amplification result of the mecA gene was 14 (20%). Conclusions and Recommendations. High rates of MDR and methicillin-resistantS. aureus were reported. PCR amplification indicated that 20% of MRSA isolates were the mecA gene carriers. Large-scale studies for the detection of MDR strains of S. aureus including MRSA using molecular techniques should be encouraged in the Amhara region.
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Affiliation(s)
- Feleke Moges
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadele Tamiru
- Institute of Biotechnology, College of Natural and Computational Sciences, University of Gondar, Gondar, Ethiopia
| | - Azanaw Amare
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getachew Mengistu
- Department of Medical Microbiology, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Setegn Eshetie
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulat Dagnew
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tigist Feleke
- Department of Hospital Laboratory, University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Mucheye Gizachew
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Wondwossen Abebe
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Alemayehu E, Fiseha T, Gedefie A, Alemayehu Tesfaye N, Ebrahim H, Ebrahim E, Fiseha M, Bisetegn H, Mohammed O, Tilahun M, Gebretsadik D, Debash H, Gobezie MY. Prevalence of carbapenemase-producing Enterobacteriaceae from human clinical samples in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:277. [PMID: 37138285 PMCID: PMC10155349 DOI: 10.1186/s12879-023-08237-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 04/10/2023] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION Carbapenemase-producing Enterobacteriaceae are by far the most public health and urgent clinical problems with antibiotic resistance. They cause longer hospital stays, more expensive medical care, and greater mortality rates. This systematic review and meta-analysis aimed to indicate the prevalence of carbapenemase-producing Enterobacteriaceae in Ethiopia. METHODS This systematic review and meta-analysis was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Electronic databases like PubMed, Google Scholar, CINAHL, Wiley Online Library, African Journal Online, Science Direct, Embase, ResearchGate, Scopus, and the Web of Sciences were used to find relevant articles. In addition, the Joanna Briggs Institute quality appraisal tool was used to assess the quality of the included studies. Stata 14.0 was used for statistical analysis. Heterogeneity was assessed by using Cochran's Q test and I2 statistics. In addition, publication bias was assessed using a funnel plot and Egger's test. A random effect model was used to estimate the pooled prevalence. Sub-group and sensitivity analysis were also done. RESULTS The overall pooled prevalence of carbapenemase-producing Enterobacteriaceae in Ethiopia was 5.44% (95% CI 3.97, 6.92). The prevalence was highest [6.45% (95% CI 3.88, 9.02)] in Central Ethiopia, and lowest [(1.65% (95% CI 0.66, 2.65)] in the Southern Nations and Nationalities People Region. In terms of publication year, 2017-2018 had the highest pooled prevalence [17.44 (95% CI 8.56, 26.32)] and 2015-2016 had the lowest [2.24% (95% CI 0.87, 3.60)]. CONCLUSION This systematic review and meta-analysis showed a high prevalence of carbapenemase-producing Enterobacteriaceae. So, to alter the routine use of antibiotics, regular drug susceptibility testing, strengthening the infection prevention approach, and additional national surveillance on the profile of carbapenem resistance and their determining genes among Enterobacteriaceae clinical isolates are required. SYSTEMATIC REVIEW REGISTRATION PROSPERO (2022: CRD42022340181).
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Affiliation(s)
- Ermiyas Alemayehu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Temesgen Fiseha
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Alemu Gedefie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | | | - Hussen Ebrahim
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Endris Ebrahim
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mesfin Fiseha
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Habtye Bisetegn
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ousman Mohammed
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mihret Tilahun
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Daniel Gebretsadik
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Habtu Debash
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mengistie Yirsaw Gobezie
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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10
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Alemu A, Girma S, Mariam SH. An Arsenal of Multiple Antimicrobial Resistance, Toxins, and Virulence Factors in Gram-Negative Bacterial Isolates from Food - A Formidable Combination! Infect Drug Resist 2023; 16:1029-1037. [PMID: 36845021 PMCID: PMC9948636 DOI: 10.2147/idr.s391072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 02/09/2023] [Indexed: 02/20/2023] Open
Abstract
Background Infectious diseases caused by pathogenic members of the family Enterobacteriaceae cause mortality and morbidity in humans. These are mediated mainly via toxins or virulence factors in combination with multiple antimicrobial resistance (MAR) against antimicrobials intended to treat infections. Resistance can be transferred to other bacteria, possibly also in association with other resistance determinants and/or virulence properties. Food-borne bacterial infections are one of the major causes of infections in humans. The level of scientific information about foodborne bacterial infections in Ethiopia is very limited at best. Methods Bacteria were isolated from commercial dairy foods. These were cultured in appropriate media for identification at the family level (Enterobacteriaceae) based on Gram-negative, catalase-positive, oxidase-negative, and urease-negative phenotypes, followed by testing for the presence of virulence factors and resistance determinants to various antimicrobial classes using phenotypic and molecular tests. Results Twenty Gram-negative bacteria isolated from the foods were found to be resistant to almost all antimicrobials belonging to the phenicol, aminoglycoside, fluoroquinolone, monobactam, and β-lactam classes. All of them were multiple-drug-resistant. The resistance to the β-lactams was due to the production of β-lactamases and were also mostly resistant to some of the β-lactam/β-lactamase inhibitor combinations. Some isolates also contained toxins. Conclusion This small-scale study demonstrated the presence, in the isolates, of high levels of virulence factors and resistance to major antimicrobials that are in clinical use. Most treatment being empirical, there can be not only a high degree of treatment failure but also the likelihood for further development and dissemination of antimicrobial resistance. Since dairy foods are animal products, there is an urgent need to control animal-food-human transmission mechanisms, restrict antimicrobial use in animal agriculture, and improve clinical treatment from the usual empirical treatment to more targeted and effective treatment.
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Affiliation(s)
- Ashenafi Alemu
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Selfu Girma
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Solomon H Mariam
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia,Infectious Diseases Program, Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia,Correspondence: Solomon H Mariam, Email
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11
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Bacterial infections epidemiology and factors associated with multidrug resistance in the northern region of Ghana. Sci Rep 2022; 12:22069. [PMID: 36543904 PMCID: PMC9772187 DOI: 10.1038/s41598-022-26547-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Bacterial infections caused by multidrug resistant organisms are a major global threat. There is still a knowledge gap on this situation in the Northern Region of Ghana. This study determined the prevalence and resistance profile of bacterial infections. It also identified factors associated with multidrug resistance in the study area. This was a retrospective cross-sectional design and it analyzed data from the samples received at the Tamale Zonal Public Health Reference Laboratory from June 2018 to May 2022. The data were analyzed using the R software version 4.2.0. Univariate and multivariable binary logistic regression analyses were used to determine the factors associated with multidrug resistance. The samples included all specimen types possible. The specimens were collected for the purpose of clinical bacteriology diagnostics. Overall a total of 1222 isolates were obtained. The three (3) main bacteria responsible for infections were: Klebsiella spp. (27%), Moraxella spp. (22%), Escherichia spp. (16%). High resistance levels were found against the tested antibiotics and about 41.60% of the bacterial strains isolated were multidrug resistant. Hospitalization was associated with multidrug resistance in univariate (COR 1.96; 95% CI 1.43-2.71; P-value < 0.001) and multivariable analyses (AOR 1.78; 95% CI 1.28-2.49; P-value < 0.001). There is the need for further research on the molecular epidemiology of antibiotic resistance genes in the study area to effectively control the spread of multidrug resistant pathogens. In addition, efforts to build the capacity of health professionals on infection prevention and control as well as diagnostic and antimicrobial stewardship needs urgent attention.
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12
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Tufa TB, Mackenzie CR, Orth HM, Wienemann T, Nordmann T, Abdissa S, Hurissa Z, Schönfeld A, Bosselmann M, Häussinger D, Pfeffer K, Luedde T, Fuchs A, Feldt T. Prevalence and characterization of antimicrobial resistance among gram-negative bacteria isolated from febrile hospitalized patients in central Ethiopia. Antimicrob Resist Infect Control 2022; 11:8. [PMID: 35033191 PMCID: PMC8761287 DOI: 10.1186/s13756-022-01053-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/03/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Infectious diseases are among the leading causes of death in many low-income countries, such as Ethiopia. Without reliable local data concerning causative pathogens and antimicrobial resistance, empiric treatment is suboptimal. The objective of this study was to characterize gram-negative bacteria (GNB) as pathogens and their resistance pattern in hospitalized patients with infections in central Ethiopia. METHODS Patients ≥ 1 year of age with fever admitted to the Asella Referral and Teaching Hospital from April 2016 to June 2018 were included. Blood and other appropriate clinical specimens were collected and cultured on appropriate media. Antibiotic susceptibility testing (AST) was performed using the Kirby-Bauer method and VITEK® 2. Species identification and detection of resistance genes were conducted using MALDI-ToF MS (VITEK® MS) and PCR, respectively. RESULTS Among the 684 study participants, 54.2% were male, and the median age was 22.0 (IQR: 14-35) years. Blood cultures were positive in 5.4% (n = 37) of cases. Among other clinical samples, 60.6% (20/33), 20.8% (5/24), and 37.5% (3/8) of swabs/pus, urine and other body fluid cultures, respectively, were positive. Among 66 pathogenic isolates, 57.6% (n = 38) were GNB, 39.4% (n = 26) were gram-positive, and 3.0% (n = 2) were Candida species. Among the isolated GNB, 42.1% (16/38) were Escherichia coli, 23.7% (9/38) Klebsiella pneumoniae and 10.5% (4/38) Pseudomonas aeruginosa. In total, 27/38 gram-negative isolates were available for further analysis. Resistance rates were as follows: ampicillin/sulbactam, 92.6% (n = 25); cefotaxime, 88.9% (n = 24); ceftazidime, 74.1% (n = 20); cefepime, 74.1% (n = 20); gentamicin, 55.6% (n = 15); piperacillin/tazobactam, 48.1% (n = 13); meropenem, 7.4% (n = 2); and amikacin, 3.7% (n = 1). The blaNDM-1 gene was detected in one K. pneumoniae and one Acinetobacter baumannii isolate, which carried an additional blaOXA-51 gene. The ESBL enzymes were detected in 81.5% (n = 22) of isolates as follows: TEM, 77.2% (n = 17); CTX-M-1 group, 68.2% (n = 15); SHV group, 27.3% (n = 6); and CTX-M-9 group, 9.1% (n = 2). Based on the in vitro antimicrobial susceptibility results, empiric treatment initiated in 13 of 18 (72.2%) patients was likely ineffective. CONCLUSION We report a high prevalence of ESBL-producing bacteria (81.5%) and carbapenem resistance (7.4%), with more than half of GNB carrying two or more ESBL enzymes resulting in suboptimal empiric antibiotic therapy. These findings indicate a need for local and national antimicrobial resistance surveillance and the strengthening of antimicrobial stewardship programs.
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Affiliation(s)
- Tafese Beyene Tufa
- College of Health Sciences, Arsi University, P.O. Box 04, Asella, Ethiopia. .,Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University, Moorenstr. 5, 40225, Duesseldorf, Germany. .,Hirsch Institute of Tropical Medicine, P.O. Box 04, Asella, Ethiopia. .,Institute of Medical Microbiology and Hospital Hygiene, University Hospital Duesseldorf, Medical Faculty, Heinrich Heine University, Universitätsstr. 1, 40225, Duesseldorf, Germany.
| | - Colin R Mackenzie
- Institute of Medical Microbiology and Hospital Hygiene, University Hospital Duesseldorf, Medical Faculty, Heinrich Heine University, Universitätsstr. 1, 40225, Duesseldorf, Germany
| | - Hans Martin Orth
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University, Moorenstr. 5, 40225, Duesseldorf, Germany.,Hirsch Institute of Tropical Medicine, P.O. Box 04, Asella, Ethiopia
| | - Tobias Wienemann
- Institute of Medical Microbiology and Hospital Hygiene, University Hospital Duesseldorf, Medical Faculty, Heinrich Heine University, Universitätsstr. 1, 40225, Duesseldorf, Germany
| | - Tamara Nordmann
- Division Tropical Medicine, Department of Medicine, University Medical Center Hamburg-Eppendorf, Bernhard-Nacht-Straße 74, 20359, Hamburg, Germany
| | - Sileshi Abdissa
- College of Health Sciences, Arsi University, P.O. Box 04, Asella, Ethiopia.,Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University, Moorenstr. 5, 40225, Duesseldorf, Germany.,Hirsch Institute of Tropical Medicine, P.O. Box 04, Asella, Ethiopia.,Institute of Medical Microbiology and Hospital Hygiene, University Hospital Duesseldorf, Medical Faculty, Heinrich Heine University, Universitätsstr. 1, 40225, Duesseldorf, Germany
| | - Zewdu Hurissa
- College of Health Sciences, Arsi University, P.O. Box 04, Asella, Ethiopia
| | - Andreas Schönfeld
- Department of Infectious Diseases, Essen University Hospital, Essen, Germany
| | | | - Dieter Häussinger
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University, Moorenstr. 5, 40225, Duesseldorf, Germany.,Hirsch Institute of Tropical Medicine, P.O. Box 04, Asella, Ethiopia
| | - Klaus Pfeffer
- Institute of Medical Microbiology and Hospital Hygiene, University Hospital Duesseldorf, Medical Faculty, Heinrich Heine University, Universitätsstr. 1, 40225, Duesseldorf, Germany
| | - Tom Luedde
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University, Moorenstr. 5, 40225, Duesseldorf, Germany.,Hirsch Institute of Tropical Medicine, P.O. Box 04, Asella, Ethiopia
| | - Andre Fuchs
- Hirsch Institute of Tropical Medicine, P.O. Box 04, Asella, Ethiopia.,Internal Medicine III - Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Duesseldorf, Medical Faculty of Heinrich Heine University, Moorenstr. 5, 40225, Duesseldorf, Germany.,Hirsch Institute of Tropical Medicine, P.O. Box 04, Asella, Ethiopia
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Abdeta A, Bitew A, Fentaw S, Tsige E, Assefa D, Lejisa T, Kefyalew Y, Tigabu E, Evans M. Phenotypic characterization of carbapenem non-susceptible gram-negative bacilli isolated from clinical specimens. PLoS One 2021; 16:e0256556. [PMID: 34855767 PMCID: PMC8638961 DOI: 10.1371/journal.pone.0256556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/16/2021] [Indexed: 01/03/2023] Open
Abstract
Background Multidrug resistant, extremely drug-resistant, pan-drug resistant, carbapenem-resistant, and carbapenemase-producing gram-negative bacteria are becoming more common in health care settings and are posing a growing threat to public health. Objective The study was aimed to detect and phenotypically characterize carbapenem no- susceptible gram-negative bacilli at the Ethiopian Public Health Institute. Materials and methods A prospective cross-sectional study was conducted from June 30, 2019, to May 30, 2020, at the national reference laboratory of the Ethiopian Public Health Institute. Clinical samples were collected, inoculated, and incubated for each sample in accordance with standard protocol. Antimicrobial susceptibility testing was conducted using Kirby-Bauer disk diffusion method. Identification was done using the traditional biochemical method. Multidrug-resistant and extensively drug-resistant isolates were classified using a standardized definition established by the European Centre for Disease Prevention and Control and the United States Centers for Disease Prevention and Control. Gram-negative organisms with reduced susceptibility to carbapenem antibiotics were considered candidate carbapenemase producers and subjected to modified carbapenem inactivation and simplified carbapenem inactivation methods. Meropenem with EDTA was used to differentiate metallo-β-lactamase (MBL) from serine carbapenemase. Meropenem (MRP)/meropenem + phenylboronic acid (MBO) were used to differentiate Klebsiella pneumoniae carbapenemase (KPC) from other serine carbapenemase producing gram-negative organisms. Results A total of 1,337 clinical specimens were analyzed, of which 429 gram-negative bacterial isolates were recovered. Out of 429 isolates, 319, 74, and 36 were Enterobacterales, Acinetobacter species, and Pseudomonas aeruginosa respectively. In our study, the prevalence of multidrug-resistant, extensively drug-resistant, carbapenemase-producing, and carbapenem nonsusceptible gram-negative bacilli were 45.2%, 7.7%, 5.4%, and 15.4% respectively. Out of 429 isolates, 66 demonstrated reduced susceptibility to the antibiotics meropenem and imipenem. These isolates were tested for carbapenemase production of which 34.8% (23/66) were carbapenemase producers. Out of 23 carbapenemase positive gram-negative bacteria, ten (10) and thirteen (13) were metallo-beta-lactamase and serine carbapenemase respectively. Three of 13 serine carbapenemase positive organisms were Klebsiella pneumoniae carbapenemase. Conclusion This study revealed an alarming level of antimicrobial resistance (AMR), with a high prevalence of multidrug-resistant (MDR) and extremely drug-resistant, carbapenemase-producing gram-negative bacteria, particularly among intensive care unit patients at the health facility level. These findings point to a scenario in which clinical management of infected patients becomes increasingly difficult and necessitates the use of “last-resort” antimicrobials likely exacerbating the magnitude of the global AMR crisis. This mandates robust AMR monitoring and an infection prevention and control program.
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Affiliation(s)
- Abera Abdeta
- National Clinical Bacteriology and Mycology Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- * E-mail:
| | - Adane Bitew
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Surafel Fentaw
- National Clinical Bacteriology and Mycology Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Estifanos Tsige
- National Clinical Bacteriology and Mycology Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Dawit Assefa
- National Clinical Bacteriology and Mycology Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tadesse Lejisa
- National Clinical Chemistry Reference Laboratory, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Yordanos Kefyalew
- Department of Applied Biology, School of Applied Natural Science, Adama Science and Technology University, Adama, Ethiopia
| | - Eyasu Tigabu
- Global One Health initiative, The Ohio State University, East African Regional Office, Addis Ababa, Ethiopia
| | - Martin Evans
- Laboratory Director and Microbiology Consultant, New York, New York, United States of America
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Getaneh A, Ayalew G, Belete D, Jemal M, Biset S. Bacterial Etiologies of Ear Infection and Their Antimicrobial Susceptibility Pattern at the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia: A Six-Year Retrospective Study. Infect Drug Resist 2021; 14:4313-4322. [PMID: 34707376 PMCID: PMC8542893 DOI: 10.2147/idr.s332348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/09/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND An ear infection is responsible for up to 40% of preventable hearing impairment; one of the reasons for frequent and unwise antibiotic usage, especially in the developing world. Since the incidence of antibiotic resistance is increasing, especially in resource-limited countries, up-to-date knowledge on the susceptibility of ear-discharge isolates to antibiotic is important for better patient treatment. Therefore, this study aimed at determining the bacterial etiologies and their antibiotic susceptibility profiles among patients suspected with ear infections. METHODS We collected retrospective data from bacteriological results of ear discharge samples from 2013 to 2018. Sample collection, culture preparation, and bacterial identification were performed using standard microbiological techniques. Antimicrobial susceptibility testing was performed following Clinical and Laboratory Standard Institute (CLSI) guidelines. We extracted and inputted the data using Epi-info version 7 and exported it to SPSS version 20 for analysis. RESULTS The overall ear-discharge culture positivity rate was 283/369 (76.7%) (95% CI = 72.4-81.3), with 14/283 (4.95%) mixed infections. Staphylococcus aureus (27.9%), Proteus spps (20.8%), Streptococcus spps (10%), and Pseudomonas spps (8.92%) were the main isolates. High-level resistance rates for tetracycline (77.6%), penicillins (67.2%), erythromycin (52.6%), and co-trimoxazole (52%), and low-level resistance rates for fluoroquinolones (23.3%), aminoglycosides (23.7%), and cephalosporins (29.8%) were observed. More than 45% of isolates, with 50.9% of Gram-negative and 37.3% of Gram-positive, were multidrug-resistant. CONCLUSION Staphylococcus aureus, Proteus mirabilis, Proteus vulgaris, Escherichia coli, and Pseudomonas aeruginosa were the leading cause of ear infections. The presence of high number of multidrug-resistant strains calls for the need for periodic and continuous follow-up of antibiotic usage in the study area. Further studies are recommended to explore the types of ear infections, with their etiologic agents and possible risk factors.
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Affiliation(s)
- Alem Getaneh
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Getnet Ayalew
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Debaka Belete
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohabaw Jemal
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Sirak Biset
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
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Biset S, Benti A, Molla L, Yimer S, Cherkos T, Eyayu Y, Ebabu A, Kasew D, Ambachew A. Etiology of Neonatal Bacterial Meningitis and Their Antibiotic Susceptibility Pattern at the University of Gondar Comprehensive Specialized Hospital, Ethiopia: A Seven-Year Retrospective Study. Infect Drug Resist 2021; 14:1703-1711. [PMID: 34007189 PMCID: PMC8121271 DOI: 10.2147/idr.s307156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/10/2021] [Indexed: 01/10/2023] Open
Abstract
Background Meningitis, which is mostly caused by infectious agents, occurs more commonly during the first month of life. Bacterial meningitis is an important source of mortality and morbidity, especially in neonates of resource-limited countries. We aimed to determine the prevalence and etiological agents of bacterial meningitis and their antibiotic susceptibility pattern in neonates at the University of Gondar Comprehensive Specialized Hospital. Methods We collected retrospective data from bacteriological results of cerebrospinal fluid of meningitis suspected neonates from 2013 to 2019. Sample collection, culture preparation, bacterial identification, and susceptibility testing were performed using standard microbiological techniques. We extracted data on socio-demographic characteristics and culture and antibiotic susceptibility testing results. We inputted the data using Epi-info version 7 and exported it to SPSS version 20 for analysis. Results In this study, 1101 cerebrospinal fluid samples, 595 (54%) male and 506 (46%) female neonates, were cultured to look for meningitis-causing bacteria. Of 1101 cerebrospinal fluid, 19 (1.73%) were culture positive for meningitis-causing bacteria. The common etiological agents were Klebsiella pneumoniae 36.8% (7), non-lactose-fermenter Gram-negative rods 21% (4), and Group B streptococcus 15.8% (3). The overall resistance rate among cephalosporin, cotrimoxazole, penicillin, and aminoglycosides classes were 90%, 88.9%, 77.3%, and 54.54%, respectively. Of all isolates, 58% (11) were multidrug-resistant, including all the non-lactose-fermenter Gram-negative rods and 71.4% of the Klebsiella pneumonia isolates. Conclusion The prevalence of neonatal bacterial meningitis was 1.73%. Klebsiella pneumonia and other Gram-negative rods, with a high multidrug-resistant rate, were the leading cause of neonatal bacterial meningitis. Further studies are needed to explore the source of infection, incidence, and risk factors of neonatal bacterial meningitis.
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Affiliation(s)
- Sirak Biset
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayantu Benti
- School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Lidya Molla
- School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Sitot Yimer
- School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Tena Cherkos
- School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Yalewayker Eyayu
- School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Ashenafi Ebabu
- University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Desie Kasew
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
| | - Aklilu Ambachew
- Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, University of Gondar, Gondar, Ethiopia
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