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Ibiam FA, Egwu E, Moses IB, Iroha CS, Adekwu A, Obasikene G, Agbonifo M, Iroha IR. Antibiogram and molecular characterization of extended-spectrum β-lactamase-producing pathogens implicated in chronic suppurative otitis media. Pan Afr Med J 2023; 46:108. [PMID: 38435409 PMCID: PMC10908298 DOI: 10.11604/pamj.2023.46.108.41156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/21/2023] [Indexed: 03/05/2024] Open
Abstract
Introduction beta-lactamase-producing bacteria, especially extended-spectrum beta-lactamase (ESBL) producers have strong clinical relevance and have been implicated in chronic suppurative otitis media (CSOM) treatment failures. This study aimed to determine the frequency, antibiogram, and molecular characteristics of ESBL-producing gram-negative bacterial (GNB) pathogens isolated from patients with CSOM. Methods three hundred (300) ear swab samples collected from patients with active CSOM were analysed using standard microbiological techniques. Antibiogram of pathogens was determined by Kirby-Bauer disk diffusion technique. Phenotypic detection and molecular characterization of ESBL-producing GNB pathogens were performed by double disk synergy test (DDST) and polymerase chain reaction (PCR). Results Escherichia coli and P. aeruginosa were more prevalent among CSOM patients with a duration of discharge >2 weeks. The frequency of ESBL producers among the GNB pathogens was 18.3%. Isolates were generally multidrug-resistant but very susceptible (100% - 70.4%) to ciprofloxacin, imipenem, and amikacin. Multiple antibiotic resistance values of the isolates ranged from 0.7-0.8. Polymerase chain reaction showed that blaSHV (47.6%) was the most predominant ESBL genotype. This was followed by blaTEM (25.2%) and blaCTX-M (10.7%) as the least predominant ESBL gene. Concomitant expression of ESBL gene was observed in 13.6% of the isolates. Conclusion this study reported the occurrence and spread of β-lactamase-producing bacteria in patients with CSOM infections. It is therefore very crucial to screen for antibiotic-resistant pathogens at early stages of CSOM infections, for proper antimicrobial therapy and to curb the increasing spread of antimicrobial resistance.
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Affiliation(s)
- Francis Amadi Ibiam
- Department of Otorhinolaryngology, Alex Ekwueme Federal University, Ndufu Alike Ikwo, Nigeria
| | - Eze Egwu
- Department of Medical Laboratory Science, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Ikechukwu Benjamin Moses
- Department of Applied Microbiology, Faculty of Science, Ebonyi State University, Abakaliki, Nigeria
| | - Chidinma Stacy Iroha
- Department of Pharmacy, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Amali Adekwu
- Department of Otorhinolaryngology, Federal University of Science Otukpo, Otukpo, Nigeria
| | - Godwin Obasikene
- Department of Otorhinolaryngology, Nnamdi Azikiwe University, Nnewi, Nigeria
| | - Monday Agbonifo
- Department of Otorhinolaryngology, Ambrose Ali University, Ekpoma, Nigeria
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Amadi IF, Nchedo OC, Obaji AT, Agbonifo M, Eze E, Stacy IC, Benjamin MI, Romanus II. Detection of FOX-AmpC-β-lactamase gene and antibiogram of AmpC-beta-lactamase-producing pathogens isolated from chronic suppurative otitis media patients in Nigeria. IRANIAN JOURNAL OF MICROBIOLOGY 2023; 15:779-787. [PMID: 38156308 PMCID: PMC10751608 DOI: 10.18502/ijm.v15i6.14139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Background and Objectives AmpC-producing Gram-negative bacterial (GNB) pathogens are distributed worldwide, especially in clinical settings. This study aimed to determine the antibiogram and the type of AmpC-β-lactamase gene harboured by GNB pathogens implicated in chronic suppurative otitis media (CSOM) cases. Materials and Methods Ear swab samples (300) collected from patients with active CSOM were analysed using standard microbiological techniques. Phenotypic and molecular detection of AmpC β-lactamase production was done by cefoxitin/cloxacillin double-disk synergy test and PCR respectively. Antibiogram was determined by disk diffusion technique. Results Among the GNB pathogens isolated from CSOM patients, P. aeruginosa was the most predominant (36.3%); followed by K. pneumoniae (22.3%), and E. coli (13.7%). Patients with active CSOM showed increased bacteria isolation rate from bilateral ear discharges than unilateral ear discharges. E. coli and P. aeruginosa were more prevalent among patients with duration of discharge >2 weeks; recording 9.0% and 20.3% respectively. AmpC β-lactamase producers accounted for 14.0%; they were highly resistant (60%-100%) to cephalosporins, trimethoprim-sulfamethoxazole, ofloxacin, amoxicillin, and tetracycline, but very susceptible (70.4%-100%) to ciprofloxacin, imipenem, and amikacin. Multiple antibiotic resistance indices of isolates ranged from 0.7-0.8. FOX-AmpC-β-lactamase gene was detected in 3.9% of the isolates. Conclusion The detection of AmpC β-lactamase-producing multidrug-resistant GNB pathogens harbouring FOX-AmpC-β-lactamase gene among patients with CSOM infections in our study is a serious public health problem which needs urgent intervention.
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Affiliation(s)
- Ibiam Francis Amadi
- Department of Otorhinolaryngology, Alex Ekwueme Federal University, Ndufu Alike Ikwo, Nigeria
| | | | - Ariom Thaddaeus Obaji
- Department of Microbiology, Institute of Food Security, Environmental Resources and Agricultural Research, Federal University of Agriculture, Abeokuta, Ogun State, Nigeria
| | - Monday Agbonifo
- Department of Otorhinolaryngology, Ambrose Ali University, Ekpoma, Nigeria
| | - Egwu Eze
- Department of Medical Laboratory Science, Alex Ekwueme Federal University, Teaching Hospital Abakaliki, Nigeria
| | - Iroha Chidinma Stacy
- Department of Pharmacy, Alex Ekwueme Federal University, Teaching Hospital, Abakaliki, Nigeria
| | - Moses Ikechukwu Benjamin
- Department of Applied Microbiology, Faculty of Sciences, Ebonyi State University, Abakaliki, Nigeria
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Shangali A, Kamori D, Massawe W, Masoud S, Kibwana U, Mwingwa AG, Manisha A, Mwandigha AM, Mirambo MM, Mshana SE, Manyahi J, Majigo M. Aetiology of ear infection and antimicrobial susceptibility pattern among patients attending otorhinolaryngology clinic at a tertiary hospital in Dar es Salaam, Tanzania: a hospital-based cross-sectional study. BMJ Open 2023; 13:e068359. [PMID: 37012005 PMCID: PMC10083798 DOI: 10.1136/bmjopen-2022-068359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVES To determine the aetiological pathogens causing ear infections and their antimicrobial susceptibility patterns among patients with ear complaints at a tertiary hospital in Dar es Salaam. DESIGN Hospital-based cross-sectional study. SETTINGS Otorhinolaryngology clinic at Muhimbili National Hospital, Dar es Salaam, Tanzania. PARTICIPANTS Patients presenting with signs and symptoms of ear infection. MAIN OUTCOME MEASURE Bacteria and fungi isolated from ear swab specimens of patients presenting with signs and symptoms of ear infection; and antimicrobial susceptibility patterns of isolated bacteria. RESULTS Two hundred and fifty-five participants were enrolled, with a median age of 31 years and an IQR of 15-49. Otitis externa was the predominant type of ear infection, accounting for 45.1%. We observed positive bacteria culture in 53.3% of study participants, in which 41% of isolates were obtained from patients with chronic suppurative otitis media. Moreover, Staphylococcus aureus (27.3%) and Pseudomonas aeruginosa (24.2%) were the most frequently isolated bacteria, while Candida spp, 12 (63.8%) and Aspergillus spp, 9 (36.2%) were the only isolated fungi. Furthermore, we report that 93% of isolated Enterobacterales were resistant to amoxicillin/clavulanic acid, and 73% were resistant to ceftazidime. In addition, we detected 34.4% extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) and 44.4% methicillin-resistance S. aureus (MRSA). We also found that 22% of the bacteria isolates were resistant to ciprofloxacin, a primary topical antibiotic used in managing ear infections. CONCLUSIONS The findings from this study reveal that the leading aetiological agent of ear infection is bacteria. Furthermore, our findings show a significant proportion of ESBL-PE and MRSA-causing ear infections. Hence, detecting multidrug-resistant bacteria is crucial to improving ear infection management.
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Affiliation(s)
- Aminiel Shangali
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
- Department of Microbiology and Immunology, Mwanza University, Mwanza, Tanzania, United Republic of
| | - Doreen Kamori
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Willybroad Massawe
- Department of Otorhinolaryngology, Muhimbili National Hospital, Dar es Salaam, Tanzania, United Republic of
| | - Salim Masoud
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Upendo Kibwana
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Anthony G Mwingwa
- Department of Microbiology and Immunology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of
| | - Anselmo Manisha
- Department of Microbiology and Immunology, Mwanza University, Mwanza, Tanzania, United Republic of
| | - Ambele M Mwandigha
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Mariam M Mirambo
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania, United Republic of
| | - Stephen E Mshana
- Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania, United Republic of
| | - Joel Manyahi
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Mtebe Majigo
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
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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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Khatun MR, Alam KMF, Naznin M, Salam MA. Microbiology of Chronic Suppurative Otitis Media: An update from a Tertiary Care Hospital in Bangladesh. Pak J Med Sci 2021; 37:821-826. [PMID: 34104172 PMCID: PMC8155403 DOI: 10.12669/pjms.37.3.3942] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: Chronic suppurative otitis media is a major cause of acquired hearing impairment, especially in children of developing countries. The study sought to explore the bacteriological profile and their antimicrobial susceptibility among patients of chronic suppurative otitis media from a tertiary care hospital in Bangladesh. Methods: A cross sectional microbiological study was conducted at the Department of Microbiology, Rajshahi Medical College, Bangladesh from January to December 2019. Aural swabs were collected aseptically from clinically suspected patients irrespective of age and gender attending the ear, nose and throat outpatient department of Rajshahi Medical College Hospital. Aerobic bacterial culture was done and isolates were identified through standard bacteriological identification scheme. Antimicrobial susceptibility testing of isolates was done by modified Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. Results: Of 96 swabs, culture yielded a total of 73 bacterial isolates from 68(70.8%) culture-positive plates including 63 (65.6%) unimicrobial and 5 (5.2%) polymicrobial (mixed growth of a pair of bacteria) growths. Frequency distribution revealed, 40(55%) gram-negative and 33(45%) gram-positive bacteria with Staphylococcus aureus was the leading isolate (37%) followed by Pseudomonas aeruginosa (31.5%), Escherichia coli (13.7%), coagulase-negative Staphylococcus (8.2%), Klebsiella pneumoniae (5.5%) and Proteus spp. (4.1%). Gram-positive bacteria were found to be highly susceptible (100%) to Linezolid and Vancomycin followed by Imipenem (83 to 96.3%), while moderate to high resistance (44 to 67%) was observed against Ciprofloxacin, Ceftriaxone, Ceftazidime, Amoxicillin/Clavulanate and Clindamycin. For gram-negative bacteria, susceptibility ranged from 67 to 100% to Imipenem, 67 to 96% to Piperacillin/Tazobactam and 67 to 83% to Gentamicin, while moderate to high resistance (50 to 75%) was observed against Ciprofloxacin, Ceftriaxone, Ceftazidime and Amoxicillin/Clavulanate. Conclusion: Moderate to high level of multidrug-resistance especially to 3rd generation cephalosporins, Ciprofloxacin and Amoxicillin/Clavulanate is an alarming situation. It warns reinforcement of judicious antibiotic prescription and introduction of antibiotic stewardship program in the tertiary care hospitals.
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Affiliation(s)
- Mst Romena Khatun
- Mst. Romena Khatun, M, Phil. Lecturer, Department of Virology, Rajshahi Medical College, Rajshahi-6000, Bangladesh
| | - Kh Md Faisal Alam
- Kh. Md. Faisal Alam, PhD. Associate Professor Department of Microbiology, Rajshahi Medical College, Rajshahi-6000, Bangladesh
| | - Mahmuda Naznin
- Mahmuda Naznin, M. Phil. Assistant Professor, Department of Microbiology, Rajshahi Medical College, Rajshahi-6000, Bangladesh
| | - Md Abdus Salam
- Prof. Md. Abdus Salam, PhD, FRCP (UK). Department of Basic Medical Sciences, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
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