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

Bacterial etiologies, antimicrobial susceptibility profiles and associated factors among patients with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center, Western Ethiopia: A cross-sectional study

BACKGROUND

Otitis media is among the leading causes of illnesses responsible for causing hearing problems and adding significant costs to the public health system. Bacteria are the most common causative agents for otitis media. Currently, there is little information on the prevalence and antimicrobial susceptibility patterns of pathogenic bacterial isolates from patients with otitis media in Ethiopia.

METHODOLOGY

A laboratory - based cross-sectional study was conducted from June to September 2023 among 242 patients with otitis media referred to Nekemte Public Health Research and Referral Laboratory Center. Sociodemographic and clinical data were obtained by trained nurses and/or health officers in face-to-face interviews using structured questionnaires. Middle ear discharge samples were collected by Ear, Nose and Throat (ENT) specialists (Otolaryngologist) following all aseptic techniques. Conventional culture, different biochemical tests and antimicrobial susceptibility testing were performed for all the isolated bacteria. Reference strains were used as a positive and negative controls. The data were checked for completeness and consistency, entered into EpiData version 4.6.06 and analyzed by SPSS version 25. Logistic regression analysis was performed to determine the associated factors of otitis media. Adjusted odds ratio was used to determine strength of association. Statistical significance was obtained at p-value of below 0.05. The data were interpreted using graphs, tables, and results statements.

RESULTS

A total of 242 middle ear discharge samples were collected and cultured from which 212 (87.6%) were culture positive. A total of 228 pathogenic bacterial isolates were recovered. The predominant bacterial isolates were S. aureus 92 (40.4%) followed by P. aeruginosa 33 (14.5%) and E. coli 24 (10.5%). One hundred and fifty-one (66.2%) bacterial pathogens were multidrug resistant. Piperacillin-tazobactam and tobramycin were relatively common drugs to which most of the isolates were susceptible while they were most resistant to ampicillin and tetracycline. Purulent discharge (p-value = 0.001), middle ear discharge ≥ 14 days (P-value = 0.000) and a history of active/passive smoking (P-value = 0.043) were significantly associated with otitis media.

CONCLUSION

The prevalence of bacterial pathogens, most of which were multidrug-resistant, was high among patients with otitis media. A significant association was observed with purulent ear discharge, chronic otitis media, and passive or active smoking. Choosing the proper antibiotic for the treatment of bacterial infection is crucial.

To Study the Microbiological Florae in Patients of Acute Otitis Externa

Aim

To identify and know the antimicrobial sensitivities of the aerobic bacteria in patients with acute otitis externa (AOE).

Materials and Methods

Sixty-six patients of acute otitis externa were prospectively analysed at a tertiary care centre in North-India from May 2021 to April 2022. Samples for culture and sensitivity were sent to the microbiology department and the results analysed.

Results

A total of 50 samples yielded positive results for bacterial cultures. The gram-negative isolates were 60%, and the gram-positive were 40%. Pseudomonas aeruginosa was the most common organism isolated overall (48%), followed by Staphylococcus aureus (36%). Pseudomonas aeruginosa isolates were found to be most susceptible to piperacillin + tazobactam and imipenem (100%), followed by cefepime (91.67%) and ciprofloxacin (87.5%) while the Staphylococcus aureus isolates were found to be most susceptible to linezolid (100%) and doxycycline (94.44%), followed by clindamycin (88.89%).

Conclusion

Causes of bacterial diversity and their varied anti-microbial sensitivities and increasing antimicrobial resistance due to inadvertent use of antibiotics over time has caused change in susceptibility of bacteria. It therefore becomes essential to periodically assess the microbiological flora so as to provide quality and cost-effective treatment to the patient population presenting with AOE.

Prevalence of bacterial ear infections and multidrug resistance patterns among ear infection suspected patients in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Otitis media is an inflammation of the middle ear that affects both adults and children, leading to hearing loss and impacting intellectual performance, especially in developing countries. Key factors contributing to its development include lack of vaccination, inadequate breastfeeding, overcrowding, and malnutrition. Major bacterial pathogens involved are Pseudomonas aeruginosa, Staphylococcus aureus, Proteus mirabilis, Klebsiella pneumoniae, Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.This systematic review and meta-analysis revealed the pooled prevalence of bacterial ear infections and multidrug resistance in Ethiopia.

METHODS

Thorough searches were conducted across electronic databases and grey literature using precise entry terms or phrases. Eligible studies were compiled into MS Excel and imported into STATA version 14 software for statistical analysis. The collective prevalence of bacterial ear infections and multidrug resistance patterns were calculated using a random-effect model, with heterogeneity assessed via the I2 value. Publication bias was examined using a funnel plot and Egger's test. Sensitivity analysis was performed to gauge the impact of individual studies on the overall effect size.

RESULT

Seventy studies met the criteria for qualitative analysis, with 14 selected for the meta-analysis. These studies reported a total of 3,667 bacterial isolates. The prevalence of bacterial ear infections varied significantly, ranging from 28.2% to 98.2% across individual studies. In this systematic review and meta-analysis, the pooled prevalence of bacterial ear infections in Ethiopia was found to be 73.39% (95% CI: 65.15-81.63), demonstrating substantial heterogeneity (I2 = 98.5%, p < 0.001). Additionally, the pooled prevalence of multidrug resistance among bacterial ear infections was 72.45% (95% CI: 66.86-78.04). The most frequently identified isolate was Staphylococcus aureus, with a pooled prevalence of 68.87% (95% CI: 13.94-123.79), followed closely by Proteus spp. at 68.55% (95% CI: 3.15-140.26), Pseudomonas aeruginosa at 48.15% (95% CI: 1.84-94.45), and Escherichia coli at 37.15% (95% CI: 14.03-88.34).

CONCLUSION

The pooled prevalence of bacterial ear infections in Ethiopia is alarmingly high, accompanied by significant levels of multidrug resistance. These findings highlight the urgent need to reevaluate empirical treatment strategies due to the rising antimicrobial resistance.

Abscesses in different body sites among children: a single-center prospective study

OBJECTIVES

An abscess is a localized collection of pus contained within a fibrous capsule. In this study, we aimed to determine the demographic pattern, common anatomical sites, risk factors, and the microbial profile of abscesses in different body sites among children.

METHODS

We conducted a prospective study in our pediatric surgical department among children with abscesses in different body sites between January 2019 and December 2022.

RESULTS

During the study period, 85 children were included. The participant age range was 0 to 14 years old, and 66% of participants were boys. The most common anatomical sites where abscesses formed were the pelvis (n = 29, 34%), abdomen (n = 22, 26%), neck (n = 14, 16%), and extremities (n = 12, 14%). Risk factors of abscesses in different body sites included cannulation, lymphadenitis, mastitis, perforated appendix, and perianal fistula. We observed that 74% of abscesses were of a polymicrobial nature.

CONCLUSION

The most common anatomical sites for abscesses in children included the pelvis, abdomen, neck, and extremities. Most abscesses in these sites were polymicrobial in nature.

Aetiologies of Ear Infections Among Patients Who Visited King Fahad Hospital in Al-Baha, Saudi Arabia

Background Ear infections encompass otitis media (OM) which is a significant cause of hearing loss and otitis externa (OE) which may affect the surrounding tissues leading to serious complications. This study reports the common pathogens causing ear infections. Methods Microbiological, clinical, and demographic data of ear-infected patients who visited King Fahad Hospital in Al-Baha, Saudi Arabia, during the period from January 2019 to June 2023 were enrolled in this study. Result  This study enrolled 307 patients aged 1-94 years, with a median age of 40 years (IQR=22-57). Overall, the detectable infection rate was 81.1% (n=249), while 18.9% (n=58) had no identified aetiology. Of all isolates, 178 (58%) were bacterial, while 71 (23.1%) were fungal. Staphylococcus aureus (S. aureus) followed by Pseudomonas aeruginosa (P. aeruginosa), Enterobacteriaceae, andcoagulase-negative Staphylococcus (CoNS) were the main bacterial isolates. Of the total 63 S. aureus isolates, 21 (33%) were methicillin-resistant (MRSA). A cohort of 227 subjects were diagnosed with either OM (n=178; 79.5%), OE (n=46; 20.5%), or both OM and OE (n=3; 1%). Of those with OM, children constituted 89.1% (41/46) as compared to 75.3% (134/178) of adults (p=0.041). The main isolates from OM patients were S. aureus followed by P. aeruginosa and fungi. Of 49 OE patients, 16 (32.7%) had no identified pathogen, while 15 (30.6%) had fungi, and 13 (29.5%) had P. aeruginosa. Conclusions Ear infections in general were mainly bacterial followed by fungal with a considerable proportion of unidentified aetiology. A significant proportion of S. aureus isolates were MRSA. S. aureus followed by P. aeruginosa and fungi were the main causes of OM, while fungi followed by P. aeruginosa were the main causes of OE.

The prevalence of vancomycin-resistant Staphylococcus aureus in Ethiopia: a systematic review and meta-analysis

INTRODUCTION

Vancomycin-resistant Staphylococcus aureus, identified as a "high priority antibiotic-resistant pathogen" by the World Health Organization, poses a significant threat to human health. This systematic review and meta-analysis aimed to estimate the pooled prevalence of vancomycin-resistant Staphylococcus aureus in Ethiopia.

METHODS

This systematic review and meta-analysis was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies that reported VRSA prevalence due to infection or carriage from human clinical specimens were extensively searched in bibliographic databases and grey literatures using entry terms and combination key words. Electronic databases like PubMed, Google Scholar, Wiley Online Library, African Journal Online, Scopus, Science Direct, Embase, and ResearchGate 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 version 14 software was used for statistical analysis. Forest plots using the random-effect model were used to compute the overall pooled prevalence of VRSA and for the subgroup analysis. Heterogeneity was assessed using Cochrane chi-square (I2) statistics. After publication bias was assessed using a funnel plot and Egger's test, trim & fill analysis was carried out. Furthermore, sensitivity analysis was done to assess the impact of a single study on pooled effect size.

RESULTS

Of the 735 studies identified, 31 studies that fulfilled the eligibility criteria were included for meta-analysis consisted of 14,966 study participants and 2,348 S. aureus isolates. The overall pooled prevalence of VRSA was 14.52% (95% CI: 11.59, 17.44). Significantly high level of heterogeneity was observed among studies (I2 = 93.0%, p < 0.001). The region-based subgroup analysis depicted highest pooled prevalence of 47.74% (95% CI: 17.79, 77.69) in Sidama region, followed by 14.82% (95% CI: 8.68, 19.88) in Amhara region, while Oromia region had the least pooled prevalence 8.07% (95% CI: 4.09, 12.06). The subgroup analysis based on AST methods depicted a significant variation in pooled prevalence of VRSA (6.3% (95% CI: 3.14, 9.43) for MIC-based methods, and 18.4% (95% CI: 14.03, 22.79) for disk diffusion AST method) which clearly showed that disk diffusion AST method overestimates the pooled VRSA prevalence. The total number of S. aureus isolates was found to be the responsible variable for the existence of heterogeneity among studies (p = 0.033).

CONCLUSION

This study showed an alarmingly high pooled prevalence of VRSA necessitating routine screening, appropriate antibiotic usage, and robust infection prevention measures to manage MRSA infections and control the emergence of drug resistance. Furthermore, mainly attributable to the overestimation of VRSA burden while using disk diffusion method, there is an urgent need to improve the methods to determine vancomycin resistance in Ethiopia and incorporate MIC-based VRSA detection methods in routine clinical laboratory tests, and efforts should be directed at improving it nationally.

TRIAL REGISTRATION

PROSPERO registration identification number: CRD42023422043.

Molecular Profile and the Effectiveness of Antimicrobials Drugs Against Staphylococcus aureus and Pseudomonas aeruginosa in the Diagnostic Approaches of Otitis Infection

Background

Otitis externa and otitis media are two types of ear infections that affect people of all ages, although they are more common in newborns and young children. Antibiotic usage, healthcare, and advanced age all play a role in the development of this illness.

Methods

Fifty-eight patients with various kinds of infections of the ears were voluntary patients attending the outpatient clinics of the Prince Mutaib Bin Abdulaziz Hospital in Sakaka, Al Jouf, Saudi Arabia, examined to evaluate the role of bacteria and the likely significance of plasmids in their antibiotic resistance as ear infectious agents.

Results

Staphylococcus aureus and Pseudomonas aeruginosa are the most prevalent bacteria found in ear infections. The greatest number of major bacterial isolates were S. aureus (54%), followed by P. aeruginosa (13%), whereas a smaller number of isolates (3%) were from Streptococcus pyogenes, Bacillus subtilis, and Proteus vulgaris, respectively. Mixed growth was noted in 3.4% of instances. The isolation rate for Gram-positive organisms was 72%, while the rate for Gram-negative species was 28%. All the isolates had DNA greater than 14 kilobases. Hind III analysis of the plasmid DNA extracted from the resistant strains of ear infection demonstrated that antibiotic-resistance plasmids were extensively dispersed. Exotoxin A PCR amplification indicated 396 pb PCR-positive DNA for all identified samples, with the exception of three strains for which no band was observed. Patients in the epidemiological study ranged in number, but all were linked together for the purposes of the study because of their shared epidemiological characteristics.

Conclusion

Vancomycin, linezolid, tigecycline, rifampin, and daptomycin are all antibiotics that have been shown to be effective against S. aureus and P. aeruginosa. Microbiological pattern evaluation and antibiotic sensitivity patterns of the microorganisms providing empirical antibiotics are becoming increasingly crucial to minimize issues and the development of antibiotic-resistant strains.

Microbiology and Drug Susceptibility Pattern of Bacterial Isolates from Patients with Chronic Suppurative Otitis Media at a Tertiary Care Hospital in Somalia

Background

This study aimed to determine the microbiological profile and antibiotic susceptibility pattern of bacterial isolates obtained from patients with chronic suppurative otitis media (CSOM) presenting to the otorhinolaryngology clinic of a tertiary care hospital in Mogadishu, Somalia.

Methods

A total of 225 patients diagnosed with chronic suppurative otitis media were included in the study. Samples of middle ear discharge were collected from each patient and cultured using standard microbiological techniques, and bacterial identification was performed. Drug susceptibility pattern was assessed according to the Clinical and Laboratory Standards Institute criteria.

Results

The study sample (n=225) comprised 122 females and 103 males. Among 225 samples tested, bacterial growth was present in 200 (88.9%) and absent in 25 (11.1%) samples. Of 200 samples with bacterial growth, monomicrobial growth was detected in 176 (88%). Gram-positive bacteria were observed in 40 (22.7%) and Gram-negative bacteria in 136 (77.3%) samples. The bacteriology of the samples with monomicrobial growth consisted of (in decreasing frequency) Pseudomonas spp, Staphylococcus aureus, Escherichia coli, Coagulase-negative staphylococci, Proteus mirabilis, and Klebsiella sp. A high rate of resistance was detected against penicillin antibiotics, erythromycin, tetracycline, and co-trimoxazole. Resistance to cephalosporins, clindamycin, vancomycin, linezolid, daptomycin, quinupristin/dalfopristin, levofloxacin, meropenem, and ertapenem was low.

Conclusion

While the frequencies of isolated bacterial species were consistent with other reports from the region, differences were observed in the antibiotic resistance of bacterial isolates when examined individually for each antibiotic. Further studies are warranted in the same region and different parts of Somalia, coupled with ongoing assessment of antibiotic susceptibility patterns in CSOM.