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Tilahun M, Gedefie A, Seid A, Debash H, Shibabaw A. Prevalence of phenotypic drug resistance profiles and multi-drug-resistant Pseudomonas and Acinetobacter species recovered from clinical specimens in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2025; 25:737. [PMID: 40410730 PMCID: PMC12103049 DOI: 10.1186/s12879-025-11136-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2024] [Accepted: 05/16/2025] [Indexed: 05/25/2025] Open
Abstract
BACKGROUND Antimicrobial-resistant Pseudomonas and Acinetobacter species are emerging as serious public health risks, both globally and in resource-limited countries such as Ethiopia. These microorganisms cause serious, life-threatening infections and are becoming increasingly resistant to commonly prescribed antibiotics. The high prevalence and resistance patterns of these bacteria need immediate action to inform treatment guidelines, increase infection control measure, and develop effective public health policies. This systematic review and meta-analysis aimed to assess the prevalence of phenotypic drug resistance profiles and multi-drug-resistant Pseudomonas and Acinetobacter species recovered from clinical specimens in Ethiopia. METHODS This systematic review and meta-analysis, which followed PRISMA principles, analyzed data from PubMed, Scopus, and Google Scholar to determine the prevalence and antibiotic resistance trends of Pseudomonas and Acinetobacter species in Ethiopia. Eligible studies were extracted by using Microsoft Excel and exported to STATA version 17 for analysis. The pooled prevalence was estimated using a random-effects model, and heterogeneity was examined using the I2 statistic. Publication bias was investigated using funnel plot analysis and Egger's test, and sensitivity analysis was used to assess the impact of individual studies on the total pooled findings. RESULT Of the 1,375 studies identified, 187 were eligible for qualitative analysis, leading to the inclusion of 65 studies in the meta-analysis. This analysis encompassed a total of 1,264 isolates, with 364 identified as Pseudomonas and Acinetobacter species. The systematic review revealed a pooled prevalence of 19.12% (95% CI: 14.86-23.38) for Pseudomonas species and 12.46% (95% CI: 5.82-19.10) for Acinetobacter species. The combined prevalence of both pathogens was 25.31 (95% CI: 18.61-32.00) with substantial heterogeneity (I2 = 93.6%, p < 0.001). across the studies. Pseudomonas exhibited high resistance rates to amoxicillin-clavulanic Acid (83.73%) and tetracycline (89.15%), while Acinetobacter showed 87.21% resistance to tetracycline and 79.72% to ceftriaxone. The overall pooled prevalence of MDR Pseudomonas species was 72.73% (95% CI: 67.02-78.44), and for Acinetobacter species, it reached 84.69% (95% CI: 78.78-90.59), respectively. Moreover, the pooled prevalence of MDR for both species isolated from clinical samples in Ethiopia was 74.79% (95% CI: 70.14-79.43), with significant heterogeneity (I2 = 99.7%, p < 0.001) across the studies. CONCLUSION The pooled prevalence of Pseudomonas and Acinetobacter species and their antibiotic resistance were alarmingly high in clinical samples in Ethiopia. These findings highlight the crucial need for more antimicrobial surveillance, stronger stewardship programs, and targeted research to combat the growing threat of resistance. Strategic public health policies are required to decrease these pathogens.
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Affiliation(s)
- Mihret Tilahun
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, P.O. Box 1145, Dessie, Ethiopia.
| | - Alemu Gedefie
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, P.O. Box 1145, Dessie, Ethiopia
| | - Abdurahaman Seid
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, P.O. Box 1145, Dessie, Ethiopia
| | - Habtu Debash
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, P.O. Box 1145, Dessie, Ethiopia
| | - Agumas Shibabaw
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, P.O. Box 1145, Dessie, Ethiopia
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Mahfouz AR, Nada HG, Magar HS, ElBaghdady KZ, Hassan RYA. Nano-biosensors for rapid detection of antibiotic resistance genes blaCTX-M in Escherichia coli and blaKPC in Klebsiella pneumoniae. Int J Biol Macromol 2025; 310:143216. [PMID: 40250654 DOI: 10.1016/j.ijbiomac.2025.143216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 03/30/2025] [Accepted: 04/14/2025] [Indexed: 04/20/2025]
Abstract
The wide spread of antibiotic resistance genes in clinical isolates of Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) has become a worrying issue worldwide. Thus, electrochemical DNA-based biosensors were developed and applied for the rapid detection of antibiotic resistance genes (blaCTX-M extended-spectrum β-lactamase (ESBL) in E. coli and blaKPC carbapenemase in Klebsiella pneumoniae). Selective ssDNA probes specific to the targeting complementary genes were designed and individually immobilized onto disposable sensor chips that were functionalized with nanocomposite (ssDNA-probe@ATP@AuNPs-PPY-V2O5). In this regard, the sensor surfaces were first modified with vanadium oxide (V2O5) and polypyrrole (PPy) then gold nanoparticles (AuNPs) to effectively promote the chemical immobilization of each of the designed bio-receptor (ssDNA probe) onto the sensor matrix using the 4-aminothiophenol (ATP) as the chemical cross-linker. Different parameters that affect the biosensing performance were studied and optimized. Accordingly, high sensitivity to both E. coli blaCTX-M and K. pneumoniae blaKPC genes were obtained with a dynamic linear range from 10-6 to 0.1 ng/μL with correlation coefficient (R2) of 0.991 and 0.988, limit of detection (LODs) of 0.5 × 10-7 ng/μL and 1 × 10-7 ng/μL, and limit of quantification (LOQs) of 1.2 × 10-7 and 3 × 10-7 ng/μL, respectively. High selectivity was provided since no electrochemical signals were obtained from various competitors of common bacteria. Finally, different types of clinical samples were analyzed and validated.
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Affiliation(s)
- Asmaa R Mahfouz
- Microbiology Department, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Hanady G Nada
- Drug Radiation Research Department, National Center for Radiation Research and Technology, Egyptian Atomic Energy Authority, Cairo 11787, Egypt
| | - Hend S Magar
- Applied Organic Chemistry Department, National Research Centre (NRC), Dokki, Giza 12622, Egypt.
| | - Khaled Z ElBaghdady
- Microbiology Department, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Rabeay Y A Hassan
- Biosensors Research Lab, University of Science and Technology (UST), Zewail City of Science and Technology, Giza 12578, Egypt; Applied Organic Chemistry Department, National Research Centre (NRC), Dokki, Giza 12622, Egypt.
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Asmare Z, Tamrat E, Erkihun M, Endalamaw K, Alelign D, Getie M, Sisay A, Gashaw Y, Reta MA. Antimicrobial resistance pattern of Acinetobacter baumannii clinical isolate in Ethiopia. A systematic review and meta-analysis. BMC Infect Dis 2025; 25:518. [PMID: 40221655 PMCID: PMC11994026 DOI: 10.1186/s12879-025-10923-5] [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: 01/16/2025] [Accepted: 04/04/2025] [Indexed: 04/14/2025] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a growing global health threat. Acinetobacter baumannii (A. baumannii) emerged as one of the most concerning critical priority pathogens due to its ability to develop resistance to multiple antimicrobial agents. In Ethiopia, the public health impact of AMR is increasingly significant, with A. baumannii responsible for a variety of infections. Although A. baumannii causes a range of infections in Ethiopian patients, the drug resistance status of the clinical isolates has not been thoroughly assessed. Therefore, this systematic review and meta-analysis aimed to determine the country-wide AMR of A. baumannii. METHODS This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted a search of articles on PubMed, Web of Science, Science Direct, Scopes electronic databases, Google Scholar search engine, and institutional repositories/libraries for studies published between 2015 and 2024. Eligible studies on A. baumannii-related infections and AMR in Ethiopia were assessed for quality using the Joanna Briggs Institute (JBI) criteria. Data on study characteristics were extracted, and statistical analyses, including heterogeneity (Invers of variance), publication bias (Eggers test), and subgroup analyses, were performed using STATA 17.0. A random effect model was used to compute the pooled prevalence of AMR. RESULTS This systematic review and meta-analysis of 26 Ethiopian studies (26,539 participants) found an A. baumannii prevalence of 3.99% (95% CI: 3.01-4.98%) and 9.13% of all bacterial infections (95% CI: 6.73-11.54%). The most common infections were surgical site infections, urinary tract infections, pneumonia, and sepsis. Pooled resistance to antibiotics varied, with amikacin showing the lowest resistance (20.27%) (95% CI: 11.51-29.03) and cefotaxime the highest (83.18) (95% CI: 71.87-94.48). A pooled multi-drug resistant (MDR) A. baumannii was found in 88.22% (95% CI: 82.28-94.15) of isolates, with regional and infection-type variations, particularly in higher prevalence in Oromia and Amhara regions and sepsis cases. CONCLUSION This systematic review underscores the alarming rise of antimicrobial resistance in A. baumannii, particularly against carbapenems. The findings highlight a high prevalence of MDR A. baumannii and widespread extended-spectrum beta-lactamase production, with notable regional variations in resistance patterns. These high resistance rates reinforce A. baumannii as a critical global health threat, necessitating urgent interventions such as enhanced antimicrobial stewardship programs, improved infection control measures, and the development of alternative treatment strategies. Healthcare professionals, policymakers, and researchers must collaborate to mitigate the clinical and public health impact of this pathogen. PROTOCOL REGISTRATION This systematic review and meta-analysis was registered on PROSPERO (Registration ID: CRD42024623927).
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Affiliation(s)
- Zelalem Asmare
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia.
| | - Ephrem Tamrat
- Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Mulat Erkihun
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Kirubel Endalamaw
- Department of Diagnostic Laboratory, Shegaw Motta General Hospital, PO Box 50, East Gojjam, Motta Town, Ethiopia
| | - Dagninet Alelign
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Molla Getie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Assefa Sisay
- Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Yalewayker Gashaw
- Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Melese Abate Reta
- Department of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia
- Department of Medical Microbiology, Faculty of Health Sciences, University of Pretoria, Pretoria, Prinshof, 0084, South Africa
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Gedefie A, Ayele FY, Getaneh FB, Ayres A, Muche A, Molla A, Wodajo S. Magnitude of Health Care Associated Infections and its Clinical Predictors in Ethiopia: A Systematic Review and Meta-Analysis. J Epidemiol Glob Health 2025; 15:50. [PMID: 40163254 PMCID: PMC11958885 DOI: 10.1007/s44197-025-00397-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Accepted: 03/21/2025] [Indexed: 04/02/2025] Open
Abstract
BACKGROUND Health care-acquired infections (HCAIs) are the growing global public health problems facing today requiring an immediate collaborative action of stockholders to be prevented and controlled. Thus, this study was aimed to assess the magnitude and clinical related factors of HCAIs in Ethiopia. METHODS Articles were extensively searched in bibliographic databases and grey literatures using entry terms or phrases. Studies meeting eligibility criteria was extracted in Ms excel and exported in to STATA version 17 software for statistical analysis. A random-effect model was used to compute the pooled magnitude of HCAIs using meta-prop. The heterogeneity was quantified by using the I2 value. Publication bias was assessed using a funnel plot and Egger's test. Sensitivity analysis, meta-regression and subgroup analysis were computed. RESULT Of the 1707 studies identified, 33 studies were selected for meta-analysis of magnitude of HCAIs. The overall pooled prevalence of HCAIs in Ethiopia was 37% (95% CI: 27.0-47.0%). The predominant bacterial aetiologies were E. coli. There was no single study effect and publication bias. Diabetes mellitus, comorbidities, contaminated wound, history of UTI and history of admission in ICU were statistically significant clinical predictors of HCAIs. CONCLUSION the pooled prevalence of HCAIs have alarmingly increased which underscores the importance of implementation of personalized infection prevention and control approach which identifies patients at risk of HCAIs from the point of admission maximizes the potential for prevention of HCAIs.
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Affiliation(s)
- Alemu Gedefie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, P.O.BOX: 1145, Dessie, Ethiopia.
| | - Fanos Yeshanew Ayele
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Fekadeselassie Belege Getaneh
- Department of Pediatrics, School of Nursing and Mid-Wifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Aznamariyam Ayres
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Amare Muche
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Asressie Molla
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Shambel Wodajo
- Department of Public Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Odoko D, Kumalo A, Alemu G, Demisse T, Mulugeta T, Temesgen M. Extended-spectrum β-lactamase and carbapenemase producing Enterobacteriaceae among patients suspected with surgical site infection at Hospitals in Southern Ethiopia. Front Microbiol 2024; 15:1417425. [PMID: 39588105 PMCID: PMC11586188 DOI: 10.3389/fmicb.2024.1417425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 10/14/2024] [Indexed: 11/27/2024] Open
Abstract
Background Extended-spectrum β-lactamase and carbapenemase-producing Enterobacteriaceae are an increasing problem for patients today. Data on clinical samples for ESBL and carbapenemase-producing Enterobacteriaceae for surgical site infection patients in developing countries are limited, including Ethiopia, mainly due to resource constraints. Hence, this study aimed to determine the prevalence of extended-spectrum beta-lactamase- and carbapenemase-producing Enterobacteriaceae among patients suspected to have surgical site infection at Hospital in Southern Ethiopia. Materials and methods A hospital-based cross-sectional study was conducted on 422 suspected surgical site infections from June 1, 2022 to August 30, 2022 at Hospitals in Southern Ethiopia. Sociodemographic and clinical data were obtained by using a structured questionnaire. Clinical samples (pus, pus aspirates, and wound swabs) were collected aseptically and processed within 30 min by placing the swabs in sterile test tubes containing sterile normal saline (0.5 mL). Samples were cultured on blood and MacConkey agar plates. All positive cultures were characterized by colony morphology, Gram staining, and standard biochemical tests. Antimicrobial sensitivity tests were performed using Kirby Baur disk diffusion on Mueller-Hinton agar. ESBL production was confirmed using a double-disc synergy test (DDST) method. Carbapenemase production was assessed using the modified Hodge test. Logistic regression analysis was used to determine associated factors. A P-value < 0.05 were considered statistically significant. Result Bacteria belonging to the order Enterobacterales were cultured in 23.7% out of 422 patients with suspected surgical wound infection. Of all the isolates, Enterobacteriaceae (69 isolates) were the most frequent, with E. coli (29/69) followed by K. pneumoniae (14/69). Of 69 Enterobacteriaceae isolates, 66.6 % (46/69) were positive for ESBL production, and 21.7 (15/69) were positive for carbapenemase-producing Enterobacteriaceae. The majority of Enterobacteriaceae isolates showed sensitivity to meropenem (72.1%); however revealed 63.9% and 70.5% were resistant to gentamicin and ciprofloxacin, respectively. Similarly, a higher resistance rate to cefepime (91.8%), amoxicillin-clavulanic acid (98.4%), ceftriaxone (95.1%), and ceftazidime (91.8%). MDR rate of Enterobacteriaceae isolates was 25/61 (41%) among patients suspected for surgical site infection. The Multivariable analysis revealed that length of hospital stay in hospital [AOR = 3.81 (95% CI 2.08-6.95)] remained statistically significant factor associated with surgical site infection due to ESBL producing Enterobacteriaceae. Conclusion Study results showed the severity of ESBL-producing Enterobacteriaceae is critical and CPE is alarming. Meropenem is the most effective antibiotic against the ESBL-producing Enterobacteriaceae. MDR rate of Enterobacteriaceae isolates was 61 (61%) among patients suspected for surgical site infection. Therefore, antibiotic selection should be based on the results of the culture and sensitivity tests.
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Affiliation(s)
- Desta Odoko
- Medical Laboratory Science Department, Sodo Christian General Hospital, Sodo, Ethiopia
| | - Abera Kumalo
- School of Medical Laboratory Sciences, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Getachew Alemu
- School of Medical Laboratory Sciences, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Tigistu Demisse
- School of Medical Laboratory Sciences, College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Teshale Mulugeta
- Medical Laboratory Science Department, Sodo Christian General Hospital, Sodo, Ethiopia
| | - Muluneh Temesgen
- Department of Medical Laboratory Science, Hosanna Health Science College, Hosanna, Ethiopia
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Befikadu D, Tamrat R, Garedo AW, Beyene G, Gudina EK, Gashaw M. Faecal carriage of extended-spectrum beta-lactamase and carbapenemase-producing enterobacterales among HIV patients at Jimma Medical Center, Southwest Ethiopia. BMC Microbiol 2024; 24:459. [PMID: 39506640 PMCID: PMC11539523 DOI: 10.1186/s12866-024-03596-8] [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: 07/23/2024] [Accepted: 10/21/2024] [Indexed: 11/08/2024] Open
Abstract
BACKGROUND Enterobacterales infections in immunocompromised individuals are associated with considerable morbidity, mortality, and health care costs. This study aimed to assess the faecal carriage of extended-spectrum β-lactamase (ESBL) and carbapenemase-producing Enterobacterales (CPE) among HIV-infected patients at Jimma Medical Center. A total of 344 stool samples were collected and inoculated on Mac-Conkey and Eosin-Methylene Blue agar and incubated at 35-37 °C aerobically. ESBL and carbapenemase production were detected using D68C ESBL/AmpC and D73C CARBA plus (Mast Group, UK). RESULTS A total of 376 Enterobacterales were isolated. The prevalence of ESBL-PE and CPE carriage rate was 13.3% (50/376) and 4.3% (16/376) respectively. The highest proportion of ESBL producing isolates were found in K. pneumoniae 29.0% (9/31) followed by E. coli 13.4% (39/292). Similarly, K. pneumoniae 12.9% (4/31) was the most common carbapenem-resistant isolate followed by E. coli 3.8% (11/292). Multi-drug resistance was observed in 66.5% (250/376) of the isolates. Prior cephalosporin use (AOR = 7.9; 2.31-27.29), CD4 count (≤ 350 cells/µL) (AOR = 3.8; 1.12-12.9), and comorbidities (AOR = 2.3; 1.24-4.32) were significantly associated with ESBL production. Additionally, cephalosporin use (AOR = 6.34; 1.27-31.66) was significantly associated with the presence of CRE. CONCLUSIONS This study revealed a high prevalence of ESBL-PE and CPE among HIV patients, with K. pneumoniae and E. coli being the dominant isolates. MDR was common, with key risk factors being prior cephalosporin use, low CD4 counts, and comorbidities. These findings emphasize the need for enhanced infection prevention and control, regular screening, and improved antibiotic stewardship to curb the spread of resistant bacteria in immunocompromised individuals.
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Affiliation(s)
- Dechasa Befikadu
- School of Medical Laboratory Sciences, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
- Department of Medical Laboratory Sciences, Institute of Health, Dambi Dollo University, Dambi Dollo, Ethiopia
| | - Rahel Tamrat
- School of Medical Laboratory Sciences, Institute of Health Sciences, Jimma University, Jimma, Ethiopia.
| | - Aster Wakjira Garedo
- School of Pharmacy, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Getenet Beyene
- School of Medical Laboratory Sciences, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
| | | | - Mulatu Gashaw
- School of Medical Laboratory Sciences, Institute of Health Sciences, Jimma University, Jimma, Ethiopia
- CIHLMU Center for International Health, Ludwig Maximilians Universität München, Munich, Germany
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Tilahun M, Sharew B, Shibabaw A. Antimicrobial resistance profile and associated factors of hospital-acquired gram-negative bacterial pathogens among hospitalized patients in northeast Ethiopia. BMC Microbiol 2024; 24:339. [PMID: 39261762 PMCID: PMC11389124 DOI: 10.1186/s12866-024-03485-0] [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: 05/21/2024] [Accepted: 09/02/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Antimicrobial resistance is a major global public health issue. Infections caused by resistant species are associated with higher mortality rates, longer hospital stays, medication failure, and rising medical costs. The World Health Organisation has declared multidrug resistance-associated infections as an epidemic of public health concern. OBJECTIVE This study aimed to evaluate the antimicrobial resistance profile and associated factors of hospital-acquired Gram-negative bacterial pathogens among hospitalized patients in Northeast Ethiopia. MATERIALS AND METHODS A health facility-based cross-sectional study was conducted among hospitalized patients from March 2021 to February 2022. About 810 clinical specimens were collected, transported, and processed from admitted patients following the standard bacteriological procedures. The clinical samples were inoculated onto blood agar, MacConkey agar, and chocolate agar. Furthermore, the species identification was done using gram reactions, colony morphology, and color and biochemical tests. Antimicrobial susceptibility tests, extended-spectrum beta-lactamase, and carbapenemase production were performed as per the clinical laboratory standard institute guidelines. For analysis, the information was entered into Epi-data and exported to SPSS. A P value of < 0.05 with a 95% confidence interval was considered as a statistically significant association. RESULTS Out of 810 clinical specimens, 285/810 (35.2%) developed bacterial infections. From the isolated bacteria, E. coli was the predominant bacteria accounting for 78/285 (27.4%) followed by K. pneumoniae, 69/285(24.42%), whereas P. vulgaris accounted for the least, 7/285 (2.5%). Overall, 132/285 (46.3%) and 99/285 (34.7%) of culture-positive patients were infected by extended-spectrum beta-lactamase and carbapenemase-producing bacteria. The overall multidrug resistance rate of the isolated bacteria was 89.4%. The highest antibiotic resistance rates were detected for doxycycline (92.9%), amoxicillin-clavulanic acid (83.9%), and ampicillin (93%). The least antibiotic resistance rate was observed for meropenem at 41.1% and amikacin at 1.7%, respectively. CONCLUSIONS AND RECOMMENDATIONS In the study area, significant health concerns include a range of hospital-acquired bacterial infections associated with elevated rates of multidrug resistance, Extended-spectrum beta-lactamase (ESBL), and carbapenemase-producing bacterial pathogens. Consequently, it is recommended to conduct drug-susceptibility testing of isolates and molecular detection at a national level to optimize antibiotic usage for treating prevalent bacterial infections in this area.
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Affiliation(s)
- Mihret Tilahun
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, 1145, Ethiopia.
| | - Bekele Sharew
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre-Tabor, Ethiopia
| | - Agumas Shibabaw
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, 1145, Ethiopia
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Monk EJM, Jones TPW, Bongomin F, Kibone W, Nsubuga Y, Ssewante N, Muleya I, Nsenga L, Rao VB, van Zandvoort K. Antimicrobial resistance in bacterial wound, skin, soft tissue and surgical site infections in Central, Eastern, Southern and Western Africa: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003077. [PMID: 38626068 PMCID: PMC11020607 DOI: 10.1371/journal.pgph.0003077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/15/2024] [Indexed: 04/18/2024]
Abstract
Antimicrobial resistance (AMR) is a major global threat and AMR-attributable mortality is particularly high in Central, Eastern, Southern and Western Africa. The burden of clinically infected wounds, skin and soft tissue infections (SSTI) and surgical site infections (SSI) in these regions is substantial. This systematic review reports the extent of AMR from sampling of these infections in Africa, to guide treatment. It also highlights gaps in microbiological diagnostic capacity. PubMed, MEDLINE and Embase were searched for studies reporting the prevalence of Staphylococcus aureus, Eschericheria coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii in clinically infected wounds, SSTI and SSI in Central, Eastern, Southern or Western Africa, and studies reporting AMR from such clinical isolates. Estimates for proportions were pooled in meta-analyses, to estimate the isolation prevalence of each bacterial species and the proportion of resistance observed to each antibiotic class. The search (15th August 2022) identified 601 articles: 59 studies met our inclusion criteria. S. aureus was isolated in 29% (95% confidence interval [CI] 25% to 34%) of samples, E. coli in 14% (CI 11% to 18%), K. pneumoniae in 11% (CI 8% to 13%), P. aeruginosa in 14% (CI 11% to 18%) and A. baumannii in 8% (CI 5% to 12%). AMR was high across all five species. S. aureus was resistant to methicillin (MRSA) in >40% of isolates. E. coli and K. pneumoniae were both resistant to amoxicillin-clavulanic acid in ≥80% of isolates and resistant to aminoglycosides in 51% and 38% of isolates respectively. P. aeruginosa and A. baumannii were both resistant to anti-pseudomonal carbapenems (imipenem or meropenem) in ≥20% of isolates. This systematic review found that a large proportion of the organisms isolated from infected wounds, SSTI and SSI in Africa displayed resistance patterns of World Health Organisation (WHO) priority pathogens for critical or urgent antimicrobial development.
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Affiliation(s)
- Edward J. M. Monk
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Infection Care Group, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Timothy P. W. Jones
- Nuffield Department of Medicine, Jenner Institute, University of Oxford, Oxford, United Kingdom
| | - Felix Bongomin
- Faculty of Medicine, Department of Medical Microbiology and Immunology, Gulu University, Gulu, Uganda
| | - Winnie Kibone
- Faculty of Medicine, Department of Medical Microbiology and Immunology, Gulu University, Gulu, Uganda
| | - Yakobo Nsubuga
- Faculty of Medicine, Department of Medical Microbiology and Immunology, Gulu University, Gulu, Uganda
| | - Nelson Ssewante
- Child and Health Development Centre, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Lauryn Nsenga
- School of Medicine, Kabale University, Kabale, Uganda
| | - V. Bhargavi Rao
- The Mason Unit, MSF UK, London, United Kingdom
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kevin van Zandvoort
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Gobezie MY, Hassen M, Tesfaye NA, Solomon T, Demessie MB, Kassa TD, Wendie TF, Andualem A, Alemayehu E, Belayneh YM. Prevalence of meropenem-resistant Pseudomonas Aeruginosa in Ethiopia: a systematic review and meta‑analysis. Antimicrob Resist Infect Control 2024; 13:37. [PMID: 38600535 PMCID: PMC11005134 DOI: 10.1186/s13756-024-01389-2] [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: 01/04/2024] [Accepted: 03/23/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a pressing global health concern, particularly pronounced in low-resource settings. In Ethiopia, the escalating prevalence of carbapenem-resistant Pseudomonas aeruginosa (P. aeruginosa) poses a substantial threat to public health. METHODS A comprehensive search of databases, including PubMed, Scopus, Embase, Hinari, and Google Scholar, identified relevant studies. Inclusion criteria encompassed observational studies reporting the prevalence of meropenem-resistant P. aeruginosa in Ethiopia. Quality assessment utilized JBI checklists. A random-effects meta-analysis pooled data on study characteristics and prevalence estimates, with subsequent subgroup and sensitivity analyses. Publication bias was assessed graphically and statistically. RESULTS Out of 433 studies, nineteen, comprising a total sample of 11,131, met inclusion criteria. The pooled prevalence of meropenem-resistant P. aeruginosa was 15% (95% CI: 10-21%). Significant heterogeneity (I2 = 83.6%) was observed, with the number of P. aeruginosa isolates identified as the primary source of heterogeneity (p = 0.127). Subgroup analysis by infection source revealed a higher prevalence in hospital-acquired infections (28%, 95% CI: 10, 46) compared to community settings (6%, 95% CI: 2, 11). Geographic based subgroup analysis indicated the highest prevalence in the Amhara region (23%, 95% CI: 8, 38), followed by Addis Ababa (21%, 95% CI: 11, 32), and lower prevalence in the Oromia region (7%, 95% CI: 4, 19). Wound samples exhibited the highest resistance (25%, 95% CI: 25, 78), while sputum samples showed the lowest prevalence. Publication bias, identified through funnel plot examination and Egger's regression test (p < 0.001), execution of trim and fill analysis resulted in an adjusted pooled prevalence of (3.7%, 95% CI: 2.3, 9.6). CONCLUSION The noteworthy prevalence of meropenem resistance among P. aeruginosa isolates in Ethiopia, particularly in healthcare settings, underscores the urgency of implementing strict infection control practices and antibiotic stewardship. Further research is imperative to address and mitigate the challenges posed by antimicrobial resistance in the country.
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Affiliation(s)
- Mengistie Yirsaw Gobezie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Minimize Hassen
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Nuhamin Alemayehu Tesfaye
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tewodros Solomon
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mulat Belete Demessie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Tesfaye Dessale Kassa
- Department of Clinical Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Teklehaimanot Fentie Wendie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Abel Andualem
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Ermiyas Alemayehu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yaschilal Muche Belayneh
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Asmare Z, Awoke T, Genet C, Admas A, Melese A, Mulu W. Incidence of catheter-associated urinary tract infections by Gram-negative bacilli and their ESBL and carbapenemase production in specialized hospitals of Bahir Dar, northwest Ethiopia. Antimicrob Resist Infect Control 2024; 13:10. [PMID: 38273339 PMCID: PMC10809431 DOI: 10.1186/s13756-024-01368-7] [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: 08/01/2023] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTIs) due to multidrug-resistant Gram-negative bacilli (GNB) is a common concern globally. Investigating the incidence of CAUTI and associated antibiotic resistance has paramount importance from the health care associated infections perspective. This study therefore assessed the incidence of CAUTIs due to GNB and the production of extended-spectrum beta-lactamase (ESBL) and carbapenemase among inpatients in specialized hospitals of Northwest, Ethiopia. METHODS A total of 363 patients with indwelling urinary catheters who were admitted in the hospital for > 48 h were consecutively enrolled and followed from 3 to 18 days. Data were collected through interviewing and review of medical records. Patients who developed at least one of the following: fever (> 38 OC), suprapubic tenderness, or costovertebral angle pain, coupled with a GNB positive urine culture of ≥ 103 CFU/mL with no more than two bacterial species were defined as CAUTI. The ESBL and carbapenemase production were detected and identified by chromogenic medium. Logistic regression analysis was done to identify associated factors. RESULTS From 363 patients followed, the incidence rate of CAUTI was 27.8 per 1000 catheter days. Catheterization for ≥ 8 days (AOR = 10.6, 95%CI:1.8-62.1) and hospitalization for > 10 days (AOR = 8.1, 95%CI: 2.4-27.2) were the factors significantly associated with CAUTIs. E. coli (n = 18, 34.6%), Proteus species (n = 7, 13.5%), and P. aeruginosa (n = 6, 11.5%) were the most frequent GNB. Isolates revealed high rates of resistance to amoxicillin-clavulanic acid (100%), cefazolin (n = 51, 98%), ceftazidime (n = 47, 90%) and cefotaxime (n = 46, 88%). Most of the GNB isolates (86.5%) were multidrug-resistant. Overall, 19.2% and 5.8% of GNB isolates were ESBL and carbapenemase producers, respectively. CONCLUSIONS Incidence of CAUTI with Gram-negative bacilli is high. As most of the GNB isolates are MDR and showed a super high rate of resistance to amoxicillin-clavulanic and third-generation cephalosporins, empirical treatment with these substances is virtually ineffective in patients with suspected GNB infection in Ethiopia. The expression of ESBL and carbapenemase among GNB isolates is also a concern. Therefore, improved infection prevention and control measures, careful use of catheters and third generation of cephalosporins are needed to improve patient outcomes and reduce the burden of CAUTIs and the spreading of antimicrobial resistance.
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Affiliation(s)
- Zelalem Asmare
- Department of Medical Laboratory Science, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tewachew Awoke
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Chalachew Genet
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Alemale Admas
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Addisu Melese
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Wondemagegn Mulu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
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Uc-Cachón AH, Molina-Salinas GM, Dzul-Beh ADJ, Rosado-Manzano RF, Dzib-Baak HE. [Gram-negative bacteria of critical priority in ICU patients from a tertiary care hospital]. REVISTA MEDICA DEL INSTITUTO MEXICANO DEL SEGURO SOCIAL 2023; 61:552-558. [PMID: 37756682 PMCID: PMC10607448 DOI: 10.5281/zenodo.8316413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/10/2023] [Indexed: 09/29/2023]
Abstract
Background Intensive care units (ICU) are the epicenter of antimicrobial resistance (AMR), and patients' infections are mainly caused by Gram-negative bacteria (GNB). Objective To describe the frequency and trends in AMR of GNB deriving from the clinical samples of ICU patients at a tertiary care hospital in Mérida, Yucatán. Material and methods Study which included the review of laboratory reports of all bacteriological samples collected from patients admitted to neonatal, pediatric and adult ICU from January 1 2019 to December 31 2021. Results 433 GNB isolates were recovered, with Klebsiella pneumoniae being the most predominant isolate (n = 117; 27.02%). The majority of GNB were recovered from bronchial secretions (n = 163). Overall, GNB showed high resistance rates to ampicillin (89.48%), ampicillin/sulbactam (66.85%), cephalosporins (58.52-93.81%), tobramycin (58.06%), and tetracycline (61.73%). Among GNB, 73.90% and 68.53% exhibited multidrug-resistant, and highly resistant microorganisms' profiles, respectively, and 47.54% of Acinetobacter baumannii exhibited an extensively drug-resistant profile. A total of 80.33% of A. baumannii was carbapenem-resistant, and 83.76% of K. pneumoniae strains were ESBL-producing. Conclusion Our data could be helpful to improve the empirical therapy and the infection-control program.
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Affiliation(s)
- Andrés Humberto Uc-Cachón
- Instituto Mexicano del Seguro Social, Hospital de Especialidades No. 1 "Lic. Ignacio García Téllez", Unidad de Investigación Médica Yucatán. Mérida, Yucatán, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Gloria María Molina-Salinas
- Instituto Mexicano del Seguro Social, Hospital de Especialidades No. 1 "Lic. Ignacio García Téllez", Unidad de Investigación Médica Yucatán. Mérida, Yucatán, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Angel de Jesús Dzul-Beh
- Instituto Mexicano del Seguro Social, Hospital de Especialidades No. 1 "Lic. Ignacio García Téllez", Unidad de Investigación Médica Yucatán. Mérida, Yucatán, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Rey Fernando Rosado-Manzano
- Instituto Mexicano del Seguro Social, Hospital de Especialidades No. 1 "Lic. Ignacio García Téllez", Laboratorio de Patología Clínica. Mérida, Yucatán, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - Haziel Eleazar Dzib-Baak
- Instituto Mexicano del Seguro Social, Hospital de Especialidades No. 1 "Lic. Ignacio García Téllez", Unidad de Investigación Médica Yucatán. Mérida, Yucatán, MéxicoInstituto Mexicano del Seguro SocialMéxico
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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: 2.0] [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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Arias Ramos D, Alzate JA, Moreno Gómez GA, Hoyos Pulgarín JA, Olaya Gómez JC, Cortés Bonilla I, Vargas Mosquera C. Empirical treatment and mortality in bacteremia due to extended spectrum β-lactamase producing Enterobacterales (ESβL-E), a retrospective cross-sectional study in a tertiary referral hospital from Colombia. Ann Clin Microbiol Antimicrob 2023; 22:13. [PMID: 36797734 PMCID: PMC9933341 DOI: 10.1186/s12941-023-00566-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Infections caused by extended spectrum β-lactamase (ESβL) producing bacteria are common and problematic. When they cause bloodstream infections, they are associated with significant morbidity and mortality. METHODS A retrospective cross-sectional observational study was conducted in a single center in Pereira, Colombia. It included people hospitalized with bacteremia due to gram-negative bacilli with the extended-spectrum β-lactamase producing phenotype. A logistic regression analysis was constructed. Clinical characteristics and risk factors for death from sepsis were established. RESULTS The prevalence of bacteremia due to Enterobacterales with extended-spectrum β-lactamase producing phenotype was 17%. 110 patients were analyzed. Most patients were men (62%) with a median age of 58 years, hospital mortality was 38%. Admission to intensive care was 45%. The following risk factors for mortality were established: shock requiring vasoactive support, Pitt score > 3 points, and not having an infectious disease consultation (IDC). CONCLUSIONS bacteremia due to Enterobacterales with extended-spectrum β-lactamase producing phenotype have a high mortality. Early recognition of sepsis, identification of risk factors for antimicrobial resistance, and prompt initiation of appropriate empiric antibiotic treatment are important. An infectious disease consultation may help improve outcomes.
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Affiliation(s)
- Deving Arias Ramos
- Universidad Tecnológica de Pereira, Pereira, Colombia. .,Grupo de investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia.
| | - John Alexander Alzate
- grid.412256.60000 0001 2176 1069Hospital Universitario San Jorge, Pereira, Universidad Tecnológica de Pereira, Pereira, Colombia ,grid.412256.60000 0001 2176 1069Grupo de investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Germán Alberto Moreno Gómez
- grid.412256.60000 0001 2176 1069Universidad Tecnológica de Pereira, Pereira, Colombia ,grid.412256.60000 0001 2176 1069Grupo de investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Julián Andrés Hoyos Pulgarín
- Oncólogos de Occidente, Pereira, Colombia ,grid.412256.60000 0001 2176 1069Grupo de investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Juan Camilo Olaya Gómez
- grid.412256.60000 0001 2176 1069Universidad Tecnológica de Pereira, Pereira, Colombia ,grid.412256.60000 0001 2176 1069Grupo de investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Isabella Cortés Bonilla
- grid.412256.60000 0001 2176 1069Universidad Tecnológica de Pereira, Pereira, Colombia ,grid.412256.60000 0001 2176 1069Grupo de investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia
| | - Camila Vargas Mosquera
- grid.412256.60000 0001 2176 1069Hospital Universitario San Jorge, Pereira, Universidad Tecnológica de Pereira, Pereira, Colombia ,grid.412256.60000 0001 2176 1069Grupo de investigación en Medicina Interna, Universidad Tecnológica de Pereira, Pereira, Colombia
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Bacteriological spectrum, extended-spectrum β-lactamase production and antimicrobial resistance pattern among patients with bloodstream infection in Addis Ababa. Sci Rep 2023; 13:2071. [PMID: 36746979 PMCID: PMC9902618 DOI: 10.1038/s41598-023-29337-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
Bloodstream infection coupled with drug resistance in bloodborne bacteria is a major health problem globally. The current study sought to identify the bacterial spectrum, extended-spectrum -lactamase production, and antimicrobial resistance pattern in patients with bloodstream infection. This prospective cross-sectional study was conducted at Arsho Advanced Medical Laboratory, Addis Ababa, Ethiopia from January 2019- until July 2020. Blood collected from patients was inoculated into blood culture bottles and incubated appropriately. Identification, antimicrobial susceptibility testing, and extended-spectrum β-lactamase-production were determined with the VITEK 2 compact system. Of the samples collected, 156 (18.5%) were culture-positive. Klebsiella pneumoniae and Staphylococcus epidermidis were the dominant isolates. In Gram-negative bacteria, the prevalence of drug resistance was the highest against ampicillin (80.8%) and the lowest against imipenem (5.2%). While in Gram-positive bacteria it was the highest against clindamycin and the lowest against vancomycin and daptomycin. The prevalence of multi-drug resistance and extended-spectrum β-lactamase production of Gram-negative bacteria were 41.6% and 34.2%, respectively. The prevalence of bloodstream infection was 18.5%. Serious life-threatening pathogens including S. aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli, and Enterobacter spp was predominant. The prevalence of multi-drug resistance to both Gram-positive and Gram-negative bacteria and extended-spectrum β-lactamase-production were high but prevalence of carbapenem resistance was low. All these situations call for the establishment of strong infection control strategies, a drug regulatory system, and established antibiotic stewardship in healthcare settings.
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Kabrah A. Extended-Spectrum Beta-Lactamase and Carbapenem-Resistant Gram-Negative Pathogens in Makkah, Saudi Arabia. Ethiop J Health Sci 2022; 32:1221-1230. [PMID: 36475249 PMCID: PMC9692147 DOI: 10.4314/ejhs.v32i6.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/15/2022] [Indexed: 12/13/2022] Open
Abstract
Background This study aimed to determine the prevalence of extended-spectrum-beta-lactamase (ESBL) and carbapenem-resistant gram-negative bacteria (GNB) isolated from patients at the King Faisal Hospital in Makkah, Saudi Arabia. Methods In this cross-sectional study, a total of 298 patients admitted to the intensive care unit for 48 hours and who had a central venous catheter were selected using a census sampling method. Only patients with ESBL and carbapenem-resistant GNB-isolated organisms (175 patients) were included. The susceptibility test of GNB was carried out according to the standard recommendations. The identified strains were tested in-vitro against several antimicrobial drugs. Statistical analysis was performed using SPSS version 24. Results 36(20.6%) of samples were ESBL-producing GNB, whereas 139(79.4%) were carbapenem-resistant GNB. The pooled proportional estimates of ESBL-producing GNB Escherichia coli, Klebsiella pneumoniae, and other GNB were 44.4%, 41.6%, and 14.0%, respectively; the pooled proportional estimates of carbapenem resistance GNB Klebsiella pneumoniae, Acinetobacter baumannii complex/hemolyticus and other GNB were 82.8%, 10.8%, and 6.4%, respectively. All ESBL-producing GNB and carbapenem-resistance GNB were multidrug-resistant pathogens. The highest carbapenem resistance GNB 139(100%) was to ampicillin, and the lowest 122(87.7%) was to Amoxicillin/clavulanic acid (Amox/clav). All ESBL-producing GNB 36 (100%) were resistant to cefotaxime, and 35 (97.2%) were resistant to ampicillin, cefuroxime, cefepime, and ceftazidime. Additionally, the effective antibiotic against ESBL-producing GNB was imipenem. Conclusion Antibiotic utilization measures appear to contribute to the control of the emergence of multidrug-resistant pathogens such as ESBL and carbapenem-resistant GNB. Strict adherence to well-accepted infection control guidelines along with caution in using broad-spectrum antimicrobial agents represents the best strategy for preventing the emergence and spread of multidrug-resistant pathogens.
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Affiliation(s)
- Ahmed Kabrah
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
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Tilahun M. Multi-Drug Resistance Profile, Prevalence of Extended-Spectrum Beta-Lactamase and Carbapenemase-Producing Gram Negative Bacilli Among Admitted Patients After Surgery with Suspected of Surgical Site Nosocomial Infection North East Ethiopia. Infect Drug Resist 2022; 15:3949-3965. [PMID: 35924020 PMCID: PMC9341454 DOI: 10.2147/idr.s376622] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mihret Tilahun
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
- Correspondence: Mihret Tilahun, Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie and Borumeda, PO.BOX 1145, Ethiopia, Tel +251 920988307, Fax +251 333115250, Email
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Tilahun M, Gedefie A, Bisetegn H, Debash H. Emergence of High Prevalence of Extended-Spectrum Beta-Lactamase and Carbapenemase Producing Acinetobacter Species and Pseudomonas aeruginosa Among Hospitalized Patients at Dessie Comprehensive Specialized Hospital, North-East Ethiopia. Infect Drug Resist 2022; 15:895-911. [PMID: 35299856 PMCID: PMC8921833 DOI: 10.2147/idr.s358116] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/24/2022] [Indexed: 12/27/2022] Open
Abstract
Background The emergence of extended spectrum beta lactamase and carbapenemase production of Acinetobacter and Pseudomonas aeruginosa is a great concern and major cause of nosocomial infections due to its ability to production of extended spectrum beta lactamase and carbapenemase enzymes. Objective To assess Emergence of high prevalence of extended-spectrum beta-lactamase and Carbapenemase producing Acinetobacter species and Pseudomonas aeruginosa among hospitalized patients at Dessie Comprehensive Specialized Hospital, North-East Ethiopia. Materials and Methods A hospital-based cross-sectional study was conducted from February–August 2021 at Dessie Referral Hospital in the North eastern Ethiopia. A total of 423 clinical samples taken from admitted patients. Clinical specimens were collected aseptically and inoculated on blood agar and MacConkey agar media. Antimicrobial susceptibility test, ESBL and carbapenemase production were performed as CLSI guideline. The data were entered into the Epi-data and imported to Statistical Package for Social Science version 25. P value of <0.05 with odds ratio and 95% confidence interval was considered as statistically significant. Results Out of 423 clinical specimens 17.7% (75/423) were culture positive nosocomial infection. The proportions of nosocomial infection were higher in blood stream followed by wound infection which accounted 24.6%, 20.8%, respectively. Overall, 32/75 (42.7%) and 19/75 (25.3%) patients had infection with ESBL and CP producing bacterial infection. P. aeruginosa was the most predominant isolated bacteria 46/75 (52.9%). The overall multidrug resistance rate of the isolated bacteria was 88% (66/75). The majority of highest resistance rate was Piperacillin tazobactam 50 (66.7%) and Aztreonam 26 (56.5%), respectively, while least resistance rate was Amikacin 27 (36%). Conclusion The incidence rates of ESBL, carbapenemase production and antimicrobial resistant Acinetobacter species and P. aeruginosa infections are high. Therefore, treatment should be based on culture and antimicrobial test result and minimize the use of antibiotics empirically.
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Affiliation(s)
- Mihret Tilahun
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
- Correspondence: Mihret Tilahun, Department of Medical Laboratory Science College of Medicine and Health Sciences, Wollo University, PO.Box: 1145, Dessie, Ethiopia, Tel +251 920988307, Fax +251 333115250, Email
| | - Alemu Gedefie
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Habitye Bisetegn
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Habtu Debash
- Department of Medical Laboratory Sciences, College of Medicine and Health Science, Wollo University, Dessie, 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: 21] [Impact Index Per Article: 5.3] [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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Kabrah AM, Kabrah SM, Bahwerth FS, Alredaini NF. Antibiotic Resistance Profile of Common Bacteria Isolated from Blood Stream, Lower Respiratory Tract and Urinary Infections in Intensive Care Unit in Saudi Arabia: A Retrospective Study. Ethiop J Health Sci 2021; 31:1231-1240. [PMID: 35392341 PMCID: PMC8968372 DOI: 10.4314/ejhs.v31i6.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 08/24/2021] [Indexed: 11/12/2022] Open
Abstract
Background The rate of infections in the intensive care units (ICUs) is rising, mainly because of the increasing use of invasive procedures and specialized devices. This study aimed to identify the antibiotic resistance profile of common bacteria isolated from lower respiratory tract infections (LRTIs), bloodstream infections (BSIs), and urinary infections (UTIs) in ICUs in Saudi Arabia. Methods In the current retrospective study, the isolates and antibiotic resistance were collected from the Electronic Medical Record (EMR) for respiratory, blood, and urine samples. The study sample compromised 96 patients admitted to the ICU at least for 48 hours and have a central venous catheter (CVC) between November 1, 2020, and January 31, 2021. Results 66 (68.8%) of the study sample were males, and 30 (31.2%) were females. LRTIs were the most common isolates (51 samples), followed by BSIs (28 samples) and UTIs (17 samples). The isolated pathogens in this study were Klebsiella pneumoniae (K. pneumoniae) (59.4%), Coagulase-negative staphylococci (CoNS) (11.5%), Escherichia coli (E. coli) (8.4%), Acinetobacter baumannii (A. baumannii) (7.3%), and Staphylococcus aureus (S. aureus) (6.2%). BSI were frequently caused by CoNS (35.7%) and K. pneumoniae (35.7%), while Methicillin-resistant Staphylococcus aureus (MRSA) represented 10.7% of BSI. Vancomycin, Synercid, and Teicoplanin were the commonly used antibiotics and showed 100% sensitivity among S. aureus, including MRSA, while almost 100% resistance was observed for penicillin and oxacillin against the same organisms. The maximum resistance was observed with aztreonam (96.4%), ampicillin (87.3%), followed by co-amoxiclav (83.9%), cotrimoxazole (79.5%) and cephalosporin group antibiotics. Conclusions Strict adherence to infection prevention practices and wise use of antibiotics are recommended to slow the spread of antimicrobial resistance (AMR).
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Affiliation(s)
- Ahmed M Kabrah
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Saeed M Kabrah
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Fayez S Bahwerth
- Molecular Genetics, King Faisal Hospital, Ministry of Health, Makkah - Kingdom of Saudi Arabia
| | - Naof F Alredaini
- Faculty Member, King Abdulaziz University in Rabigh, Rabigh - Kingdom of Saudi Arabia
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Mohamed A, Daef E, Nafie A, Shaban L, Ibrahim M. Characteristics of Carbapenem-Resistant Gram-Negative Bacilli in Patients with Ventilator-Associated Pneumonia. Antibiotics (Basel) 2021; 10:antibiotics10111325. [PMID: 34827263 PMCID: PMC8615042 DOI: 10.3390/antibiotics10111325] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 01/16/2023] Open
Abstract
Carbapenem-resistant Gram-negative bacilli (CR-GNB) has become a global threat. In hospital settings, the association of CR-GNB with ventilator-associated pneumonia (VAP) is a critical public health concern owing to their high resistance rate to most antibiotics. The present study aims to identify the frequency of carbapenem-resistance and to determine the rate of multidrug resistance (MDR), extensive drug resistance (XDR) and pan-drug resistance (PDR) among CR-GNB infections in VAP. Antimicrobial susceptibility testing was carried out using the disk diffusion method and the detection of carbapenemases was screened using the imipenem-E test and the modified carbapenem-inactivation method (mCIM). The isolates were verified by polymerase chain reaction (PCR) for the presence of blaNDM, blaSPM, blaVIM, blaIMP and blaGIM genes. 89.5%, 14%, 17.5%, 10.5%, 3.5% of isolates exhibited the presence of blaNDM, blaVIM, blaSPM, blaIMP and blaGIM, respectively. 76%, 17% and 7% of isolates were PDR, XDR, and MDR, respectively. Carbapenem-resistance genes were identified in a significant percentage and blaNDM was the most predominant gene. All isolates were highly resistant to most antibiotics. This health concern has proven to be a big challenge in developing countries such as Egypt, as it is associated with high morbidity, high mortality, and raised healthcare costs.
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Affiliation(s)
- Amira Mohamed
- Clinical Pharmacy, Women’s Health Hospital, Assiut University, Assiut 71711, Egypt;
| | - Enas Daef
- Microbiology and Immunology Department, Faculty of Medicine, Assiut University, Assiut 71711, Egypt; (E.D.); (A.N.)
| | - Amany Nafie
- Microbiology and Immunology Department, Faculty of Medicine, Assiut University, Assiut 71711, Egypt; (E.D.); (A.N.)
| | - Lamia Shaban
- Chest Department, Faculty of Medicine, Assiut University, Assiut 71711, Egypt;
| | - Maggie Ibrahim
- Microbiology and Immunology Department, Faculty of Medicine, Assiut University, Assiut 71711, Egypt; (E.D.); (A.N.)
- Correspondence:
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