Bacterial etiology, antimicrobial resistance and factors associated with community acquired pneumonia among adult hospitalized patients in Southwest Ethiopia.

Background and Objectives: Antibiotic resistance is a significant problem that restricts the options for treating bacterial pneumonia. This research aimed to determine the bacterial causes of pneumonia and antibiotic resistance among hospitalized patients in southwest Ethiopia. Materials and Methods: We collected and analyzed 150 sputum samples from individuals with community-acquired pneumonia from April 1st to October 30th, 2019. Standard bacteriological procedures were used to identify the bacteria. Kirby Bauer's disk diffusion method was used to assess the bacteria's susceptibility patterns. Production of carbapenemase and extended-spectrum-lactamase were confirmed phenotypically. Odds ratios and the chi-square test were computed. Results: On the whole, bacterial pathogens were verified in 50% of the sputum samples. The predominant bacterial isolates were Klebsiella species, followed by Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus pneumoniae. About 77.5% of isolates were multidrug resistant. Moreover, 40.5% and 10.8% of the isolates were ESBL and carbapenemase producers, respectively. Aging, tobacco smoking, previous history of pneumonia, heart disease, and chronic respiratory disease had association with sputum culture-positivity. Conclusion: As a result, it is important to regularly monitor the bacterial etiologies and their patterns of resistance. Additionally, sociodemographic and clinical characteristics should all be taken into account while managing patients with pneumonia empirically in this context.

Magnitude of extended-spectrum ß-lactamase and carbapenemase producing Enterobacteriaceae among commonly vended street foods in Arba Minch town, southern Ethiopia.

BACKGROUND: The rising prevalence of extended-spectrum beta-lactamase and carbapenemase-producing Enterobacteriaceae (ESßL-PE) in street foods poses a significant risk to human health due to its epidemiological significance. Thus, the aim of this study was to determine the magnitude of foodborne Enterobacteriaceae that produce carbapenemase and ESßL, as well as their patterns of antibiotic resistance, in the studied area. METHODS: A community-based cross-sectional study was carried out from January 1st, 2023, to February 30th, 2023. One hundred randomly chosen street-vended food items (one hundred grams of each food item) were aseptically collected, and aliquots of 0.1 ml from the homogenized (25 g of samples into 225 ml of buffered peptone water (BPW)) were inoculated on MacConkey agar and Xylose Lysine Deoxycholate Agar (XLD). Enterobacteriaceae isolates were identified using various biochemical tests. ESßL and carbapenemase were first screened by indicator cephalosporins and carbapenem antibiotics, respectively. ESßL and carbapenemase were confirmed by a double-disc synergy test and modified carbapenem inactivation methods, respectively. Kirby-Bauer disc diffusion method was used for the antimicrobial-resistant test. RESULTS: A total of 112 Enterobacteriaceae belonging to six different genera were isolated. E. coli was attributed 39 (34.8%), followed by Citrobacter spp. 22 (19.6%) and K. pneumoniae 18 (16.1%), with only 8 (7.1%) isolated Salmonella spp. About 15.2% (n = 17) and 8.9% (n = 10) of Enterobacteriaceae were phenotypically confirmed to be extended-spectrum beta-lactamase (ESßL) and carbapenemase producers, respectively. The highest percentage of ESßL-producing isolates was attributed to K. pneumoniae (n = 5), E. coli (n = 4), and Enterobacter spp. (n = 3). Proteus spp. and Salmonella spp. isolates were carbapenemase-negative. All carbapenemase-positive isolates were found to be ESßL-producers. 70.6% (12/17) of ESßL-producing Enterobacteriaceae were found to be multidrug-resistant (MDR). CONCLUSION: A considerable number of multidrug-resistant ESßL and carbapenemase-producing Enterobacteriaceae were identified, suggesting that street foods may be a potential source of MDR foodborne infections. Consequently, it is important to conduct routine examinations of street food items and track trends in medication resistance.

Bacteriological Quality and Antimicrobial Resistant Patterns of Foodborne Pathogens Isolated from Commonly Vended Street Foods in Arba Minch Town, Southern Ethiopia.

Background: Ready-to-eat foods sold by street vendors act as potential sources for the spread of various foodborne infectious diseases. Thus, local determination of the level of foodborne bacterial pathogens and their antimicrobial resistance pattern is essential. Methods: A community-based cross-sectional study was conducted from September 5th, 2022 to December 31th, 2022. The required data were collected by a structured questionnaire and observation checklist. Randomly selected street-vended foods were aseptically collected, and the bacteriological quality was assessed by using culture techniques. Different biochemical tests were used to identify and characterize bacterial isolates. The antimicrobial-resistant test for isolated foodborne bacterial pathogens was carried out by using the Kirby-Bauer disc diffusion method. The data were analyzed using SPSS version 22. Results: A total of 34.2% (113/330) with a 95% CI of 29.1-39.4 of commonly consumed street-vended foods were identified as having unsatisfactory total mean aerobic bacterial counts (>105 CFU/g; 4.3 × 105 CFU/g). The mean total Enterobacteriaceae, coliform, and staphylococcal counts were found to be 1.4 × 105 CFU/g, 2.4 × 104 CFU/g, and 3.4 × 104 CFU/g, respectively. A total of 12.7% (42/330) of foodborne pathogens were recovered attributed to Staphylococcus aureus (31, 9.4%), Salmonella species (6, 1.8%), and E. coli O157:H7 (5, 1.5%). 6.5% and 16.1% of isolated S. aureus were found to be methicillin-resistant and multidrug-resistant (MDR), respectively. Additionally, 33.3% of Salmonella isolates and 40% of E. coli O157:H7 isolates were found to be MDR. Conclusion: Street-vended foods in this setting have a considerable number of unsatisfactory bacterial qualities, along with drug-resistant foodborne pathogens. Thus, more effective health education and training for vendors, regular inspections of vending sites, and regular surveillance of drug resistance patterns of foodborne pathogens are all essential.

Decision to Delivery Interval, Perinatal Outcome and Factors Following Emergency Cesarean Section in Southern Ethiopia.

Background: The interval between the decision for an emergency cesarean section and the delivery of the fetus should be made within 30 minutes. In a setting like Ethiopia, the recommendation of 30 minutes is unrealistic. Decision to delivery interval should, therefore, be considered as vital in improving perinatal outcomes. This study aimed to assess the decision to delivery interval, its perinatal outcomes, and associated factors. Methods: A facility-based cross-sectional study was employed, and a consecutive sampling technique was used. Both the questionnaire and the data extraction sheet were used, and data analysis was done using a statistical package for social science version 25 software. Binary logistic regression was used to assess the factors associated with decision to delivery interval. P-value < 0.05 level of significance with a 95% Confidence interval was considered statistically significant. Results: Decision-to-delivery interval below 30 minutes was observed in 21.3% of emergency cesarean sections. Category one (AOR=8.45, 95% CI, 4.66, 15.35), the presence of additional OR table (AOR=3.31, 95% CI, 1.42, 7.70), availability of materials and drugs (AOR=4.08, 95% CI, 1.3, 12.62) and night time (AOR=3.08, 95% CI, 1.04, 9.07) were factors significantly associated. The finding revealed that there was no statistically significant association between prolonged decisions to delivery interval with adverse perinatal outcomes. Conclusions: Decision-to-delivery intervals were not achieved within the recommended time interval. The prolonged decision to delivery interval and adverse perinatal outcomes had no significant association. Providers and facilities should be better equipped in advance and ready for a rapid emergency cesarean section.

Drug-Resistant Aerobic Bacterial Pathogens in Patients with Crocodile Bite Wounds Attending at Arba Minch General Hospital, Southern Ethiopia.

Background: A polymicrobial infection containing a diverse range of drug-resistant bacteria worsens the success of treatment for crocodile bite wound infection. However, there is a dearth of data in Ethiopia, where crocodile bite injuries are relatively common, particularly in the area around Lake Abaya and Lake Chamo in southern Ethiopia. Methods:  A hospital-based cross-sectional study was conducted from May 1st, 2021, to April 30th, 2022, at Arba Minch General Hospital. Eleven consenting patients with crocodile bite wounds were enrolled in this study. Wound swabs were collected aseptically following microbiological procedures. The diversity and type of aerobic bacterial pathogens, and drug-resistant patterns were used to determine and characterize the nature of crocodile bite wound infections. Results: Among 11 patients with crocodile bite wounds, 72.7% (8/11) of wound samples were found to be culture-positive, with a total of 21 aerobic bacterial isolates. Gram-negative bacterial isolates were found in 57.1% (12/21). Triple-bacterial isolates were found in 62.5% (5/8) of wound samples, followed by 37.5% (3/8) of double bacterial isolates. Pseudomonas aeruginosa (n = 5), followed by Citrobacter spp. (n = 4), and coagulase-negative Staphylococci (CoNS) (n = 4) were frequently isolated bacteria. Methicillin resistance (MR-CoNS) was found in 75% of isolated CoNS. 6.7% of the isolated Enterococcus faecalis was vancomycin-resistant (VRE), while 60% of the isolated P. aeruginosa were piperacillin-resistant. Overall, 85.7% (18/21) of the isolates were found to be multidrug-resistant (MDR), with 55.6% (10/18) of them being Gram-negative MDR bacterial isolates. Conclusion: Numerous aerobic bacteria that are resistant to the majority of common antibiotics have been associated with infections in crocodile bite wounds. Thus, the key to providing empirical therapy for such wounds is detecting the drug-resistant pattern of bacterial isolates.

Vertical Transmission, Risk Factors, and Antimicrobial Resistance Patterns of Group B Streptococcus among Mothers and Their Neonates in Southern Ethiopia.

Background: Group B Streptococcus (GBS) contributes to maternal and neonatal morbidity and mortality by increasing intrauterine infection or vertical transmission at the time of birth. Despite many efforts to reduce the potential risk of vertical transmission, GBS remains the main cause of serious disease (neonatal sepsis, meningitis, and/or pneumonia) in vulnerable newborns during the first week of life. This study aimed to assess vertical transmission, risk factors, and antimicrobial resistance patterns of GBS among pregnant women and their neonates. Methods: A facility-based cross-sectional study was conducted among mothers and their neonates from February to May 2021. A total of 201 pregnant women with their neonates participated in this study. A well-designed questionnaire was used to collect sociodemographic and clinical data. A vaginal swab from mother before delivery and neonatal nasal and ear canal swab samples were taken as soon as after delivery within 30 minutes. Vaginal swabs, neonatal ear canal, and nasal swabs were placed into Todd-Hewitt broth and incubated at 37°C for 18-24 hours at 35-37°C in 5% CO2 conditions and then subcultured on 5% sheep blood agar for 18-48 hours. Presumptive identification of GBS was made by morphology, Gram stain, catalase, and hemolytic activity on sheep blood agar plates. CAMP and bacitracin susceptibility tests were used as confirmatory tests for GBS. Data were analyzed using SPSS version 21. P value ≤0.05 was considered statistically significant. Results: Vertical transmission rates of GBS (mother to neonates) were 11.9%. The prevalence of GBS among pregnant women and newborns was 24/201 (11.9%) (95% CI = 7.5-16.9) and 11/201 (5.5%) (95% CI = 2.5-9.0), respectively. The history of prolonged rupture of membranes (AOR = 3.5, CI = 2.2-18.8) and urinary tract infection (AOR = 2.9, CI = 1.7-16.3) were associated factors for maternal GBS colonization. Gestational age of <37 weeks (p=0.008), low birth weight of <2.5 kg (p=0.001), and maternal history of vaginal discharge (p=0.048) were associated factors for neonatal GBS colonization. Low antibiotic resistance was observed for erythromycin 8.6%, clindamycin 5.7%, and chloramphenicol 2.9%. Conclusion: In this study, high vertical transmission (mother to neonates) rate was observed. The prevalence of vaginal GBS colonization of women at delivery was 11.9% and significantly associated with the history of prolonged rupture of membranes and urinary tract infections. Gestational age of <37 weeks, low birth weight of <2.5 kg, and maternal history of vaginal discharge were associated with neonatal GBS colonization. Hence, there is a need for antenatal culture-based GBS screening, risk factor-based interventions, and regular follow-up of drug resistance patterns for proper treatment and management of GBS.

Bacteriological Profiles, Antimicrobial Susceptibility Patterns, and Associated Factors in Patients Undergoing Orthopedic Surgery with Suspicion of Surgical Site Infection at Arba Minch General Hospital in Southern Ethiopia.

Background: In the thoughts of all orthopedicians, the emergence of drug-resistant and biofilm-forming bacterial infections at orthopedic surgical sites is the most feared problem. Thus, this study aimed to determine the bacteriological profiles, antimicrobial susceptibility patterns, and biofilm forming ability of isolates, as well as factors associated with orthopedic surgical site infections (OSSIs). Methods: An institution-based cross-sectional study was conducted from March 1st, 2021, to February 30th, 2022 at Arba Minch General Hospital. About 245 suspected orthopedic patients with surgical site infection were enrolled and structured questionnaires were used to collect the required information. Wound swabs or pus aspirates were aseptically collected. The frequency and type of bacterial pathogen(s), antimicrobial susceptibility pattern, and biofilm formation were used to determine and characterize the magnitude of OSSIs. SPSS version 25 was used to analyze factors associated with OSSIs. Results: The overall magnitude of symptomatic OSSIs was 29.4% (72/245). External fixation [AOR = 4.761, 95% CI: (1.108-20.457)], implant use [AOR = 3.470, 95% CI: (1.460-8.246)], length of time for surgery [AOR = 3.225, 95% CI: (1.545-6.731)], and post-operative hospitalization [AOR = 4.099, 95% CI: (2.026-8.293)] were all statistically significant. Staphylococcus aureus was the most frequently isolated bacteria, accounting for 76%. Methicillin-resistant was observed in 57.9% and 40% of isolated S. aureus (MRSA) and coagulase-negative staphylococci (CoNS), respectively. One-third of the isolated E. faecium was vancomycin-resistant (VRE). Overall, 67.1% (51/76) of isolates were multidrug-resistant (MDR). About 27.6% (21/76) of isolates were found to be strong biofilm producers. Conclusion: OSSIs were shown to be caused by a significant number of drug-resistant and biofilm-producing bacterial isolates. To mitigate the problem, aseptic surgical practice and conventional wound management, as well as constant observation of antimicrobial resistant patterns, should be followed.

Prevalence and Associated Factors of Carpal Tunnel Syndrome Among Diabetic Patients in Arba Minch General Hospital, South West Ethiopia, 2021.

Purpose of the Study: This study aimed to assess the prevalence of carpal tunnel syndrome and associated factors among diabetic patients in Arba Minch General Hospital, Southwest Ethiopia. Carpal tunnel syndrome (CTS) is the second most common cause of absence from work which causes functional loss of the hands and leads to disability. However, it is understudied among diabetic patients in Ethiopia. Patients and Materials: An institution-based cross-sectional study was conducted from May 1 to October 1, 2021. Systematic random sampling method was used to select 353 study participants. CTS-6 Evaluation tool was applied to assess carpal tunnel syndrome. The data was coded and entered into Epi-Data version 3.1 statistical packages and exported to SPSS version 25 for analysis. Binary logistic regression model was applied to assess the association between outcome variable and independent variables. Odds ratio (OR) with 95% CI and p-values <0.05 were used to identify significantly associated factors with an outcome variable. Results: The study was conducted among 353 diabetic patients. The cumulative prevalence of carpal tunnel syndrome among diabetes was 3.1%. CTS was statistically significantly associated with high body mass index; AOR=0.34 (0.12, 0.97, 95% CI) (p=0.04. Majority of participants 322 (91.2%) had type 2 DM. Mean fasting blood sugar level ± standard error of study participants was 157.52 ± 1.91 mg/dl. Conclusion: The prevalence of carpal tunnel syndrome was relatively low. High body mass index (BMI) was significantly but negatively associated with carpal tunnel syndrome compared to diabetic patients with normal BMI. Diabetic patients with normal BMI should be screened for CTS for early management of the disease and prevention of further complications. Further investigations are recommended.

Magnitude of Drug-Resistant Gram-Positive Bacterial Pathogens, and Its Associated Factors from External Ocular Infected Patients Attending at Jinka General Hospital Ophthalmic Clinic, Southern Ethiopia.

Background: The emergence and the incidence of antimicrobial-resistant Gram-positive bacteria increase the risk of treatment failure of ocular infection. Thus, this study aimed to determine the magnitude of drug-resistant Gram-positive bacterial pathogens and associated factors among patients attending Jinka General Hospital Ophthalmic Clinic in Southern Ethiopia. Methods: A facility-based cross-sectional study was conducted on 347 external ocular infected patients attending Jinka General Hospital Ophthalmic Clinic from 15th March to 20th June 2021. Study participants were selected by a systematic random sampling technique. Required data were collected by using structured questionnaires. Swabs of the external eye were obtained with a sterile cotton swab and processed in the Jinka branch Public Health Laboratory. Each sample was inoculated on blood agar, chocolate agar, and mannitol salt agar and incubated aerobically and micro-aerobically at 37°C for 48 hrs. Identification was done by standard microbiological protocols and antimicrobial resistance testing by Kirby Bauer's disk diffusion technique. Logistic regression was used to identify the associated factors with Gram-positive bacterial external-ocular infection. Results: The overall prevalence of Gram-positive bacterial pathogens among external ocular samples was 119/347 (34.3%). S. aureus 57/119 (47.39%), followed by coagulase-negative Staphylococcus spp. 38/119 (31.9%), and S. pneumoniae 13/119 (10.9%) were predominantly isolated. Overall, multi-drug resistance was observed in 72/119 (60.5%) of the bacteria isolates. The 78.9% of isolated S. aureus were MDR. Methicillin-resistant S. aureus (MRSA) and Methicillin-resistant CoNS (MR-CoNS) were accounted for 45.6% and 36.8%, respectively. Previous use of ocular antibiotics was statistically associated to external-ocular Gram-positive bacterial infection [AOR= 1.624, 95% CI: (1.037-2.542)]. Conclusion: High levels of drug resistance were observed for commonly prescribed antibiotics, which attracted the attention of an ophthalmic clinic. Thus, for the effective treatment and management of bacterial eye infections, regular monitoring of drug resistance trends is essential.

Magnitude of Malaria-Typhoid Fever Coinfection in Febrile Patients at Arba Minch General Hospital in Southern Ethiopia.

Background: Coinfection with malaria and typhoid fever is a major public health issue in developing countries. In endemic areas, including Ethiopia, people are at risk of acquiring both malaria and typhoid fever at the same time. Therefore, this study aimed to determine the magnitude of malaria-typhoid fever coinfection in febrile patients attending hospital at Southern Ethiopia. Methods: A hospital-based cross-sectional study was carried out on 416 febrile patients attending Arba Minch General Hospital from 1st October to 30th December 2021. The data was collected using a pretested structured questionnaire. Capillary and Venus blood samples were collected for assessing malaria and typhoid fever, respectively. Blood smear, culture, and biochemical tests were performed based on standard parasitological and microbiological methods. The P-value ≤ 0.05 was considered statistically significant. Results: The magnitude of malaria, typhoid fever, and their coinfections was 26.2% (109/416), 6.5% (27/416), and 3.1% (13/416), respectively. Among the confirmed malaria cases, about 66% of infections were Plasmodium falciparum. The malaria-typhoid fever coinfection showed a statistically significant association with a clinical presentation of a continuous pattern of fever (AOR = 5.84; 95% CI: 1.44-23.71, P = 0.014) and chills (AOR = 3.94; 95% CI: 1.04-14.89, P = 0.044). About 29.6% of Salmonella isolates were multidrug-resistant (MDR). Conclusion: The total rate of coinfection with malaria and typhoid fever was comparable to that of previous studies. With the consideration of higher prevalence of drug resistance of Salmonella spp. and higher prevalence of malaria-typhoid fever coinfection, proper diagnostic procedure should be implemented for proper use of drugs.

Bacterial Pathogens, Drug-Resistance Profile and Its Associated Factors from Patients with Suspected Peritonitis in Southern Ethiopia.

BACKGROUND: Ascitic fluid plays a critical role in the microbiological diagnosis of peritonitis. Drug-resistant bacterial infection of the peritoneal cavity is becoming a public health threat. However, data on bacterial profile and antimicrobial-resistant pattern of isolates from the ascitic fluid are scarce. Thus, this study was aimed to assess drug-resistant bacteriological profiles and factors associated with peritonitis in southern Ethiopia. METHODS: An institutional-based cross-sectional study was conducted from March 2019 to December 2019. A semi-structured questionnaire was used to collect socio-demographic and clinical data. A total of 147 ascitic fluid samples were aseptically collected and inoculated onto blood agar, MacConkey agar, and chocolate agar. The inoculated culture media were incubated aerobically and micro-aerobically at 37°C for 48 hrs. Bacterial identification was done by standard protocols and the antimicrobial susceptibility testing by Kirby Bauer's disk diffusion method. Logistic regression was used to identify the associated factors with bacterial peritonitis. RESULTS: Of the total study participants, the overall magnitude of bacterial peritonitis was 19.05% with a total of 30 bacterial isolates. Majority of the isolates were Gram negative bacteria with predominant species E. coli 36.67% followed by Gram positive S. aureus 13.33%. The multidrug resistant isolates accounts about 43.3% while a quarter of isolated S. aureus were methicillin resistant. The bacterial peritonitis was associated with recent history of surgery [AOR = 8.724, 95% CI: (2.688-28.314)], hospitalization more than seven days [AOR = 8.990, 95% CI: (2.755-29.342)], cirrhosis [AOR = 2.751, 95% CI: (1.109-6.822)] and alcoholism [AOR = 5.802, 95% CI: (1.948-17.285)]. CONCLUSION: Nearly half of the isolated bacteria were observed to be MDR, and this may alarm all healthcare workers and policymakers. Thus, continuous surveillance of antimicrobial resistance patterns along with associated factors is essential for regular monitoring of transmission of drug-resistant bacteria and the emergence of antibiotic resistance.

Prevalence of Opportunistic Intestinal Parasites and Associated Factors among HIV Patients while Receiving ART at Arba Minch Hospital in Southern Ethiopia: A Cross-sectional Study.

BACKGROUND: Opportunistic Intestinal Parasites (OIPs) commonly cause morbidity in HIV/AIDS patients due to the decline of CD4+T-cells. The burden of Opportunistic Intestinal Parasitic Infections (OIPIs) in Ethiopia is expected to be high due to poor sanitation and co-pandemicity of HIV/AIDs. Therefore, frequent assessment of the magnitude and associated factors for intestinal parasitosis is essential for the management of HIV/AIDS patients. METHODS: A hospital based cross-sectional study was conducted among patients attending Arba Minch Hospital Antiretroviral Therapy (ART) Clinic from March to June 2016. Stool specimens were processed for parasitological examination using direct wet mount, formol-ether sedimentation and modified Ziehl-Neelsen staining techniques. CD4+ T-cell count data were taken from patients' medical records. A structured questionnaire was used to collect data on socio-demographic characteristics and possible associated factors for OIPIs. All the data were analyzed using SPSS version 20. RESULTS: Two hundred and twenty ART patients participated in the study. The overall prevalence of intestinal parasitic infections was 28.18% while that of OIPIs alone was 17.72%. Among identified intestinal parasites, Cryptosporidium species accounts for the highest frequency (19/220, 8.63%), followed by Cyclospora species (13/220, 5.90%). Presence of domestic animals (AOR=2.07, 95%CI:1.07-8.40, P= 0.032) and CD4+ T-cell count <500cell/µl (AOR=4.66, 95%CI:1.17-5.35, P= 0.001) were significantly associated with OIPIs. CONCLUSION: The study indicated that co-infection rate of OIPs is high among ART patients. It also found that contact with domestic animals and having CD4+ count <500 cell/µl predict for the presence of OIPs.