Nosocomial sepsis and drug susceptibility pattern among patients admitted to adult intensive care unit of Ayder Comprehensive Specialized Hospital, Northern Ethiopia.

OBJECTIVE: Developing nosocomial sepsis within intensive care unit (ICU) is associated with increased mortality, morbidity, and length of hospital stay. But information is scarce regarding nosocomial sepsis in intensive care units of Northern Ethiopia. Hence, this study aims to determine the incidence of nosocomial sepsis, associated factors, bacteriological profile, drug susceptibility pattern, and outcome among patients admitted to the adult ICU of Ayder Comprehensive Specialized Hospital (ACSH), which is the largest tertiary hospital in Northern Ethiopia. METHOD: Facility-based longitudinal study was conducted by following 278 patients who were admitted for more than 48 h to adult ICU of ACSH, from October 2016 to October 2017. Data were collected from charts, electronic medical records, and microbiology registration book using a checklist. The collected data were subjected to descriptive statistics and multivariable logistic regression using SPSS version 25. Statistical significance was declared at p < 0.05. RESULT: Of all the patients, 60 (21.6%) of them acquired nosocomial sepsis. The risk of mortality was about two times higher among adult ICU patients who acquired nosocomial sepsis (RR = 2.2; 95% CI of RR = 1.3-3.5; p = 0.003). The odds of acquiring nosocomial sepsis among those who were on a mechanical ventilator (MV) and stayed more than a week were 5.7 and 9.3 times higher, respectively, than their corresponding counterparts. Among 48 isolates, Klebsiella was the most common pathogen. The isolates had a broad antibiotic resistance pattern for cephalosporins, penicillins, and methicillin. CONCLUSION: The incidence of nosocomial sepsis in the adult ICU patients of ACSH was higher when compared to the incidence reported from some African and Asian countries. Mortality was higher among patients who acquired nosocomial sepsis. Use of MV and longer length of ICU stay were the significant predictors of nosocomial sepsis. The isolates were resistant to several antibiotics. Therefore, strict application of infection prevention strategies and appropriate use of antibiotics is so crucial. As well, priority should be given to patients who develop nosocomial sepsis in ICU.

Adverse events of Oxford/AstraZeneca's COVID-19 vaccine among health care workers of Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia.

Background: : The safety of COVID vaccines should be continuously followed. This study reports adverse events of the Oxford/AstraZeneca COVID-19 vaccine. Methods: : A prospective single-cohort study design was conducted to assess adverse events following immunization and associated factors of the first dose of Oxford/AstraZeneca's COVID-19 vaccine in Ayder Comprehensive specialized hospital. A structured questionnaire was administered consecutively to 423 participants. Follow-up data were collected 72 hours after vaccination via phone. Bivariate and multivariate logistic regression models were used to find associations between adverse events and independent variables. Statistical significance was declared at P<0.05. Results: : Out of 423 health care workers approached, 395 responded. At least one adverse event (95% CI: 63.58, 72.77) was reported by 270 participants. Local and systemic symptoms occurred in 46.8% (95% CI: 41.94, 51.79) and 58.48% (95% CI: 53.53, 63.26)], respectively. Muscle ache, fatigue, headache and fever were the most common local symptoms. No reports of hospitalization, disability or death. Age (adjusted odds ratio [AOR]=0.97, P=0.048), female sex (AOR=1.84, P=0.028), and comorbidity (AOR=2.28, P=0.040) were independent predictors of adverse events. Conclusion and recommendation: : Adverse events following immunization are commonly reported after the first dose of the Oxford/AstraZeneca COVID-19 vaccine; age, female sex and comorbidity are independent predictors.

MANAGEMENT OF PHEOCHROMOCYTOMA IN THE ABSENCE OF ALPHA BLOKERS: A CASE REPORT FROM AYDER REFERRAL HOSPITAL.

A 13-year-old girl with right adrenal pheochromocytoma pretreated with Nifedipine, underwent surgical removal of the tumor. General anesthesia with Propofol infusion and pethidine analgesia was performed. To control the blood pressure (BP), Nitroglycerine infusions were administered successfully. Following the ligation of the adrenal veins, patient was hypotensive and inotropic support was required. This case report showed that in the absence of alpha blockers and short acting drugs the surgery could be done with a very good follow up and Nitroglycerine as antihypertensive.

Aerobic bacteria in post surgical wound infections and pattern of their antimicrobial susceptibility in Ayder Teaching and Referral Hospital, Mekelle, Ethiopia.

BACKGROUND: Post surgical wound infections are global problem in the field of surgery associated with long hospital stay, higher treatment expenditure, morbidity and mortality. Hence to address the limited data in Ethiopia on post surgical wound infections, we conducted this research to determine the prevalence and antimicrobial susceptibility patterns of aerobic bacteria in post-surgical wound infected patients in Ayder teaching and referral hospital, Mekelle, Ethiopia. METHODS: Hospital based prospective cross sectional study was carried-out in 128 patients who had undergone surgery in general surgery and orthopaedic wards, and showed symptoms of infection clinically from January to June 2012. Standard bacteriological methods were used for bacterial isolation and antimicrobial susceptibility pattern. RESULTS: A total of 128 patients (98 male and 30 female) with clinical signs of post surgical wound infections were enrolled. The age of the patients ranged from 15-79 years (with mean 35.95 ± 19.01 years). Out of the 128 wound swabs taken, 96/128 (75%) were culture positive aerobically, yielding 123 bacterial isolates. Out of these the predominant bacterial isolates were Staphylococcus aureus 44 (35.77%), Klebsiella species 29 (22.76%) and Coagulase negative Staphylococci (CoNS) 18 (14.63%). No bacterial isolates was found to be sensitive to all antibiotics tested. Isolated bacteria showed 102/123 (82.92%) multi drug resistance to the commonly used antibiotics in the hospital. However, 54/ 65 (83.1%) of Gram negative and 58/58 (100%) of Gram positive isolates were sensitive to Gentamicin and Vancomycin, respectively. CONCLUSION: Prevalence of was Post-operative wound infections rate in this current study was 75% and multi drug resistance was seen in 102/123(82.92%) of the isolates leaving clinicians with few choices of drugs for the treatment of post surgical wound infected patients. This underscores for periodic surveillance of etiologic agent and antibiotic susceptibility to prevent further emergence and spread of resistant bacteria pathogens.