Prevalence and Antimicrobial Susceptibility Patterns of Neisseria gonorrhoeae among Suspected Patients Attending Private Clinics in Jimma, Ethiopia.

BACKGROUND: In most African countries including Ethiopia, Neisseria gonorrhoeae infections were diagnosed clinically and its antibiotic susceptibility was rarely tested. This study aimed to determine the prevalence and antimicrobial susceptibility patterns of N. gonorrhoeae among suspected patients attending private clinics in Jimma, Ethiopia. METHODS: Institution-based cross-sectional study was conducted to determine the prevalence and antimicrobial susceptibility pattern of N. gonorrhoeae isolated from urogenital specimens. Urogenital samples were collected aseptically and then transported using Amie's transport media and processed in a microbiology laboratory following the standard protocol. RESULTS: Of the total 315 samples examined, 31 (9.8%) were confirmed to have gonococcal infection. Of these, 30 (96.7%) were females. High proportion of culture confirmed cases (18 (12.5%)) were observed in the 20-24 age group. All of the identified organisms were susceptible to ceftriaxone and had high resistance to penicillin (80.6%) and tetracycline (54.8%). CONCLUSION: The prevalence of gonococcal infection is high. In the current study, participants who have no information about sexually transmitted infection were more likely to be infected by N. gonorrhoeae. According to our study, ciprofloxacin is effective against gonococcal infection.

Magnitude of Biofilm Formation and Antimicrobial Resistance Pattern of Bacteria Isolated from Urinary Catheterized Inpatients of Jimma University Medical Center, Southwest Ethiopia.

Biofilm formation is one of the features of most bacteria. Catheterization in medicine is a source of highly resistant bacterial infections, and those bacteria respond poorly to antimicrobial therapy. Bacterial biofilm features were not described from catheterized inpatients in Ethiopia as its formation is known to afford antimicrobial resistance and challenge patient management. The aim of this study was to isolate catheter-associated urinary bacterial pathogens, their biofilm formation, and antimicrobial susceptibility pattern among inpatients of Jimma University Medical Center (JUMC) in Southwest Ethiopia. A prospective cross-sectional study was conducted among urinary catheterized inpatients of JUMC from February to August 2016. A total of 143 study participants were enrolled consecutively in this study. Urine samples were collected from catheterized patients and processed using a standard bacteriological protocol for isolation and identification. Evaluation of in vitro biofilm formation and antimicrobial susceptibility pattern of uropathogenic bacteria was done using microtiter plates and disk diffusion method, respectively. Data were cleaned, coded, and entered into SPSS version 20 for analysis. All statistical test values of p < 0.05 were considered statistically significant. From all study participants, mean age was 44 years. Sixty bacterial strains were recovered from 57 urinary catheterized inpatients among which 54 of them were monomicrobial (94.7%). The remaining six bacterial strains were recovered from three study participants each with two bacterial isolates. The predominant bacterial isolates were Gram-negative bacteria with E. coli turning out first. About 80% of bacterial isolates were biofilm formers. The majority of the bacteria were resistant to commonly prescribed antimicrobial agents. In conclusion, the majority of bacterial uropathogen isolates were Gram-negative, biofilm formers, and resistant to commonly prescribed antimicrobial agents. Relatively ciprofloxacin, nitrofurantoin, and amikacin were highly effective against most isolated bacteria.

Prevalence and associated risk factors of Hepatitis B and C virus infections among mothers in Jimma, South West Ethiopia: a community-based study

Background: Viral hepatitis affects over 400 million people globally with 6 to 10 million people newly infected each year. Viral hepatitis infectious agents such as hepatitis B virus (HBV) and hepatitis C virus (HCV) are among the greatest threats to the liver and can cause liver cancer. One of the most important modes of transmission of these viruses is a vertical transmission from mother to child. The aim of this study is to assess the prevalence of HBV and HCV infection as well as its associated risk factors among mothers in Jimma. Methods: A community-based cross-sectional study was conducted among 455 mothers in Jimma from June to December 2016. Simple random sampling was employed to recruit study participants and informed consent was obtained. From each mother, about 5ml of blood was collected and tested for HBsAg, anti-HBc, and HCVAg/Ab using ELISA. Chi-square and logistic regression tests were used to assess statistically significant associations between dependent and independent variables. P-values less than 0.05 were considered statistically significant. Result: HBsAg, anti-HBc and HCVAg/Ab prevalence was 5.7%, 30.5% and 2.5%, respectively. Multivariate logis-ic regression analysis showed that history of hospital admission (AOR = 3.098; P <0.040) and abortion (AOR = 15.514, P <0.001) remained independent predictors of HBsAg seropositivity. Conclusion: Hospital admission and abortion are the major risk factors for hepatitis B and C virus infection among mothers. Awareness creation for adult HBV vaccine and health education on modes of transmission should be promoted and strengthened

Seroprevalence of Hepatitis B virus infection and seroprotection of Hepatitis B vaccine among children in Jimma Town, South-West Ethiopia

Background: Hepatitis B virus is the leading cause of viral hepatitis and about 240 million people worldwide are chronic carriers. The virus is reported to be widely prevalent in Ethiopia and routine vaccination of children has been initiated in the country recently. We assessed the seroprevalence of HBV infection and seroprotection of HBV vaccine among children in Jimma. Methods: A community-based cross-sectional study was conducted among 900 children who were 5-9 years of age between June and December 2016. A simple random sampling technique was employed to recruit study participants by proportional allocation into different Kebeles of Jimma. Data were collected using pretested questionnaire.3-5ml of blood sample was collected from each child and it was tested for HBsAg, anti-HBc, and anti-HBs using ELISA (Bio-rad, Monolisa, Lacquote, France). Data were analyzed using chi-square and logistic regression analysis. Result: HBsAg and anti-HBc prevalence among all participants was 3.5% and 3.8%, respectively. The prevalence of HBsAg among vaccinated and non-vaccinated children was 2.1% and 7.0% whereas anti-HBc positivity was 1.1% and 6.2%, respectively. It was also found that 58.4% of vaccinated children maintained a protective level of HB surface antibodies which is defined as ≥ 10 mIU/ml anti-HBs. While 1.8%(4/222) vaccinated children with protective anti-HBs levels were positive for hepatitis B core antibody, none of the vaccinated children with non-protective anti-HBs levels were positive for hepatitis B core antibody. Multi-variable logistic regression revealed that lack of vaccination (AOR =2.788, P < 0.029), children who were born at home (AOR= 3.211, P < 0.009), and children who had a history of hospital admission (AOR= 7.122, P <0.001) were more likely to be HBV surface antigen positive. Conclusion: The seroprevalence of hepatitis B infection is high among children who have not received HBV vaccination. Hepatitis B vaccine has contributed to the reduction of the infection in this endemic area, though further efforts are required to improve timely vaccination and its coverage. The prevalence of protective anti-HBs is low among fully vaccinated children, hence, it is better to include the monovalent birth dose of the vaccine and conduct further studies to evaluate underlining causes for the waning of serum anti-HBs level

Emergence of high drug resistant bacterial isolates from patients with health care associated infections at Jimma University medical center: a cross sectional study.

Background: The rates of resistant microorganisms which complicate the management of healthcare associated infections (HAIs) are increasing worldwide and getting more serious in developing countries. The objective of this study was to describe microbiological features and resistance profiles of bacterial pathogens of HAIs in Jimma University Medical Center (JUMC) in Ethiopia. Methods: Institution based cross sectional study was carried out on hospitalized patients from May to September, 2016 in JUMC. Different clinical specimens were collected from patients who were suspected to hospital acquired infections. The specimens were processed to identify bacterial etiologies following standard microbiological methods. Antibacterial susceptibility was determined in vitro by Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. Results: Overall, 126 bacterial etiologies were isolated from 118 patients who had HAIs. Of these, 100 (79.4%) were gram negative and the remaining were gram positive. The most common isolates were Escherichia coli 31(24.6%), Klebsiella species 30(23.8%) and Staphylococcus aureus 26 (20.6%). Of 126 bacterial isolates, 38 (30.2%), 52 (41.3%), and 24 (19%) were multidrug-resistant (MDR, resistant to at least one agent in three or more antimicrobial categories), extensively drug resistant (XDR, resistant to at least one agent in all but two or fewer antimicrobial categories (i.e. bacterial isolates remain susceptible to only one or two categories), pan-drug resistant (PDR, resistant to all antibiotic classes) respectively. More than half of isolated gram-negative rods (51%) were positive for extended spectrum beta-lactamase (ESBL) and/or AmpC; and 25% of gram negative isolates were also resistant to carbapenem antibiotics. Conclusions: The pattern of drug resistant bacteria in patients with healthcare associated infection at JUMC is alarming. This calls for coordinated efforts from all stakeholders to prevent HAIs and drug resistance in the study setting.

Healthcare associated infection and its risk factors among patients admitted to a tertiary hospital in Ethiopia: longitudinal study.

Background: Healthcare associated infection (HAI) is alarmingly increasing in low income settings. In Ethiopia, the burden of HAI is still not well described. Methods: Longitudinal study was conducted from May to September, 2016. All wards of Jimma University Medical Centre were included. The incidence, prevalence and risk factors of healthcare associated infection were determined. A total of 1015 admitted patients were followed throughout their hospital stay. Biological specimens were collected from all patients suspected to have hospital aquired infection. The specimens were processed by standard microbiological methods to isolate and identify bacteria etiology. Clinical and laboratory data were collected using structured case report formats. Results: The incidence rate of hospital acquired infection was 28.15 [95% C.I:24.40,32.30] per 1000 patient days while the overall prevalence was 19.41% (95% C.I: (16.97-21.85). The highest incidence of HAI was seen in intensive care unit [207.55 (95% C.I:133.40,309.1) per 1000 patient days] and the lowest incidence was reported from ophthalmology ward [0.98 (95% C.I: 0.05,4.90) per 1000patient days]. Among patients who underwent surgical procedure, the risk of HAI was found to be high in those with history of previous hospitalization (ARR = 1.65, 95% C.I:1.07, 2.54). On the other hand, young adults (18 to 30-year-old) had lower risk of developing HAI (ARR = 0.54 95% C.I: 0.32,0.93) Likewise, among non-surgical care groups, the risk of HAI was found to be high in patients with chest tube (ARR = 4.14, 95% C.I: 2.30,7.46), on mechanical ventilation (ARR = 1.99, 95% C.I: 1.06,3.74) and with underlying disease (ARR = 2.01, 95% C.I: 1.33,3.04). Furthermore, hospital aquired infection at the hosoital was associated with prolonged hospital stay [6.3 more days, 95% C.I: (5.16,7.48), t = 0.000] and increased in hospital mortality (AOR, 2.23, 95% CI:1.15,4.29). Conclusion: This study revealed high burden and poor discharge outcomes of healthcare associated infection at Jimma University Medical Centre. There is a difference in risk factors between patients with and without surgery. Hence, any effort to control the observed high burden of HAI at the hospital should consider these differences for better positive out put.

Catheterized and non-catheterized urinary tract infections among patients attended at Jimma University Teaching Hospital, Southwest, Ethiopia.

OBJECTIVES: Prospective cross sectional study was undertaken to assess the bacterial profile and antimicrobial resistance pattern of catheterized urinary tract infection in comparison with non-catheterized UTI in Jimma University Teaching Hospital, Southwest, Ethiopia. METHODS: One hundred and twenty patients, 30 catheterized (age range 20-78 years, male to female ratio 0.36:1) and 90 non-catheterized patients (age range 7-60 years, male to female ratio 2:1) with symptoms and signs of UTI were investigated for significant bacteriuria from January to March 2005. RESULTS: Significant bacteruria was observed in 13/30 (43.3%) and 20/90 (22.2%) of catheterized and non-catheterized patients, respectively (p<0.05). Klebsiella spp. (33.3%) and E. coli (27.7%) were the most common bacteria pathogens isolated in both groups and followed by Enterobacter spp. (6%). Proteus spp., Pseudomonas spp. and coagulase negative Staphylococci were isolated only from catheterized patients. Gram-negative bacteria isolated in both groups showed a high level of resistance (88-100%) to ampicillin, amoxicillin carbencillin and cephalexin. and intermediate level of resistance (48-68%) to amoxicillin-clauvlanic acid, gentamicin and trimethoprim-sulphamethoxazole. Low level of resistance (16-24%) observed to amikacin, ciprofloxacin, nalidxic acid and nitrofurantoin. Similar pattern of resistance was observed in all the gram-positive isolates including for methicillin, oxacillin and vancomycin (100%). On the other hand, amoxicillin-clavulanic acid and polymixin B were found effective against all gram-positive bacteria isolated from both groups. CONCLUSION: The present study revealed that UTIs in both catheterized and non-catheterized patients was shown very high resistance pattern to most of antibiotics in use mainly at Jimma University Teaching Hospital, southwest Ethiopia. This calls for concerted efforts at all levels including regulatory bodies and the public healthcare providers as well as private ones. Creating awareness of the community will also have a significant role to curb this problem.