Background. Over the past decade, drug resistance pattern has worsened for many of the uropathogens due to overuse of antibiotics for empiric treatment. The burden of extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae associated urinary tract infections (UTI) has become increasingly more common, limiting treatment options among children presenting with febrile UTI. We investigated the burden and correlates of ESBL producing Enterobacteriaceae associated UTI among children and antibacterial resistance pattern. Methods. 284 midstream urine specimens were collected using standard aseptic techniques from 284 children who were diagnosed with suspected UTI. Urine culture and bacteria isolation were performed following standard bacteriological techniques. The Kirby-Bauer disk diffusion technique and the double-disc synergy test were used to investigate antibiotic susceptibility and presence of ESBL production. Results. UTI was confirmed using a positive urine culture for a relevant pathogen in 96/284 (33.8%) of the cases. Enterobacteriaceae accounted for 75% (72/96) of etiologies of UTI in children. The most frequent Enterobacteriaceae spp. were E. coli, 44.4% (32/72) and K. pneumonia, 27.8% (20/72). The overall multidrug resistance rate was 86.1% (62/72). ESBL-producers accounted for 41.7% (30/72) of the isolated Enterobacteriaceae. ESBL producing K. pneumonia and E. coli isolates accounted for 70% (14/20) and 37.5% (12/32), respectively. History of UTI in the past 1 year ( adjusted   odds   ratio   AoR = 0.08 , 95 % CI   0.01 − 0.57 ) and medium family wealth index ( AoR = 0.03 , 95 % CI   0.00 − 0.27 ) protected from infection with ESBL-producing Enterobacteriaceae. Conclusion. ESBL production was more common in K. pneumonia and appeared to be a major factor contributing drug resistance UTI in children. The findings call for the need to incorporate ESBL testing in the routine clinical practice. The resistance level to commonly prescribed first-line antibiotics observed within Enterobacteriaceae was alarming calling for strengthened antimicrobial stewardship.

Background Carbapenem-resistant gram-negative bacteria are an emergent source of both community-acquired and healthcare-associated infection that poses a substantial hazard to public health. This study aimed to conclude the magnitude of carbapenem resistance gram-negative bacteria from a clinical specimen at Hawassa University Comprehensive Specialized Hospital. Methods A hospital-based cross-sectional study was accompanied from February 13 to June 7, 2020, in which consecutive patients with 103 gram-negative bacteria were encompassed. The isolates included were 54 urine, 17 blood, 17 pusses, 4 cerebrospinal fluid (CSF), 3 aspirates, 3 effusions, 2 stools, 2 ear discharges, and 1 nasal swab. A semi-structured questionnaire was used to gather socio-demographic data from the attendant and clinical data from the patient’s chart. Patients admitted in any wards and visited outpatients department were included for the study if gram-negative bacteria was identified for those who accepted the consent. A routine manual culture, Gram’s staining and biochemical tests used to identify the bacteria. Antibiotic susceptibility was determined for twelve antibiotics including cotrimoxazole, ceftazidime, meropenem, gentamycin, chloramphenicol, ampicillin, ciprofloxacin, cefotaxime, cefuroxime, nitrofurantoin, piperacillin-tazobactam, and amikacin using the Kirby-Bauer disc diffusion method. Modified carbapenem inactivation (mCIM) method was used to determine carbapenem resistance using meropenem disk as per the recommendation of Clinical and Laboratory Standards Institute guideline. Statistical package for social science software version 21 was used for data entry and analysis. The odds ratio at 95% confidence interval (CI) and p-value <0.05 were taken as a statistically significant association. Results Generally, 111 gram-negative bacteria were identified from 103 patients. Of 111 isolates, thirteen isolates (nine resistance and four intermediates) were identified in disk diffusion testing for meropenem. Of this, 10 isolates were carbapenemases producer with the overall rates of 9% in the Modified carbapenem inactivation method (mCIM). Pseudomonas spp. 3 (30.0%), E. coli, K. pneumonia, Acinetobacter spp. each two (20.0%), and K. oxytoca 1 (10.0%) were identified as carbapenemases positive. The rates of the multidrug, extensive, pan drug were 86.5, 43.3, and 1.8, respectively. Ampicillin 94 (97.9%), followed by cefuroxime 52 (91.2%), cefotaxime 94 (88.7%), cotrimoxazole 58 (88.1%), ceftazidime 40 (83.3%), ciprofloxacin 47 (77.1%), nitrofurantoin 35 (70.0%), gentamycin 71 (65.7%), with high level of resistance. However, piperacillin-tazobactam 41 (48.8%), chloramphenicol 25 (47.2%), meropenem 13 (11.7%), and amikacin 9 (8.5%) were with low rates of resistance. In this study, there were no variables statically associated with carbapenem resistance that is p > 0.05. ...

Currently, antibiotic-resistant bacterial infections are a challenge for the health care system. Although physicians demand timely drug resistance data to guide empirical treatment, local data is rather scarce. Hence, this study performed a retrospective analysis of microbiological findings at the Hawassa public hospital. Secondary data were retrieved to assess the prevalence and level of drug resistance for the most common bacterial isolates from clinical samples processed at Hawassa University Comprehensive Specialized Hospital. Out of 1085 clinical samples processed in the microbiology laboratory, the prevalence of bacterial infection was 32.6%. Bacterial bloodstream infection was higher in children than in adults (OR, 4; 95% CI 1.8–14.6; p = 0.005). E. coli and K. pneumoniae were the commonest bacterial isolate both in children (36.8%, 26.3%) and in adults (33.3%, 26.7%) from the urine sample while, the leading bacteria identified from the CSF sample was P. aeruginosa, 37% in children and 43% in adult. In this study, all identified bacterial isolates were multi-drug resistant (MDR) ranging from 50 to 91%. The highest proportion of MDR was S. aureus 91.1 followed by K. pneumoniae 87.6%. Since the nationwide investigation of bacterial isolate, and drug resistance is rare in Ethiopia, a report from such type of local surveillance is highly useful to guide empirical therapy by providing awareness on the level resistance of isolates.

Background: Resistance of Gram-negative bacteria to antibiotics had increased at an alarming pace over the last two decades. Empirical antibiotic treatment of UTI practice created opportunity for frequent use of antibiotics that resulted in emergence of resistant strains. Extended spectrum beta-lactamase producing Enterobacteriaceae are emerging worldwide and are usually multi-drug resistant; thus, limiting treatment options for these organisms. Hence, it is mandatory to scrutinize the extent of the problem in the study area. Objective: We investigated the prevalence and correlates of extended spectrum beta-lactamase producing Enterobacteriaceae and their antibacterial resistance profile among children with urinary tract infection (UTI) at Hawassa University Comprehensive Specialized Hospital. Method: A hospital-based cross sectional study was conducted from February 1-July 30/ 2018. A semi-structured questionnaire was used to collect data from 284 children suspected of UTI. Bacterial species were isolated using standard bacteriological techniques. Antibiotic susceptibility testing was done using Kirby-Bauer disk diffusion method and ESBL production was detected by double disc synergy test. Data entry, cleaning and statistical analysis was done using SPSS version 20. Results: Overall, Enterobacteriaceae accounted for 75% (72/96) of UTI infections. The most frequent Enterobacteriaceae were E. coli , 44.4% (32/72) and K. pneumoniae , 27.8% (20/72). Overall, ESBL-producers within Enterobacteriaceae accounted for 41.7% (30/72) and magnitude of multi-drug resistance level was 86.1% (62/72). ESBL producing K. pneumoniae and E. coli accounted for 70% (14/20) and 37.5% (12/32), respectively of all the respective isolates. Previous UTI within the past 12 month (AOR= 0.08, 95% CI (0.01-0.57) and medium family wealth index (AOR = 0.03, 95% CI (0.00-0.27) were associated with infection of ESBL-producing Enterobacteriaceae . Conclusion: ESBL producing Enterobacteriaceae were prevalent among UTI cases; where E. coli and K. pneumoniae were the major isolated resistant strains that contributed mainly to the problem. Majority of Enterobacteriaceae isolated were resistant to commonly prescribed drugs. Key words : ESBL, Antimicrobial Resistance, UTI, Children.