Antimicrobial Resistance Profiles and associated factors of Acinetobacter and Pseudomonas aeruginosa nosocomial infection among patients admitted at Dessie comprehensive specialized Hospital, North-East Ethiopia. A cross sectional study

Abstract

Background:- Hospital admitted patients are at increased risk of nosocomial infections (NIs) with multi-drug resistant (MDR) pathogens which are prevalent in the hospital environment. P. aeruginosa and A. baumannii are common causes of NIs worldwide. The objective of this study is to determine the magnitude, antimicrobial resistance profiles, and associated factors of Acinetobacter and P. aeruginosa NIs among patients hospitalized at Dessie Comprehensive Specialized Hospital (DCSH), North-East Ethiopia.Methods:- A cross-sectional study was conducted at DCSH from February 1 to April 30, 2020. A total of 254 patients who were suspected of either bloodstream, urinary tract, or surgical site nosocomial infection were enrolled consecutively. Sociodemographic and other variables of interest were collected using a structured questionnaire. The specimens were collected and processed following standard microbiological procedures. Antibacterial susceptibility was determined by the Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines. Data were analyzed with SPSS version 23 and p-value < 0.05 was considered to be statistically significant.Results: Overall, 13% of patients had nosocomial Acinetobacter and/or P. aeruginosa infections. The culture positivity rate was 16(6.3%) for Acinetobacter spp and 18(7.1%) for P. aeruginosa. All isolates of Acinetobacter spp. were from patients with intravenous catheterization. Patients admitted in the surgical ward (Adjusted odds ratio (AOR): 10.66; 95% confidence interval (CI): 1.22-93.23), pediatric ward (AOR: 14.37; 95% CI: 1.4-148.5), intensive care unit (AOR: 41.93; 95% CI:4.7-374.7) and orthopedics (AOR: 52.21;95%CI:7.5-365) were significantly at risk to develop NIs compared to patients admitted in the medical ward. Patients who took more than two antimicrobial types were 94% (AOR: 0.06; 95% CI: 0.004-0.84) times more protected from NIs compared to those who did not take any antimicrobial. About 81% of Acinetobacter spp. and 83% of P. aeruginosa isolates were MDR. Amikacin and meropenem showed promising activity against Acinetobacter and P. aeruginosa isolates.Conclusion: The high prevalence of MDR Acinetobacter and P. aeruginosa nosocomial isolates highlighted the need of improving and implementing infection control programs in the hospitals. Treatment of NIs should be guided by antimicrobial susceptibility testing.

Occurrence of Multiple, Extensive and Pan Drug-Resistant Pseudomonas aeruginosa and Carbapenemase Production from Presumptive Isolates Stored in a Biobank at Ethiopian Public Health Institute

“…Even though carbapenemase-producing strains may limit their use 17 these agents are the last-resort drugs for gramnegative bacterial infections. Our findings were consistent with other reports from Ethiopia, 22 Uganda, 17 and Europe. 20 However, higher levels of resistance were reported in Mexico (70% and 54%) 19 and in India (53% and 63%) 12 for imipenem and meropenem, respectively.…”

“…Among 18 imipenem-resistant strains tested for aminoglycosides, 16 (89%) and 15 (83%) of the isolates were susceptible to amikacin and gentamicin, respectively. Our finding on aminoglycosides was comparable with the European surveillance report 20 and relatively lower than the reports in Ethiopia (13-28%) for gentamicin, 11,22 and the resistance rates in Uganda (31% and 69%), 17 India (58% and 68%), 12 and Mexico (58% and 52%) 19 for amikacin and gentamicin, respectively. Amikacin is reserved for use in specialized centers for the treatment of multidrug-resistant tuberculosis in Ethiopia 27 and physicians are not able to prescribe this drug as it is not available in local pharmacies; this might be the reason for the lower resistance rate reported in this study.…”

“…This is consistent with the previous finding in Ethiopia that reported 19.7% and 23% resistance to ciprofloxacin and levofloxacin, respectively 11 and 19% average resistance for both drugs were reported in 2019 Europe AMR surveillance. 20 In contrast, Ethiopian researchers reported 35-61%, 14,21,22 Uganda 64%, 17 and India 67% 12 resistance rates for ciprofloxacin. The reason for this discrepancy could be due to merged analysis of intermediate and resistant categories, lower isolates or variation in sample size, different study settings and patient conditions, and considerable geographical difference.…”