Bacterial Isolates and Antibacterial Resistance Patterns in a Patient with Acute Exacerbation of Chronic Obstructive Pulmonary Disease in a Tertiary Teaching Hospital, Southwest Ethiopia

Abstract

Introduction. Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality worldwide. The natural course of COPD is characterized by acute exacerbation. Infectious agents, particularly bacteria, cause exacerbation of COPD in the majority. This study aimed to determine the bacteriology and antibiotic resistance patterns among patients with acute exacerbations of COPD (AECOPD) at Jimma Medical Center. Methods. A cross-sectional study was conducted from March to October 2019. Demographic, clinical, and sputa samples were collected from 39 study participants, who were diagnosed with AECOPD. Bacterial pathogens were identified using standard bacteriological techniques, and anti-microbial susceptibility testing was done by Kirby Bauer’s disk diffusion method. Extended-spectrum β-lactamase (ESβL) and carbapenemase production were confirmed by MASTTM D68C and MASTTM D73C combination disc sets, respectively. Chi-square and odds ratios were calculated. Results. Overall, 69.2% (27/39) of sputum samples were confirmed to be culture-positive. A total of 32 bacterial isolates with 78.1% (25/32) Gram-negative and 21.9% (7/32) Gram-positive bacteria were identified. The predominant bacterial isolates were Pseudomonas aeruginosa 21.9% (7/32), Klebsiella pneumoniae 18.75% (6/32), and Staphylococcus aureus 15.62% (7/32). Overall, 30 (93.8%) of the isolates were multidrug-resistant (MDR). About 48% (12/25) and 8 (32%)of gram negative bacterial isolates were ESBL betalatemase and OXA-48 carbapenemase producers, respectively. Having two or more exacerbation experiences in the previous year were found to be important determinants of the sputum culture positivity. Conclusions. High rates of MDR, ESBL, and carbapenemase producer bacteria were isolated from patients with AECOPD. Empiric antibiotic therapy should consider the prevalence of antibiotic-resistant pathogens and the factor that may increase the occurrence of MDR bacterial pathogens.

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

“…In addition, the difference between the different studies could be the fact that our study subjects were hospitalized patients and commonly with underlying diseases. But the MDR resistance rate was lower than the rate of antibiotic resistance patterns of bacterial isolates among patients with lower respiratory tract infection reported in the same study setting by Mussema et al 93.8% of the isolates were MDR and the resistance rates of gram-negative bacterial isolates were ranged from 88% to 80% to third and fourth-generation cephalosporin’s ( 18 ). This might be as a result of exposure to beta lactam medications repeatedly during recurrent exacerbations.…”

“…The resistance for these β-lactam antibiotics due to the production of β-lactamases is becoming a worldwide problem. These can be developed when bacterial gene mutate continuously in response to overuse or misuse of β-lactam antibiotics ( 18 , 29 ). In this study, the magnitude of ESBLs production was in agreement with study reported in Jimma Ethiopia 40.4% ( 30 ), higher than study reported in Addis Ababa Ethiopia 57.7% ( 31 ) and Nigeria 58.0% ( 32 ), and higher than study finding reported in Nepal 28.1% ( 33 ).…”

“…The inoculated chocolate agar was incubated at 35–37°C for 72 hours in a candle jar to provide a 5–10% CO 2 concentration for isolation of Streptococcus pneumoniae, and Hemophilus influenzae . After the indicated time, quantitative sputum culture was employed ( 18 , 19 ). Finally, the bacterial identification was done using standard microbiological techniques including colony characterization, series of biochemical tests ( 20 ).…”

“…The specimen’s quality was assessed using Bartlett’s acceptance and rejection criteria. Furthermore, sputum washing technique and quantitative sputum culture were employed to reduce the heavy growth of commensal organisms from sputum culture ( 18 , 19 ). The CLSI guideline was followed while using the control strains from the American Type Culture Collection (ATCC): P. aeruginosa ATCC 27853, E. coli ATCC 25922, and S. aureus ATCC 25923.…”

Bacterial Species and Inflammatory Cell Variability in Respiratory Tracts of Patients with Chronic Obstructive Pulmonary Disease Exacerbation: A Multicentric Study

“…In addition, variations in the distributions of the respiratory microbiota between various populations may be a contributing factor. 12 For example, the predominant isolated organism in one South Korean study 13 and another Ethiopian one 14 was Pseudomonas aeruginosa, while Klebsiella pneumoniae prevailed in an Indian study. 15 It was also noted that isolated organisms may vary between upper and lower respiratory tracts in patients with stable COPD and AECOPD.…”