Bacterial Pathogens, Drug-Resistance Profile and Its Associated Factors from Patients with Suspected Peritonitis in Southern Ethiopia

Abstract

Background: Ascitic fluid plays a critical role in the microbiological diagnosis of peritonitis. Drug-resistant bacterial infection of the peritoneal cavity is becoming a public health threat. However, data on bacterial profile and antimicrobial-resistant pattern of isolates from the ascitic fluid are scarce. Thus, this study was aimed to assess drug-resistant bacteriological profiles and factors associated with peritonitis in southern Ethiopia. Methods: An institutional-based cross-sectional study was conducted from March 2019 to December 2019. A semi-structured questionnaire was used to collect socio-demographic and clinical data. A total of 147 ascitic fluid samples were aseptically collected and inoculated onto blood agar, MacConkey agar, and chocolate agar. The inoculated culture media were incubated aerobically and micro-aerobically at 37°C for 48 hrs. Bacterial identification was done by standard protocols and the antimicrobial susceptibility testing by Kirby Bauer's disk diffusion method. Logistic regression was used to identify the associated factors with bacterial peritonitis. Results: Of the total study participants, the overall magnitude of bacterial peritonitis was 19.05% with a total of 30 bacterial isolates. Majority of the isolates were Gram negative bacteria with predominant species E. coli 36.67% followed by Gram positive S. aureus 13.33%. The multidrug resistant isolates accounts about 43.3% while a quarter of isolated S. aureus were methicillin resistant. The bacterial peritonitis was associated with recent history of surgery [AOR = 8.724, 95% CI: (2.688-28.314)], hospitalization more than seven days [AOR = 8.990,)], cirrhosis [AOR = 2.751, 95% CI: (1.109-6.822)] and alcoholism [AOR = 5.802,]. Conclusion:Nearly half of the isolated bacteria were observed to be MDR, and this may alarm all healthcare workers and policymakers. Thus, continuous surveillance of antimicrobial resistance patterns along with associated factors is essential for regular monitoring of transmission of drug-resistant bacteria and the emergence of antibiotic resistance.

Antibacterial susceptibility patterns and factors associated with secondary peritonitis among patients with acute abdomen: a cross-sectional study

“…Escherichia coli (35.8%) and Klebsiella spp (17.0%) were identi ed as the commonest bacteria cultured from infected peritoneal uid. These ndings are similar to the study done in Ethiopia by Alelign, (10) which reported E. coli (36.67%) and Klebsiella (20%) to be the commonest isolates. Furthermore, other studies conducted in Tanzania by Seni et (12); in Nigeria by Akujobi et al (25) and in India by Kumar-m al.…”

“…Following secondary peritonitis, different bacterial organisms may be involved mainly depending on the cause of the peritonitis. Drug-resistant to bacteria that cause infections of peritoneal cavity are becoming a public health concern (10). Although antimicrobial resistance containment interventions in healthcare structures have mostly been implemented in high-income countries, there is a pressing need to intervene in the antimicrobial resistance problem in low and middle income countries (LMIC) such as Uganda (11).…”

“…Even though just 1% of all hospital admissions worldwide are due to secondary peritonitis, it is the most frequent reason for admission to the surgical wards, increasing workload, length of hospital stays, and consequences such sepsis, surgical site infections, and enterocutanous stula (2). Secondary peritonitis has also been reported to be the second leading cause of sepsis worldwide (3,10). In Africa the proportion of secondary peritonitis has been reported to vary depending on the region with Alelign (10) reporting a prevalence of 19.1% in Ethiopia, Seni et al (12) 23.7% in Tanzania and Amone et al (13) 17.1% in Uganda.…”

Burden of Antibiotic Resistance at Wolaita Sodo University Comprehensive Specialized Hospital

“…P. aeruginosa isolates were resistant to tetracycline (91.7%), ampicillin (66.7), and cotrimoxazole (60.0%). Comparable findings were also reported elsewhere from Ethiopia [28,41,42]. In addition, that it had lower resistance to ciprofloxacin was in line with the literature evidences [26,43].…”

“…Its resistance to the tested antibiotics ranged from 15 to 86% with the overall rate of 55.7% which is lower than the report from Greek where it was 88% [27]. On the other hand, it was higher than the report of resistance, 40%, observed in patients with suspected peritonitis in Southern Ethiopia [28] and the 3 years retrospective study report from the same region in which the resistance of S. aureus was 42.02% [23] conducted elsewhere in Ethiopia and Nigeria [20,29]. The resistance towards ampicillin in this study was extremely higher than that reported for Enterococci elsewhere in Ethiopia [30].…”