Multi-drug resistance and nosocomial infections of Acinetobacter baumannii and Pseudomonas aeruginosa among patients hospitalized at Felegehiwot Referral Hospital, Northwest Ethiopia: A cross-sectional study

Abstract

Background:Multi-drug resistant(MDR) Acinetobacter baumannii and Pseudomonas aeruginosa are major causes of nosocomial infections globally. They are the current World Health Organization critical priority pathogens for resistance and discovery of new antibiotics. However, there is paucity of data on nosocomial infections caused by such superbugs in Ethiopia.Therfore, this study determined the magnitude and profile of nosocomial MDR Acinetobacter baumannii and Pseudomonas aeruginosa infections among patients hospitalized at Felegehiwot referral hospital, Northwest Ethiopia.Methods:A cross-sectional study was conducted at Felegehiwot referral hospital from April 1 to July 31, 2018.A total of 238 patients presumptive for blood stream, urinary tract and surgical site nosocomial infections were enrolled using convenient sampling technique.Either blood, urine and wound swab specimens were collected and processed using standard bacteriological procedures.A.baumannii and P.aeruginosa isolates were identified using standard bacteriological techniques and confirmed by automated Vitek2 Compact.Antimicrobial susceptibility testing on isolates was performed using the disk diffusion technique.The results interpreted as per the standard zone sizes of Clinical and Laboratory Standards Institute.Chi-square test was done to determine associations among variables.P.value< 0.05 was considered statistical significant. Results:The median age of participants was 29 years.Overall, 20(8.4%) of patients had nosocomial MDR A.baumannii and P.aeruginosa infections.The proportion of nosocomial MDR blood stream, urinary tract and surgical site infections were 13(8.9%),5(8.3%) and 2(6.3%), respectively. The mean age of patients with nosocomial infection was significantly lower (24.9 years) than their counter parts (29.6years) (P=0.035). All isolates of nosocomial infections were from patients with intravenous catheterization.The frequency of nosocomial MDR A.baumannii infection was 9(3.8%) and for P.aeruginosa nosocomial infections was 11(4.6%). A.baumannii and P.aeruginosa isolates were 100% MDR.MDR A.baumannii isolates were 100% resistant to ampicillin and piperacillin.MDR P.aeruginosa isolates was 100% resistant to ampicillin, piperacillin, cefotaxime and ceftriaxone.On the other hand, A.baumannii isolates showed 36.4% and 44.5% resistance against ciprofloxacin and meropenem while P.aeruginosa isolates revealed 33.3% and 45.5% resistance against Pseudomonas aeruginosa.Conclusions:Health care associated MDR A.baumannii and P.aeruginosa infections are critical problems in the study area.Therefore,urgent focused interventions required to contain the spreading of MDR NIs.Treatment of NIs for patients on health care should be guided by antimicrobial susceptibility testing.