Multiresistant Bacterial Pathogens Causing Bacterial Pneumonia and Analyses of Potential Risk Factors from Northeast Ethiopia

Abstract

Background. Pneumonia is the most common cause of morbidity and mortality in developing countries, mostly caused by different species of bacterial pathogens. Hence, patient management needs awareness of the pathogens and antimicrobial susceptibility testing (AST). This study was aimed to assess the type of bacterial isolates and their antimicrobial susceptibility patterns among pneumonia suspected patients at Dessie Referral Hospital, Northeast Ethiopia. Potential risk factors were also assessed to apply preventive measures accordingly. Materials and Methods. A cross-sectional study design was employed among pneumonia suspected patients from February to April 2020 at Dessie Referral Hospital. Sociodemographic characteristics and associated risk factors were collected using a pretested questionnaire, and clinical data were extracted by reviewing medical records. Sputum specimens were collected and inoculated into chocolate agar, blood agar, mannitol salt agar, and MacConkey agar which are then incubated at 35°C or 37°C for 24–48 hours. Bacterial species were identified based on Gram stain, colony characteristics, and biochemical techniques. The data were entered in to Epi-Info version 7.1.5 and analyzed with SPSS software version 20. p value <0.05 at 95% CI was considered as statistically significant. Results. A total of 406 sputum specimens were collected and cultured, among which 157 (38.7%) were positive for different bacterial pathogens. The predominant pathogens were Klebsiella pneumoniae (28.0%), Streptococcus pneumoniae (24.8%), Staphylococcus aureus (18.5%), and Pseudomonas aeruginosa (14.0%). Majority of the isolates exhibited resistance to ampicillin with 81.5% followed by penicillin with 75.9% and amoxicillin-clavulanate with 61.2%. Multivariable logistic regression showed a significant association of culture positivity with older age (AOR = 2.43, CI: 1.12–5.28, p value = 0.025), cigarette smoking (AOR = 4.67, CI: 2.39–9.20, p value <0.001), and alcohol use (AOR = 5.58, CI: 3.14–9.92, p value <0.001). Resistance to ampicillin and penicillin was associated with repeated prescription and use. Conclusions. This study found high prevalence of bacterial pneumonia in the study area, and high rate of bacterial resistance was observed in ampicillin, penicillin, and amoxicillin-clavulanate. Repeated prescriptions and use of antimicrobials were significantly independent factors of bacterial resistance. Therefore, patient management needs identification of bacteria by routine culture with antimicrobial susceptibility testing.

Bacterial profile, antimicrobial susceptibility patterns, and associated factors of community-acquired pneumonia among adult patients in Gondar, Northwest Ethiopia: A cross-sectional study

“…In this study, the overall prevalence of culture-positive sputum of bacterial CAP among adult patients was 39.4% (123/312; 95% CI: 34.1%–44.9%). This finding is comparable with previous Ethiopian studies in Bahir Dar (40.3%) [ 12 ], Dessie (38.7%) [ 14 ], Arba Minch (40.0%) [ 15 ], and findings from Sudan (42.0%) [ 47 ]. However, our finding is lower than other findings reported in Jimma, Ethiopia (45.0%) [ 13 ], India (48.0%) [ 48 ], Tripura, North-eastern India (58.8%) [ 49 ], Egypt (50.4%) [ 16 ], China (55.1%) [ 50 ], and Saudi Arabia (46.6%) [ 51 ].…”

“…Sixty-seven (53.2%) of the isolates were gram-negative bacteria, while 59 (46.8%) were gram-positive bacteria, indicating the predominance of gram-negative bacteria in causing CAP. Comparable findings documented by other studies in Ethiopia [ 13 , 14 ]. This is due to the presence of various virulence factors dedicated to colonization and invasion of the respiratory airways, as well as prior use of ineffective antibiotics by people outside the hospital, which results in the selection of gram-negative bacteria and increased resistance gene transmission.…”

“…pneumoniae was the second most frequently isolated bacteria, accounting for 26.2% of the isolates. This result is comparable with the studies conducted in India (13.3%) [ 48 ], Bangladesh (19.1%) [ 52 ], Dessie (24.8%) [ 14 ], Jimma (28.3%) [ 13 ], and Arba Minch (11.8%) [ 15 ]. However, our finding is higher than studies in Tripura, North-eastern India (4.2%) [ 49 ], and China (9.4%) [ 50 ].…”

“…S . aureus accounted for 20.6%, which is comparable with other studies [ 12 – 14 , 47 , 49 – 51 ] but higher than studies reported in Bangladesh [ 52 ] and Arba Minch [ 15 ]. In our study, E .…”

“…Similarly, K . pneumoniae was the most commonly isolated bacteria from previous studies in India (29.1%) [ 48 ], China (27.4%) [ 50 ], Tanzania (29.9%) [ 53 ], and Dessie (28.0%) [ 14 ]. However, our finding is significantly higher compared to studies reported in Tripura, North-eastern India (20.4%) [ 49 ], Bangladesh (13.3%) [ 52 ], Saudi Arabia (12.0%) [ 51 ], Jimma (11.7%) [ 13 ], Arba Minch (4.7%) [ 15 ], and Bahir Dar (18.0%) [ 12 ].…”