Phenotypic Detection of Carbapenem-Resistant Gram-Negative Bacilli from a Clinical Specimen in Sidama, Ethiopia: A Cross-Sectional Study

Abstract

Background Carbapenem-resistant gram-negative bacteria are an emergent source of both community-acquired and healthcare-associated infection that poses a substantial hazard to public health. This study aimed to conclude the magnitude of carbapenem resistance gram-negative bacteria from a clinical specimen at Hawassa University Comprehensive Specialized Hospital. Methods A hospital-based cross-sectional study was accompanied from February 13 to June 7, 2020, in which consecutive patients with 103 gram-negative bacteria were encompassed. The isolates included were 54 urine, 17 blood, 17 pusses, 4 cerebrospinal fluid (CSF), 3 aspirates, 3 effusions, 2 stools, 2 ear discharges, and 1 nasal swab. A semi-structured questionnaire was used to gather socio-demographic data from the attendant and clinical data from the patient’s chart. Patients admitted in any wards and visited outpatients department were included for the study if gram-negative bacteria was identified for those who accepted the consent. A routine manual culture, Gram’s staining and biochemical tests used to identify the bacteria. Antibiotic susceptibility was determined for twelve antibiotics including cotrimoxazole, ceftazidime, meropenem, gentamycin, chloramphenicol, ampicillin, ciprofloxacin, cefotaxime, cefuroxime, nitrofurantoin, piperacillin-tazobactam, and amikacin using the Kirby-Bauer disc diffusion method. Modified carbapenem inactivation (mCIM) method was used to determine carbapenem resistance using meropenem disk as per the recommendation of Clinical and Laboratory Standards Institute guideline. Statistical package for social science software version 21 was used for data entry and analysis. The odds ratio at 95% confidence interval (CI) and p-value <0.05 were taken as a statistically significant association. Results Generally, 111 gram-negative bacteria were identified from 103 patients. Of 111 isolates, thirteen isolates (nine resistance and four intermediates) were identified in disk diffusion testing for meropenem. Of this, 10 isolates were carbapenemases producer with the overall rates of 9% in the Modified carbapenem inactivation method (mCIM). Pseudomonas spp. 3 (30.0%), E. coli, K. pneumonia, Acinetobacter spp. each two (20.0%), and K. oxytoca 1 (10.0%) were identified as carbapenemases positive. The rates of the multidrug, extensive, pan drug were 86.5, 43.3, and 1.8, respectively. Ampicillin 94 (97.9%), followed by cefuroxime 52 (91.2%), cefotaxime 94 (88.7%), cotrimoxazole 58 (88.1%), ceftazidime 40 (83.3%), ciprofloxacin 47 (77.1%), nitrofurantoin 35 (70.0%), gentamycin 71 (65.7%), with high level of resistance. However, piperacillin-tazobactam 41 (48.8%), chloramphenicol 25 (47.2%), meropenem 13 (11.7%), and amikacin 9 (8.5%) were with low rates of resistance. In this study, there were no variables statically associated with carbapenem resistance that is p > 0.05. ...

Phenotypic characterization of carbapenem non-susceptible gram-negative bacilli isolated from clinical specimens

“…In our study, the prevalence of carbapenemase-producing gram-negative bacilli was 5.4%, which is higher than the prevalence of study conducted at the University of Gondar, Ethiopia by Eshetie et al at 2.72% [ 41 ] and the Ethiopian Public health Institute by Beyene et al at 2% [ 37 ]. However, our result was lower than the result of studies conducted at Tikur Anbessa Specialized Hospital, Ethiopia by Melese et al with 12.12% [ 42 ], Three Hospitals in Amhara region, Ethiopia by Moges et al 15.7% [ 43 ], Felegehiwot Hospital, Ethiopia by Moges et al 16.2% [ 44 ], Sidama, Ethiopia by Alemayehu et al 9% [ 45 ], Mulago National Referral Hospital, Uganda by Okoche et al 22.4% [ 46 ], and data from laboratories in Spain by Lopez-Hernandez et al 62% [ 47 ]. The variation might be due to the method utilized, i.e.…”

Prevalence and Trends of Carbapenem-Resistant Pseudomonas aeruginosa and Acinetobacter Species Isolated from Clinical Specimens at the Ethiopian Public Health Institute, Addis Ababa, Ethiopia: A Retrospective Analysis

“…In this retrospective study, we analyzed the five-year antimicrobial resistance profiles of P. aeruginosa and Acinetobacter species with an emphasis on the prevalence and trends of carbapenem resistance at the Ethiopian Public Health Institute, Addis Ababa, Ethiopia. The prevalence of carbapenem-resistant Acinetobacter species in the current study was 61%, which is consistent with the findings of the study from Pretoria, South Africa (63%), 27 and Jimma, Ethiopia (56.4%), 25 however, it is higher than the findings of studies from Lusaka, Zambia (18.2%), 28 Switzerland (9.2%), 29 North-East, Ethiopia (34.5%), 18 Sidama, Ethiopia (9.9%), 22 North Gondar, Ethiopia (20.77%), 24 Northwest Ethiopia (33.3%), 17 and Dessie, Ethiopia (43.8). 16 The variation could be attributed to differences in study design, the number of isolates analyzed, the types of specimens considered, and the amount of data analyzed, as some studies only analyzed fewer data, while others analyzed a large amount of national antimicrobial resistance data, geographical differences, and antibiotic prescription policy differences.…”

“…During the study period, Acinetobacter species demonstrated the highest resistance to piperacillin/tazobactam (85.5%), extended-spectrum cephalosporins (ceftazidime 94.6%, ceftriaxone 94.1%, and cefepime 90%) and lowest resistance to aminoglycosides (amikacin 31.5%, and tobramycin 51.7%) and carbapenems (imipenem 59%) Table 2. Although the prevalence of resistance is higher in our study, the result is partially in agreement with studies from Sidama, Ethiopia, 22 and Northeast Ethiopia, 16,18 which reported the highest resistance to extended-spectrum cephalosporins and piperacillin/ tazobactam and lowest resistance to aminoglycosides and carbapenems.…”

“…17 The observed variation could be attributed to the fact that they only analyzed 46, 10, and 11 P. aeruginosa isolates, respectively, and additionally the differences in study design since these studies used specimens collected from single health facilities. However, it was higher compared to the study from Sidama, Ethiopia (7.8%), 22 Asella, Ethiopia (0%), 23 Dessie, Ethiopia (16.7%), and 16 Taiwan (10.2%). 30 The observed variations may result from variations in the number of isolates analyzed, and differences in antibiotic prescription policies.…”

Detection and phenotypic characterization of carbapenem non susceptible gram-negative bacilli isolated from clinical specimens

“…Ethiopia by Moges et al15.7%[25], Felegehiwot Hospital, Ethiopia by Moges et al 16.2%[26], Sidama, Ethiopia by Alemayehu et al 9%[27], Mulago National Referral Hospital, Uganda by Okoche et al 22.4%[28], and data from laboratories in Spain by Lopez-Hernandez et al 62%[29]. The variation might be due to the technique utilized, modified carbapenem inactivation method was utilized in our investigation unlike other investigators who used the modified Hodge test, the number of bacterial isolates analyzed, geographic location.…”