Bacterial Isolates and Drug Susceptibility Pattern of Sterile Body Fluids from Tertiary Hospital, Northern Ethiopia: A Four-Year Retrospective Study

Unveiling the Silent Threat: The Rise of Β-Lactamase Enzymes in Gram-Negative Bacterial Isolates Identified From Sterile Body Fluids in an Indian Healthcare Institution

Background Bacterial infections in sterile body fluids represent a significant clinical concern, particularly when caused by resistant pathogens. β-lactamase-producing gram-negative bacteria, including extended-spectrum-lactamase (ESBL), metallo-β-lactamase (MBL), and AmpC β-lactamase producers, complicate treatment strategies, leading to poor patient outcomes. Infections in vulnerable patients, particularly in intensive care units (ICUs), are more susceptible to these resistant organisms, highlighting the need for urgent surveillance and effective antimicrobial strategies. Objectives The primary goal of this study was to assess the prevalence and antimicrobial resistance patterns of bacterial isolates from sterile body fluids, with a focus on β-lactamase-producing gram-negative bacteria. The study further aimed to highlight the implications of antimicrobial resistance patterns in guiding effective empirical therapy and infection control strategies. Methodology A total of 180 sterile body fluid samples, including cerebrospinal fluid (CSF), pleural fluid, pericardial fluid, bile, peritoneal or ascitic fluid, and synovial fluid, were collected and processed for bacterial isolation. Standard microbiological procedures, including Gram staining, culture on appropriate media, and biochemical identification tests, were utilized to identify the isolates, followed by antimicrobial susceptibility testing (AST) using the Kirby-Bauer disk diffusion susceptibility test to determine resistance profiles, with particular attention to ESBL, MBL, and AmpC β-lactamase production. Results Of the 180 samples, 27 (15%) showed bacterial growth, with Escherichia coli and Pseudomonas aeruginosa being the most frequently isolated pathogens. Testing for antimicrobial susceptibility showed notable resistance levels to commonly used antibiotics, including cefoperazone-sulbactam and piperacillin-tazobactam. ESBL production was found in 40.74% of the gram-negative isolates, and MBL production was present in 48.15%. The study recorded maximum resistance rates in CSF samples, indicating the critical need for rapid and accurate diagnostic methods. The resistance profiles of isolated pathogens revealed limited options for empirical treatment, underscoring the need for targeted antimicrobial stewardship strategies. Conclusion The study underscores the growing concern of multidrug-resistant gram-negative bacteria in sterile body fluid infections, particularly in vulnerable patient populations. The detection of ESBL, MBL, and AmpC-producing organisms highlights the urgency for enhanced surveillance, rapid diagnostics, and strict antimicrobial stewardship to mitigate the impact of these resistant pathogens.

A Comprehensive Study of Bacterial Etiological Agents in Sterile Body Fluids and Antimicrobial Susceptibility Patterns Among Hospitalized Patients at an Academic Medical Center in India

Background  Sterile body fluids are devoid of any microbial presence, including commensal bacteria. However, bacterial invasion of these fluids can result in life-threatening infections, often leading to significant morbidity and mortality. Timely detection and precise identification of pathogens, along with antimicrobial susceptibility testing, are critical for optimizing therapeutic interventions and improving patient outcomes.  Objective To study the prevalence of bacterial infections in various body fluids in hospitalized patients and to determine the antimicrobial susceptibility pattern and the phenotypic detection of extended-spectrum beta-lactamase (ESBL), metallo-beta-lactamase (MBL) and AmpC beta-lactamase producers within bacterial isolates. Materials and methods Sterile body fluid samples, excluding blood and urine, were collected and cultured at the Department of Microbiology, Krishna Institute of Medical Sciences, Western Maharashtra, India, from November 2022 to 2023. The microorganisms isolated from these fluids were identified using standard biochemical tests. Antibiotic sensitivity was assessed through the disc diffusion assay (zone of inhibition) and phenotypic identification of beta-lactamase enzymes was performed using the combined disc diffusion method. Results During the study period, 180 sterile fluid specimens were collected representing 48 cerebrospinal fluid (CSF), 53 pleural fluid, 23 peritoneal fluid, and other sterile body fluid samples. Out of these, (n=32, 17.77%) samples were culture-positive. Gram-negative bacteria were oftentimes isolated at 84% (27/32), while gram-positive were 16% (5/32). Escherichia coli was frequently isolated and (n=9, 28.12%) exhibited maximum sensitivity to gentamicin and fosfomycin (n=7, 77.78%) and maximum resistance to cefoperazone-sulbactam (n=8, 88.88%). Pseudomonas aeruginosa was isolated as the second most common organism and showed maximum susceptibility to fosfomycin (n=5, 83.34%) and maximum resistance to gentamicin, cefotaxime, cefoxitin, etc. (n=5, 83.34%). Among gram-positive isolates, coagulase-positive Staphylococcus was high in prevalence rate and (n=3, 9.37%) presented 100% sensitivity to vancomycin and maximum sensitivity to tetracycline (n=2, 66.67%) and 100% resistance to ciprofloxacin, cefoxitin, erythromycin, and other antibiotics. Among gram-negative isolates, MBL producers were 48.15%, ESBL producers were 40.74%, and 18.51% were AmpC beta-lactamase producers with a multidrug-resistant (MDR) occurrence rate of 93.75%. Conclusion Infections affecting sterile body fluids are critical due to their high mortality and morbidity rates. Timely identification of the causative organisms and their antibiotic susceptibility is essential. The prompt initiation of appropriate antibiotic therapy can decrease the duration of hospitalization and mitigate the emergence of drug resistance. The presence of MDR organisms in sterile body fluids constitutes considerable challenges in the management of critically ill patients.

Epidemiological Study of Pathogens in Spontaneous Bacterial Peritonitis in 2017-2024-A Preliminary Report of the University Hospital in South-Eastern Poland

Spontaneous Bacterial Peritonitis (SBP) is a serious complication and a common cause of death in patients with liver cirrhosis. Between January 2017 and March 2024, a retrospective study was conducted involving 302 patients (>18 years old) with ascites treated at a tertiary referral center in south-eastern Poland. Microbiological analysis of the ascitic fluids was performed in all patients. The presence of microorganisms was found in samples from 17 patients, and 21 pathogens were isolated, including 15 Gram-positive bacteria and 6 Gram-negative bacteria. Staphylococcus epidermidis, MRCNS (methicillin-resistant coagulase-negative staphylococci, resistant to all beta-lactam antibiotics: penicillins, penicillins with beta-lactamase inhibitor, cephalosporins and carbapenems) was the main pathogen detected (19.05%, 4/21), followed by Enterococcus faecalis (9.52%, 2/21), Enterococcus faecium (9.52%, 2/21), Staphylococcus haemolyticus, MRCNS (4.76%, 1/21), Streptococcus mitis (9.52%, 2/21), Streptococcus parasanguinis (9.52%, 2/21), Micrococcus luteus (4.76%, 1/21) and Bacillus spp. (4.76%, 1/21). The following Gram-negative bacteria were also found in the specimens examined: Escherichia coli, ESBL (extended-spectrum β-lactamase producing E. coli) (4.76%, 1/21), Escherichia coli (4.76%, 1/21), Pseudomonas aeruginosa (4.76%, 1/21), Klebsiella oxytoca (9.52%, 2/21) and Sphingomonas paucimobilis (4.76%, 1/21). Gram-positive bacteria caused nosocomial infections in nine patients with SBP, Gram-negative bacteria caused nosocomial infections in two patients. In six patients with SBP, community-acquired infections caused by Gram-negative bacteria were found in three cases, Gram-positive bacteria in two cases, and in one case, community-acquired infection was caused by mixed Gram-positive and Gram-negative. Bacteria isolated from patients with hospital-acquired SBP showed higher drug resistance than those found in patients with non-hospital SBP. Bacterial infections in cirrhotic patients with complications may be responsible for their deteriorating health. Prompt intervention is critical to reducing mortality.

Bacterial etiologies, antimicrobial susceptibility pattern and associated factors among patients suspected sterile body site infections at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia

Background

Sterile body locations are usually associated with clinical urgency and life-threatening illnesses, and they are typically contaminated with diverse bacterial etiologies. If the bacteria acquire resistance to antimicrobial drugs, the public health crisis will only worsen. In developing countries, drug-resistant bacteria are common because of poor surveillance, diagnostic capacity, and control measures. Early diagnosis, and assessing the drug resistance and factors associated with infection are important to combat the drug resistance and treatment. This study aimed to assess the bacterial etiologies, antimicrobial susceptibility pattern, and possible associated factors among patients suspected of sterile body sites.

Methods

A hospital-based cross-sectional study was conducted from June 2022 to August 2022 at Debre Markos Comprehensive Specialized Hospital in Amhara regional state, Ethiopia. One hundred seven study participants were selected using consecutive convenient sampling techniques. A structured questionnaire was used to collect socio-demographic and clinical data. Gram stain was done for a preliminary report and inoculated into blood agar, MacConkey agar, and chocolate agar and incubated aerobically and micro aerobically at 37°C for 24 h. Antimicrobial susceptibility testing was done by the modified Kirby Bauer's disk diffusion method. Data were analyzed using bivariate and multivariate logistic regression was used. A p-value less than 0.05 is considered as statistically significant.

Results

The overall magnitude of sterile body site infection among study participants was 7.5% (14/187). The majority of the isolates were Gram-negative bacteria with the predominant species Enterobacter cloacae accounting for 28.57% (4/14). Among isolates 78.57%(11/14) of them were multidrug-resistant isolates. Being inpatient, co-morbidity, and alcohol consumption were significantly associated with sterile body site infection.

Conclusion

In our study, Gram-negative bacteria were the predominant bacteria that infects sterile body fluid. The prevalence of multi-drug resistance bacteria isolates was significantly high. Therefore, before prescribing an empirical treatment, a medical professional should identify the bacterial etiology of sterile body fluids and the susceptibility of microbes to the drug.

Pleural Infections: Antimicrobial Susceptibility Patterns of Bacterial Isolates and Associated Factors in Suspected Hospitalized Patients at Arba Minch General Hospital, Southern Ethiopia

Background:

Pleural infection remains a clinical problem with high morbidity and mortality all over the world. Antimicrobial options are uncertain due to the lack of understanding of the bacteriology of pleural infection. Thus, the goal of this study was to determine bacteriological profiles, antimicrobial susceptibility patterns, and factors associated with pleural infection.

Methods:

An institution-based cross-sectional study was undertaken in Arba Minch General Hospital from 1st January to 30th November 2020. Socio-demographic, clinical, and behavioral data were collected using a pre-tested, structured questionnaire. Adducted amounts of pleural fluid samples were collected aseptically with sterile test tubes. Standard procedures were utilized for bacterial identification, and antimicrobial susceptibility testing was done using Kirby–Disk Bauer's diffusion method. Version 25 of the Statistical Package for the Social Sciences (SPSS) was used to analyze the data. The p-value of 0.05 was considered statistically significant.

Results:

A total of 152 hospitalized patients were enrolled in this study. The overall magnitude of bacterial pleural infection was 27.6%. The predominant bacteria isolated were Staphylococcus aureus with 34.9%, followed by Escherichia coli with 11.6%. Multidrug-resistant (MDR) isolates account for around 48.8% of all isolates, with Gram-positive bacterial isolates accounting for 71.4%. Methicillin-resistant was found in 26.7% and 33.3% of isolated Staphylococcus aureus (MRSA) and coagulase-negative staphylococci (CoNS), respectively. One isolate of Enterococcus spp. was found to be vancomycin-resistant. All isolated Streptococcus pneumoniae and Streptococcus pyogenes were susceptible to penicillin, erythromycin, cotrimoxazole, and vancomycin. Likewise, isolated Pseudomonas aeruginosa was susceptible to piperacillin. The pleural infection showed a statistically significant association with age group less than or equal to 25 years old (p<0.001), hospital admission for more than seven days (p<0.007), chest tube drainage (p<0.021), previous history of pneumonia (p<0.029) and habit of alcohol drinking (p<0.029).

Conclusion:

The overall rate of culture-confirmed pleural infection was high, and a considerable percentage of bacteria isolates showed increased resistant to routinely used antibiotics, indicating that more attention is needed to follow the spread and emergence of drug-resistant bacterial agents.

Gram-negative bacteria isolates and their antibiotic-resistance patterns among pediatrics patients in Ethiopia: A systematic review

Objective:

Antimicrobial resistance is one of the serious threats in the world, including Ethiopia. Even though several studies were conducted to estimate common bacteria and their antibiotic-resistance profile in Ethiopia, it is difficult to estimate the overall resistant patterns due to the lack of a nationwide study. This systematic review aimed to determine the prevalence of gram-negative bacteria isolates and their antibiotic-resistance profile among pediatrics patients in Ethiopia.

Methods:

A web-based search using PubMed, EMBASE, Science Direct, the Cochrane Database for Systematic Reviews, Scopus, Hinari, Sci-Hub, African Journals Online Library, and free-text web searches using Google Scholar was conducted from August to September 16, 2021. Each of the original articles was searched by Boolean search technique using various keywords and was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The data were extracted using Microsoft Excel format and exported to STATA 14.0 for statistical analyses.

Results:

The database search delivered a total of 2,684 studies. After articles were removed by duplications, title, reading the abstract, and assessed for eligibility criteria, 19 articles were included in the systematic review. Of a total of 1372 (16.77%) culture-positive samples, 735 (53.57%) were gram-negative. Escherichia coli was the most frequently isolated bacteria followed by Klebsiella species, 139/1372 (10.13%), and 125/1372(9.11%), respectively. More than 66.67% of isolates were resistant to ampicillin except for Neisseria meningitidis which was 32.35% (11/34). Pseudomonas aeruginosa, Klebsiela species, and Citrobacter species were 100% resistance for cefepime. Haemophilus influenzae was 100% resistant to meropenem. Salmonella species were 93.30%, 78.26%, and 63.64% resistant to tetracycline, chloramphenicol, and cotrimoxazole, respectively.

Conclusion:

Gram-negative bacteria were identified as the common pathogen causing infection in pediatrics and the level of resistance to commonly prescribed antibiotics was significantly higher in Ethiopia. Culture and susceptibility tests and well-designed infection control programs are important measures.

Aerobic Bacterial Profile and Their Antibiotic Susceptibility Patterns of Sterile Body Fluids Among Patients at Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia

BACKGROUND

Infections of sterile body fluids are susceptible to serious invasive bacterial infections and critical, with high morbidity and sequelae risk. This study has not been conducted previously in eastern Ethiopia.

OBJECTIVE

The present study was designed to determine the bacterial profile, associated factors, and their susceptibility to antimicrobial agents of isolates among patients with sterile body fluids at Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia.

METHODS

Hospital-based cross-sectional study was conducted from April to June 2021 among 204 patients selected using a convenient sampling technique. Data were collected using a pretested structured questionnaire. All consenting patients submitting body fluid specimens for testing at the clinical laboratory were included and analyzed using standard microbiology methods. Antimicrobial susceptibility testing was performed using the disk diffusion method and interpreted as per Clinical and Laboratory Standards Institute guidelines. Data were double entered into Epi data version 4.6, exported, and analyzed using Statistical Package for Social Science version 25. Bivariate and multivariable logistic regressions were used to assess the association between outcome and predictor variables. P-value <0.05 was considered to be statistically significant.

RESULTS

The overall prevalence of bacteria among different sterile body fluid samples was 16.7% (95% CI: 12-22%). Most of the bacterial isolates (70.6%) were Gram-negative bacteria, mainly K. pneumoniae (26.5%) and E. coli (20.6%). Multidrug resistance was identified in 76.5% of the isolates. Being inpatient (AOR = 3.59; 95% CI: 1.52, 8.51) and turbid appearance (AOR = 4.35; 95% CI: 1.67, 11.29) were significantly associated with culture growth rate.

CONCLUSION

The prevalence of bacterial isolates in this study comprises about 17%. Gram-negative bacteria, particularly K. pneumoniae and E. coli, were the major etiologic agents. Being inpatient and the turbid appearance of the specimen were significantly associated with the culture-positive result. Significant numbers of multidrug-resistant bacteria were isolated, mainly against beta-lactams. Therefore, culture and susceptibility testing should be an integral part of the laboratory investigation.

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

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, 95% CI: (2.755–29.342)], cirrhosis [AOR = 2.751, 95% CI: (1.109–6.822)] and alcoholism [AOR = 5.802, 95% CI: (1.948–17.285)].

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.

Major bacterial isolate and antibiotic resistance from routine clinical samples in Southern Ethiopia

Currently, antibiotic-resistant bacterial infections are a challenge for the health care system. Although physicians demand timely drug resistance data to guide empirical treatment, local data is rather scarce. Hence, this study performed a retrospective analysis of microbiological findings at the Hawassa public hospital. Secondary data were retrieved to assess the prevalence and level of drug resistance for the most common bacterial isolates from clinical samples processed at Hawassa University Comprehensive Specialized Hospital. Out of 1085 clinical samples processed in the microbiology laboratory, the prevalence of bacterial infection was 32.6%. Bacterial bloodstream infection was higher in children than in adults (OR, 4; 95% CI 1.8-14.6; p = 0.005). E. coli and K. pneumoniae were the commonest bacterial isolate both in children (36.8%, 26.3%) and in adults (33.3%, 26.7%) from the urine sample while, the leading bacteria identified from the CSF sample was P. aeruginosa, 37% in children and 43% in adult. In this study, all identified bacterial isolates were multi-drug resistant (MDR) ranging from 50 to 91%. The highest proportion of MDR was S. aureus 91.1 followed by K. pneumoniae 87.6%. Since the nationwide investigation of bacterial isolate, and drug resistance is rare in Ethiopia, a report from such type of local surveillance is highly useful to guide empirical therapy by providing awareness on the level resistance of isolates.

The Epidemiology of Bloodstream Infections and Antimicrobial Susceptibility Patterns: A Nine-Year Retrospective Study at St. Dominic Hospital, Akwatia, Ghana

Background

Bloodstream infections are among the top causes of morbidity and mortality in people of all ages, especially in immunocompromised patients in sub-Saharan Africa. This study aimed at describing the epidemiology of bloodstream infections and antimicrobial susceptibility pattern over a nine-year period at St. Dominic Hospital, Akwatia, in the Eastern Region of Ghana.

Method

This study retrospectively analysed data from 4,489 patients who were referred to the Laboratory Department for blood culture and sensitivity testing from January 2009 to December 2017. Sociodemographic data included age, gender, and patients' department. Blood culture results were retrieved from archival records in the laboratory. The authorities of St. Dominic Hospital granted approval for the study.

Results

The incidence of bloodstream infection over the 9 years was 51.4 positive cultures per 100,000 hospital attendance. Staphylococcus aureus was the leading causative agent of bacteraemia for the first two scalar years (2009–2011 (38.9%) and 2012–2014 (42.2%)) while coagulase-negative staphylococcus (CoNS) (50.5%) was predominant for the last scalar year (2015–2017), followed by Staphylococcus aureus (169/587 (28.8%)). The highest incidence of bloodstream infections was recorded in the wet seasons (months of May (8.9 per 10,000 persons) and October (10.1 per 10,000 persons)). The bacterial isolates demonstrated high resistance to tetracyclines (390/531 (73.4%)), penicillins (1282/1669 (76.8%)), and sulphonamides (450/499 (90.2%)).

Conclusion

Bloodstream infection and antimicrobial resistance are high in patients seeking healthcare in Akwatia. This therefore calls for concerted efforts aimed at reducing the incidence in the study area.