Isolation and antimicrobial susceptibility pattern of Staphylococcus aureus in patients with surgical site infection at Debre Markos Referral Hospital, Amhara Region, Ethiopia

Antimicrobial resistance in bacterial wound, skin, soft tissue and surgical site infections in Central, Eastern, Southern and Western Africa: A systematic review and meta-analysis

Antimicrobial resistance (AMR) is a major global threat and AMR-attributable mortality is particularly high in Central, Eastern, Southern and Western Africa. The burden of clinically infected wounds, skin and soft tissue infections (SSTI) and surgical site infections (SSI) in these regions is substantial. This systematic review reports the extent of AMR from sampling of these infections in Africa, to guide treatment. It also highlights gaps in microbiological diagnostic capacity. PubMed, MEDLINE and Embase were searched for studies reporting the prevalence of Staphylococcus aureus, Eschericheria coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii in clinically infected wounds, SSTI and SSI in Central, Eastern, Southern or Western Africa, and studies reporting AMR from such clinical isolates. Estimates for proportions were pooled in meta-analyses, to estimate the isolation prevalence of each bacterial species and the proportion of resistance observed to each antibiotic class. The search (15th August 2022) identified 601 articles: 59 studies met our inclusion criteria. S. aureus was isolated in 29% (95% confidence interval [CI] 25% to 34%) of samples, E. coli in 14% (CI 11% to 18%), K. pneumoniae in 11% (CI 8% to 13%), P. aeruginosa in 14% (CI 11% to 18%) and A. baumannii in 8% (CI 5% to 12%). AMR was high across all five species. S. aureus was resistant to methicillin (MRSA) in >40% of isolates. E. coli and K. pneumoniae were both resistant to amoxicillin-clavulanic acid in ≥80% of isolates and resistant to aminoglycosides in 51% and 38% of isolates respectively. P. aeruginosa and A. baumannii were both resistant to anti-pseudomonal carbapenems (imipenem or meropenem) in ≥20% of isolates. This systematic review found that a large proportion of the organisms isolated from infected wounds, SSTI and SSI in Africa displayed resistance patterns of World Health Organisation (WHO) priority pathogens for critical or urgent antimicrobial development.

Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus among Patients Diagnosed with Surgical Site Infection at Four Hospitals in Ethiopia

Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of severe surgical site infections (SSI). The molecular epidemiology of MRSA is poorly documented in Ethiopia. This study is designed to determine the prevalence of MRSA and associated factors among patients diagnosed with SSI. A multicenter study was conducted at four hospitals in Ethiopia. A wound culture was performed among 752 SSI patients. This study isolated S. aureus and identified MRSA using standard bacteriology, Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS), and cefoxitin disk diffusion test. The genes mecA, femA, vanA, and vanB were detected through PCR tests. S. aureus was identified in 21.6% of participants, with 24.5% of these being methicillin-resistant Staphylococci and 0.6% showing vancomycin resistance. Using MALDI-TOF MS for the 40 methicillin-resistant Staphylococci, we confirmed that 31 (77.5%) were S. aureus, 6 (15%) were Mammaliicoccus sciuri, and the other 3 (2.5%) were Staphylococcus warneri, Staphylococcus epidermidis, and Staphylococcus haemolyticus. The gene mecA was detected from 27.5% (11/40) of Staphylococci through PCR. Only 36.4% (4/11) were detected in S. aureus, and no vanA or vanB genes were identified. Out of 11 mecA-gene-positive Staphylococci, 8 (72.7%) were detected in Debre Tabor Comprehensive Specialized Hospital. Methicillin-resistant staphylococcal infections were associated with the following risk factors: age ≥ 61 years, prolonged duration of hospital stay, and history of previous antibiotic use, p-values < 0.05. Hospitals should strengthen infection prevention and control strategies and start antimicrobial stewardship programs.

Antimicrobial Resistance Patterns of Staphylococcus aureus and Enterococcus Species at the Ethiopian Public Health Institute, Ethiopia: A Five-Year Retrospective Analysis

Purpose

The study aimed to investigate the antimicrobial resistance patterns of Staphylococcus aureus and Enterococcus species isolated from clinical specimens over a period of five years, including resistance to methicillin and vancomycin.

Patients and Methods

Bacterial identification and antimicrobial susceptibility testing reports from 2017 to 2021 at the Ethiopian Public Health Institute were used for this retrospective study. The organisms were identified using either BD Phoenix M50, Vitek 2 compact, or conventional biochemical methods, whichever was available at the time of testing. The antimicrobial susceptibility profiles of the isolates were determined using either Kirby-Bauer disc diffusion, BD phoenix M50, or Vitek 2 compact. WHONET software was used to analyze the antimicrobial resistance patterns of both organisms. The p-values of ≤0.05 were considered statistically significant.

Results

During the study period, a total of 315 Staphylococcus aureus and 92 Enterococcus species were isolated. Out of 315 Staphylococcus aureus isolates, 27% and 5.1% were methicillin and vancomycin resistant, respectively. Staphylococcus aureus showed very high resistance to Penicillin G (86.7%). Out of 92 Enterococcus species recovered, 8.7% were vancomycin-resistant. Enterococcus species showed very high resistance to Penicillin G (71.4%) and tetracyclines (83.3%). Methicillin-resistant Staphylococcus aureus shows 100% resistance to penicillin followed by ciprofloxacin (50%), erythromycin (45.6%), and tetracycline (44.2%) and lower resistance to vancomycin (18.8%). All vancomycin-resistant isolates of both organisms were fully resistant (100%) to all antibiotics tested, except for linezolid and daptomycin, to which they were susceptible.

Conclusion

This study found a high prevalence of methicillin and vancomycin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus species between 2017 and 2021. However, there were no statistically significant changes in the prevalence of these organisms during the study period. This suggests that larger and more representative nationwide data is needed to show trends of these pathogens.

Antibiogram, prevalence of methicillin-resistant and multi-drug resistant Staphylococcus spp. in different clinical samples

Methicillin-resistant Staphylococcus spp. (MRSS) are causing numerous forms of illness in humans ranging from mild to fatal infections. We need to investigate the resistant pattern for different clinical isolates to control the resistance phenomena. This study was designed to provide the resistance pattern of isolated Staphylococcus spp. from various clinical samples in Khartoum State and to elucidate the frequencies of Multidrug-resistant (MDR), Extensively drug-resistant (XDR) and pan-drug resistant (PDR). Two hundred and ten bacterial isolates were from different sources (catheter tip, sputum, vaginal swab, urine, tracheal aspirate, blood, pus, nasal swab, stool, throat swab, pleural fluid, and ear swab). Isolates were identified based on their morphological characters and biochemical reaction. Antibiotics susceptibility screening was performed using twenty-three antibiotics from eighteen classes against all isolated Staphylococcus spp. following the Clinical and Laboratory Standards Institute (CLSI) guideline. The result revealed that out of 63 Gram-positive isolated bacteria, 52 (82.5%) were Staphylococcus spp. with a high incidence of S. aureus 37(71.2%). Out of all Staphylococcus spp., 38 (73.1%) were Methicillin-resistant (MR). The prevalence of MDR was higher in S. aureus (89.2%) than in S. epidermidis (75%). All Staphylococcus spp. displayed resistance to ampicillin and penicillin, while all S. aureus were sensitive to daptomycin and fosfomycin. One isolate was XDR possible PDR, while no PDR was reported in all isolated bacteria. This study provided evidence for the antimicrobial-resistant (AMR) burden in Sudan and highlighted the need for a practical and functional stewardship program to reduce the unreasonable costs of antibiotics.

Prevalence and Clindamycin Resistance Profile of Staphylococcus aureus and Associated Factors among Patients Attending the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia

Clindamycin can serve as an alternative treatment for staphylococcal infections. Routine susceptibility tests may fail to determine inducible type clindamycin resistance and can be a source of failure in clinical therapeutics. Therefore, this study aimed to determine Staphylococcus aureus (S. aureus) prevalence, inducible clindamycin resistance pattern, and associated factors among patients attending the University of Gondar Comprehensive Specialized Hospital, Gondar, northwest Ethiopia. Methods. A cross-sectional study was conducted from January to April 2018. Clinical samples were inoculated on appropriate culture media. Standard bacteriological tests, including Gram stain, catalase, and coagulase tests, identified the presence of S. aureus. The antimicrobial susceptibility tests and the D-test were performed by using the Kirby-Bauer disk diffusion technique on the Mueller-Hinton agar. The D-test was performed using clindamycin (CLI) 2 ug and erythromycin (ERY) 15 ug disks located approximately 15 mm apart, and the cefoxitin susceptibility test was used to characterize methicillin-resistant S. aureus (MRSA). The association between S. aureus infection and different variables was assessed using bivariate and multivariate analysis. A P value <0.05 was considered statistically significant. Result. Of 388 study participants, the overall prevalence of S. aureus was 17% (66/388). Of these, the inducible type of clindamycin resistance was 25.8% (17/66) and 21.2% (14/66) were MRSA. All isolates were susceptible to chloramphenicol and resistant to tetracycline. A family size of 4-6 (AOR = 2.627, 95% CI (1.030-6.702)) and >7 (AOR = 3.892, 95% CI (1.169-12.959)), inpatient study participants (AOR = 3.198, 95% CI (1.197-8.070)), illness in the previous 4 weeks (AOR = 2.116, 95% CI (1.080-4.145)), and a history of chronic disease (AOR = 0.265, 95% CI (0.094-0.750)) were likely to have S. aureus infection. Conclusion. This study shows a considerable high magnitude of MRSA and inducible clindamycin resistance S. aureus isolates. To rule out clindamycin susceptibility testing, the D-test should be routinely performed.

Healthcare providers infection prevention practices and associated factors in community clinics in Bangladesh: A cross-sectional study

Healthcare associated infections impose serious challenges to safe and high-quality healthcare delivery, and have been closely associated with poor infection prevention practices. Infection prevention practices are poorly studied in Bangladesh, and no previous studies have examined these practices among healthcare providers of community clinics. The study aimed to assess infection prevention practices and associated factors among healthcare providers of community clinics in the rural area of Bangladesh. A cross-sectional study was conducted among 128 community healthcare providers in the Kurigram district of Bangladesh who were identified from 128 community clinics using a stratified random sampling technique. Data were collected between November and December, 2019 via face-to-face survey using a pre-tested semi-structured questionnaire. Only 37.5% community healthcare providers had adequate knowledge on infection prevention measures, and 39.1% had good infection prevention practices. Community healthcare providers with higher education were significantly more likely to have good infection prevention practices, and good infection prevention practices were associated with availability of hand washing facilities, and of soap in community clinic, and adequate knowledge of infection prevention. Implementation of an effective training program regarding infection prevention, along with adequate supply of infection prevention basic resources, and continuous monitoring and supervision are required to improve the currently faltering infection prevention knowledge and practices among community healthcare providers in Bangladesh.

Methicillin-Resistant Staphylococcus aureus: The Magnitude and Risk Factors among Patients Admitted to Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Background

In healthcare facilities, a gradual increase in methicillin-resistant Staphylococcus aureus (MRSA) infections has been seen over the past 2 decades. Similarly, it has been responsible for the most frequent and invasive pathogens associated with admitted patient infection. Currently, it is considered an urgent threat to public health and classified as one of the top-priority antimicrobial-resistant pathogens. This study aimed to determine the magnitude and associated risk factors of MRSA infection among admitted patients.

Methods

A facility-based cross-sectional examination was led on 413 patients admitted to Tikur Anbessa Specialized Hospital from January 2018 to January 2019. A convenient sampling technique was used. Clinical specimens of pus and blood were collected from admitted patients who developed the infection after 48 hours of admission. Gram stain, culture media preparations, and biochemical tests were conducted to identify and isolate the causative agent. Staphylococcus aureus (S. aureus) were identified as MRSA strains after having a zone of inhibition less than or equal to 21 mm to the cefoxitin (30 ug) disc. Bivariate and multivariable logistic regression analyses were computed. The odds ratio, along with 95% CI, was estimated to identify associated risk factors for MRSA infection.

Results

Out of 413 collected specimens, 38.7% had coagulase-positive S. aureus of which 35.6% (95% CI: 28.2%–43.0%) were MRSA. Being within the age group of 19–29 years and 30–39 years with AOR = 5.02 and 95% CI: 1.24–20.35 and AOR = 6.65 and 95% CI: 1.78–24.78, respectively, admitting in the hematology ward and the pediatric ward with AOR = 7.80 and 95% CI: 1.82–33.49 and AOR = 10.54 and 95% CI: 1.78–62.42, respectively, and experiencing poor prognosis with AOR = 10.97 and 95% CI: 4.57–26.36 were significantly associated with MRSA infection. Conclusion and Recommendation. The significant magnitude of MRSA was found among patients admitted to this hospital. Therefore, identified risk factors should be considered when executing hospital-acquired infection prevention programs. We also suggest that healthcare providers should consider the identified risk factors while prescribing the antibiotic.

Methicillin and Vancomycin Resistant Staphylococcus aureus and Associated Factors from Surgical Ward Inpatients at Debre Markos Referral Hospital, Northwest Ethiopia

Introduction

Staphylococcus aureus is a well-known superbug and leading causes of wound infections. The clinical epidemiology of methicillin resistant S. aureus (MRSA) and vancomycin resistant S. aureus (VRSA) is not well documented in Ethiopia. The aim of this study was to determine the proportion of MRSA, VRSA and associated factors from surgical inpatients in Debre Markos Referral Hospital (DMRH), Northwest Ethiopia.

Methods

A facility-based cross-sectional study was conducted from February to April 2020 at DMRH. A structured questionnaire was used to gather demographic and clinical data. Wound swab was collected from inpatients and then inoculated on blood agar and mannitol salt agar. The presence of MRSA and VRSA was determined using the cefoxitin (30 μg) antibiotic disk diffusion and vancomycin E-test methods, respectively. The data were analyzed using SPSS 20. Data were analyzed using bivariate and multivariate logistic regression analysis. A P-value <0.05 was considered statistically significant.

Results

A total of 242 wound cases were enrolled and the majority of them were males 172 (71.1%). Among the total enrolled cases, S. aureus was identified from 71 (29.3%) of the admitted patients. The proportion of MRSA was 32 (13.22%) and that of VRSA was 4.1%. The proportion of vancomycin intermediate S. aureus (VISA) was gauged at 4.5%. Hospital stay over 72 hrs, wound depth, current antibiotic use, and previous history of wound infection showed statistically significant association with MRSA. On the contrary, VRSA did not showed any significant association against the analyzed variables.

Conclusion

High proportions of S. aureus isolates became MRSA; resistant to all β-lactam antimicrobial agents excluding newer cephalosporin. In addition, the proportion of VRSA/VISA was also high. Multiple variables demonstrated significant associations with MRSA. Hence, intervention measures for MRSA risk groups must be in place. Furthermore, hospital infection control and an antibiotic stewardship program should be strengthened.

Prevalence and Associated Factors of Methicillin Resistance Staphylococcus aureus (MRSA) Among Urinary Tract Infection Suspected Patients Attending at Arba Minch General Hospital, Southern Ethiopia

BACKGROUND

Urinary tract infection (UTI) is a very frequent infection both in the community and hospital patients, and the emergence of methicillin-resistant Staphylococcus aureus (MRSA) in the community setting and infections with this pathogen become a prevalent problem among UTI patients. Therefore, the aim of this study was to determine prevalence and associated factors of methicillin resistance staphylococcus aureus (MRSA) among urinary tract infection suspected patients attending at Arba Minch General Hospital.

METHODS

Facility-based cross-sectional study was done at Arba Minch General Hospital from July to October 2020. Midstream urine specimen was collected from outpatients, cultured and biochemical tests were performed to identify the intended pathogen, finally the antibiotic susceptibility pattern of MRSA was done and possible associated factors were determined. The cleaned data were entered and analyzed using SPSS version 21.

RESULTS

Four hundred and twenty two (422) adult outpatients were enrolled in this study, of which males accounted for 238 (56.4%) of the participants. The mean and standard deviation age of the participants was 27.4 (SD 27.4 ± 15.6) years. A total of 54 S. aureus isolates were recovered from urine specimen. The prevalence of MRSA among the isolated S. aureus was 23/54 (42.59% (95% CI (35.0, 47.0)). Participants who had previous exposure to UTI (p < 0.002), presence of chronic disease (p < 0.029), and hospitalization (p < 0.006) were statically associated with the prevalence of MRSA. From all the MRSA isolates, 53.7% were resistant against Nitrofurantoin.

CONCLUSION

This study revealed that MRSA could be prevalent in isolates from patients suspected of urinary tract infection and exhibiting different resistance pattern for antibiotics commonly used for treatment of staphylococcal infections.

Assessment of eugenol inhibitory effect on biofilm formation and biofilm gene expression in methicillin resistant Staphylococcus aureus clinical isolates in Egypt

Methicillin-resistant Staphylococcus aureus (MRSA) biofilm infection is a major threat in Healthcare facilities. The search for biofilm inhibitors is essential to overcome the antibiotic resistance. Eugenol is a phyto-compound that possesses many biological properties. In this study, the aim was to estimate the effect of eugenol on biofilms of MRSA through quantifying the level of gene expression of three genes (IcaA, IcaD and SarA) involved in biofilm development.. Fifty MRSA biofilm producers collected from the microbiology lab at Theodor Bilharz Research Institute were incubated with different concentrations of eugenol for 24 h. The minimum inhibitory concentration of eugenol (MIC) that eradicates the biofilms growth was detected. mRNA was extracted from all isolates before and after the application of eugenol at 0.5 x MIC, and then subjected to quantitative real-time PCR (qPCR). Results showed that fourteen isolates out of 50 (28%) exhibited intermediate biofilm formation ability, and 36 out of 50 (72%) were strong biofilm producers. The MIC values of eugenol for MRSA ranged from 3.125% to 0.01%. The mean values of MIC in both strong and intermediate biofilm forming MRSA isolates were statistically comparable (p = 0.202). qPCR results revealed that the levels of expression of the studied genes IcaA, IcaD, and SarA were decreased after eugenol treatment when compared with their corresponding values before treatment (p = 0.001). Eugenol inhibited the formation of biofilm of MRSA isolates, indicating it could be used to control infections associated with MRSA biofilms.

Prevalence of Methicillin-Resistant Staphylococcus aureus and Associated Risk Factors among Patients with Wound Infection at Referral Hospital, Northeast Ethiopia

Background

The spectrums of infections due to methicillin-resistant Staphylococcus aureus are manifold and are associated with worse outcomes. A study on the prevalence of these pathogens and their sensitivity patterns will give updated information which is very helpful for health personnel responsible in the management of patients and timely monitoring of the emergence of resistant bacteria. Hence, the study aimed at assessing the prevalence of methicillin-resistant Staphylococcus aureus and associated factors among patients with wound infection at Dessie Referral Hospital.

Method

A cross-sectional study was conducted among 266 patients at Dessie Referral Hospital from February to May 2016. Wound swab samples were collected aseptically using Levine's technique and transported to Dessie Regional Laboratory by using brain-heart infusion transport media. Isolation of Staphylococcus aureus was done based on cultural and biochemical profiles. Drug susceptibility test was performed using the disc diffusion technique as per the standard and interpreted based on the Clinical and Laboratory Standards Institute guidelines. The data were entered and analyzed by using SPSS version 20.

Result

Staphylococcus isolates from 266 processed wound swabs were 92 (34.58%). Of these, 26 (28.3%) were identified as methicillin-resistant S. aureus and 66 (71.7%) were methicillin-sensitive S. aureus. The overall prevalence of methicillin-resistant S. aureus among the study population was 9.8%. The isolated methicillin-resistant S. aureus showed full resistance to penicillin (100%) followed by erythromycin and ciprofloxacin (16, 61.5%) and cotrimoxazole and gentamicin (14, 53.8%). From the total S. aureus isolates, 20 (21.7%) of them showed multidrug resistance. Of these methicillin-resistant S. aureus, 18 (69.8%) showed high multidrug resistance. Patients who are farmers in occupation (AOR = 6.1, 95% CI (1.086–33.724)), admitted in the hospital (AOR = 3.56, 95% CI (1.429–8.857)), and have low BMI (<18.5) (AOR = 13.89, 95% CI (4.919–39.192)) were among the risk factors significantly associated with wound infection due to methicillin-resistant S. aureus.

Conclusion

All methicillin-resistant S. aureus isolates were 100% resistant to penicillin and showed high multidrug resistance. Therefore, antibiotic susceptibility test should be performed prior to treatment.

Incidence and Bacterial Etiologies of Surgical Site Infections in a Public Hospital, Addis Ababa, Ethiopia

Background:

Surgical Site Infections (SSIs) are among the frequently reported healthcare-acquired infections worldwide. Successful treatment of SSIs is affected by the continuous evolvement of drug-resistant microbes. This study investigated the incidence of SSIs, identifying the major etiologic agents and their drug resistance patterns in Yekatit 12 Hospital, Ethiopia.

Methods:

A cross-sectional study was conducted on 649 patients who underwent surgery at Yekatit 12 hospital from April 2016 to April 2017. Socio-demographic and clinical data were collected from each patient on admission. After surgery, they were followed for SSI occurrence. SSI was initially diagnosed by a senior surgeon based on standard clinical criteria and then confirmed by culture. Isolates were tested for drug resistance according to the clinical and laboratory standards institute guideline.

Results:

Of the 649 study participants, 56% were females. Their age ranged from 9 months to 88 years with a median age of 37 years. The incidence of culture-confirmed SSI was 10.2% (66/649) where 73 isolates were recovered. About two-third of the isolates were Gram-positive bacteria. Staphylococcus aureus was the most frequently isolated (27/73, 37%) followed by Coagulase-negative staphylococci (18/73, 24.7%), Escherichia coli (11/73, 15.1%) and Klebsiella species (10/73, 13.7%). About 89% and 44% of S. aureus isolates were resistant to penicillin and trimethoprim-sulfamethoxazole, respectively. MRSA constituted 11% of the S. aureus isolates. All the Gram-negative isolates were resistant to ampicillin and trimethoprim-sulfamethoxazole but susceptible to amikacin and meropenem. Klebsiella species showed 70-100% resistance to ceftazidime, cefuroxime, augmentin, chloramphenicol, ciprofloxacin, cefepime and gentamicin. About 82% of E. coli isolates were resistant for chloramphenicol, cefepime, ceftazidime, augmentin, cefuroxime and 64% for gentamicin and ciprofloxacin.

Conclusion:

The incidence of surgical site infection in Yekatit 12 hospital is 10.2%. Most of the SSIs were due to Gram-positive bacteria. Gram-negative isolates showed high resistance to the most commonly prescribed drugs. No resistance was found for meropenem indicating the absence of carbapenem-resistant bacteria. SSI treatments should be guided by culture and drug resistance test. Better infection prevention practices and continuous surveillance of antimicrobial resistance in the hospital are recommended for better patient care.

Methicillin-resistant Staphylococcus aureus colonization in HIV patients of Arba Minch province, Ethiopia: Carriage rates, antibiotic resistance, and biofilm formation

Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a significant opportunistic pathogen among human immunodeficiency virus (HIV) patients of Ethiopia. This study aimed at delineating the prevalence, antimicrobial resistance, and biofilm-forming potentials of nasally colonized MRSA among HIV patients in the Arba Minch province of Ethiopia. A cross-sectional study was performed in HIV patients who visit anti-retroviral therapy clinic of the Arba Minch Hospital between February and April 2017. Nasal samples were collected and inspected for Staphylococcus following standard procedures. MRSA was identified using cefoxitin disk and antibiotics sensitivity test was performed as per Kirby-Baur disk diffusion method. The formation of biofilm was inspected using both qualitative and quantitative methods. A total of 307 HIV patients were examined. The overall prevalence of S. aureus was found to be 39.7%. The prevalence of MRSA was 20.8%. The rate of nasal colonization of MRSA was relatively higher among females. In bivariate analysis, MRSA colonization was statistically significant in patients with CD₄ count ≤350 (p value = 0.002) and co-trimoxazole prophylaxis (p value = 0.003). Concomitant resistance to erythromycin, tetracycline, and co-trimoxazole were 48.4%, 45.3%, and 39.0%, respectively. Invariably, all MRSA isolates were 100% sensitive to vancomycin. Of the 64 MRSA isolates, 18.7% were considered as multidrug-resistant. The rate of biofilm formation was 34.3%. The results revealed a high prevalence rate in the nasal colonization of MRSA in HIV patients.

Microbial epidemiology and antimicrobial resistance patterns of wound infection in Ethiopia: a meta-analysis of laboratory-based cross-sectional studies

BACKGROUND

Wound infections are responsible for significant human morbidity and mortality worldwide. Specifically, surgical site infections are the third most commonly reported nosocomial infections accounting approximately a quarter of such infections. This systematic review and meta-analysis is, therefore, aimed to determine microbial profiles cultured from wound samples and their antimicrobial resistance patterns in Ethiopia.

METHODS

Literature search was carried out through visiting electronic databases and indexing services including PubMed, MEDLINE, EMBASE, CINAHL, and Google Scholar. Original records, available online from 2000 to 2018, addressing the research question and written in English were identified and screened. The relevant data were extracted from included studies using a format prepared in Microsoft Excel and exported to STATA 15.0 software for analyses of outcome measures and subgrouping. Der-Simonian-Laird's random effects model was applied for pooled estimation of outcome measures at 95% confidence level. Comprehensive meta-analysis version-3 software was used for assessing publication bias across studies. The study protocol is registered on PROSPERO with reference number ID: CRD42019117638.

RESULTS

A total of 21 studies with 4284 wound samples, 3012 positive wound cultures and 3598 bacterial isolates were included for systematic review and meta-analysis. The pooled culture positivity was found to be 70.0% (95% CI: 61, 79%). Regarding the bacterial isolates recovered, the pooled prevalence of S. aureus was 36% (95% CI: 29, 42%), from which 49% were methicillin resistant strains. The pooled estimate of E. coli isolates was about 13% (95% CI: 10, 16%) followed by P. aeruginosa, 9% (95% CI: 6, 12%), K. pneumoniae, 9% (95% CI: 6, 11%) and P. mirabilis, 8% (95% CI: 5, 11%). Compared to other antimicrobials, S. aureus has showed lower estimates of resistance against ciprofloxacin, 12% (95% CI: 8, 16%) and gentamicin, 13% (95% CI: 8, 18%). E. coli isolates exhibited the highest point estimate of resistance towards ampicillin (P = 84%; 95% CI: 76, 91%). Gentamicin and ciprofloxacin showed relatively lower estimates of resistance with pooled prevalence being 24% (95% CI: 16, 33%) and 27% (95% CI: 16, 37%), respectively. Likewise, P. aeruginosa showed the lowest pooled estimates of resistance against ciprofloxacin (P = 16%; 95% CI: 9, 24%).

CONCLUSION

Generally, the wound culture positivity was found very high indicating the likelihood of poly-microbial contamination. S. aureus is by far the most common bacterial isolate recovered from wound infection. The high estimate of resistance was observed among β-lactam antibiotics in all bacterial isolates. Ciprofloxacin and gentamicin were relatively effective in treating wound infections with poly-microbial etiology.

Methicillin- and Inducible Clindamycin-Resistant Staphylococcus aureus among Patients with Wound Infection Attending Arba Minch Hospital, South Ethiopia

Background

Wound infection is one of the most common hospital-acquired infections. Different bacteria cause infection, of which Staphylococcus aureus is one of the known bacteria in causing infection with increased drug-resistant isolates.

Objective

To assess the prevalence and antimicrobial susceptibility pattern of methicillin and inducible clindamycin-resistant Staphylococcus aureus among patients with wound infections attending Arba Minch Hospital.

Methods

A facility-based cross-sectional study was conducted from April to June 2017. A pretested questionnaire was used to collect demographic data and clinical characteristics. Wound swabs were cultured and identified by standard techniques. Antibiotic susceptibility tests were performed by the Kirby–Bauer disc diffusion method. Methicillin resistance was detected using the cefoxitin (30 μg) antibiotic disc while inducible clindamycin resistance was detected by the D-zone test. The data were analyzed using Statistical Package for Social Science, version 20. p value <0.05 was considered statistically significant.

Results

A total of 161 patients were enrolled and a majority of them were female (90, 50.9%). Among the collected samples, 79 (49.7%) were positive for S. aureus; of this, methicillin resistance accounted for 65 (82.3%). Out of 22 (27.8%) erythromycin-resistant isolates, 19 (24.1%) showed inducible clindamycin resistance. Methicillin-resistant S. aureus showed higher resistance against tetracycline (72.3%) followed by cotrimoxazole (43.1%) and 100% sensitivity to vancomycin. The overall prevalence of inducible clindamycin resistance among methicillin-resistant isolates was 16 (24.6%).

Conclusion

The increasing prevalence of methicillin-resistant S. aureus and the coresistance against other therapeutic options like clindamycin is becoming an obstacle in the treatment of infections which need attention from concerned bodies.

A systematic review of healthcare-associated infections in Africa: An antimicrobial resistance perspective

Background

Healthcare-associated infection (HCAI) is a global health challenge, not only as an issue of patient safety but also as a major driver of antimicrobial resistance (AMR). It is a major cause of morbidity and mortality with economic consequences.

Objective

This review provides an update on the occurrence of HCAI, as well as the contribution of emerging AMR on healthcare delivery in Africa.

Methods

We searched PubMed, Cochrane database, African Journals Online and Google Scholar for relevant articles on HCAI in Africa between 2010 and 2017. Preferred reporting items of systematic reviews and meta-analyses guidelines were followed for selection. Thirty-five eligible articles were considered for the qualitative synthesis.

Results

Of the 35 eligible articles, more than half (n = 21, 60%) were from East Africa. Klebsiella spp., Staphylococcus aureus, Escherichia coli and Pseudomonas spp. were the common pathogens reported in bloodstream infection, (catheter-associated) urinary tract infection, surgical site infection and healthcare-associated pneumonia. Among these various subtypes of HCAI, methicillin-resistant S. aureus (3.9% – 56.8%) and extended-spectrum beta-lactamase producing Gram-negative bacilli (1.9% – 53.0%) were the most reported antimicrobial resistant pathogens.

Conclusion

This review shows a paucity of HCAI surveillance in Africa and an emergence of AMR priority pathogens. Hence, there is a need for a coordinated national and regional surveillance of both HCAI and AMR in Africa.

Assessment of knowledge and practices of healthcare workers towards infection prevention and associated factors in healthcare facilities of West Arsi District, Southeast Ethiopia: a facility-based cross-sectional study

Background

The prevention of healthcare associated infections is central to the provision of safe, high quality healthcare. Infections acquired in healthcare facilities are a major public health concern, contributing to increased morbidity, mortality, and cost in both developed and developing countries. Although most of these infections can be prevented with relatively inexpensive infection prevention and control measures in many developing countries, in sub-Saharan African healthcare facilities have no effective infection prevention programs. Additionally, there is limited information on healthcare worker infection prevention knowledge and practice in countries such as Ethiopia. The aim of this study was to assess the knowledge and practices of healthcare workers with respect to infection prevention and associated factors in healthcare facilities in southeast Ethiopia.

Methods

A facility-based cross-sectional study design was used to study healthcare workers in the southeast, Ethiopia. Multi-stage sampling was employed to select 680 healthcare workers from 30 randomly selected healthcare facilities. Data was collected using a self-administered structured questionnaire. Descriptive statistics were computed. Multivariable logistic regression was performed to identify factors associated with healthcare workers infection prevention knowledge and practice.

Results

A total of 648 healthcare workers participated in this study, for a response rate of 95.3%. Of these, 53.7% (95% CI: 49.8, 57.4%) and 36.3% (95% CI: 32.4, 40.1%) of the respondents were assessed as knowledgeable and reported safe infection prevention practices respectively. The likelihood of self-reporting safe infection prevention practice significantly increased if healthcare workers had received training (AOR = 5.31; 95% CI: 2.42,11.63) and had infection prevention guidelines available (AOR = 3.34; 95% CI: 1.65, 6.76). Healthcare workers were more likely to have infection prevention knowledge if they worked longer ten years or more (AOR = 3.41; 95% CI: 1.22, 9.55); worked in facilities with infection prevention committees (AOR = 1.78; 95% CI: 1.01, 3.13), had infection prevention guidelines available (AOR = 2.44; 95% CI: 1.45, 4.12); had training (AOR = 5.02; 95% CI: 1.45, 8.59).

Conclusions

Inadequate infection prevention knowledge and unsafe practices were frequent among study participants, reflecting a potentially common problem at public healthcare facilities in southeast Ethiopia. Healthcare workers have better knowledge and safer practices if they had received infection prevention training and had infection prevention guidelines in their workplace. Interventions should be designed to consider these identified factors.

Antimicrobial resistance profile of Staphylococcus aureus isolated from patients with infection at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

BACKGROUND

Staphylococcus aureus is one of the major pathogens of public health importance responsible for various forms of infection. Development of resistance to commonly used antimicrobials limited treatment options against infections due to this pathogen. Antimicrobial resistance profile of Staphylococcus aureus isolated from patients with surgical site infection and ear infection and corresponding nasal swab was investigated in Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia.

METHODS

Wound and corresponding nasal swabs from patients with surgical site infection from general surgery ward (n = 14), orthopedic ward (n = 21) and those with otitis media (n = 59) from Ear Nose and Throat (ENT) ward were cultured for S. aureus isolation according to standard procedures from December 2013 to June 2014. Isolates were investigated for susceptibility to panel of 17 antimicrobials using Kirby Bauer disc diffusion assay. Susceptibility to methicillin was phenotypically determined based on sensitivity of isolates to cefoxitin and oxacillin.

RESULTS

A total of 79 S. aureus isolates were recovered from 54(57.4%) of patients. The isolates were resistant to ampicillin (100%), oxacillin and cefoxitin (68.4%, each), clindamycin (63.3%), cephalothin (59.5%), tetracycline (57%), sulfamethoxazole + trimethoprim and bacitracin (53.2%, each), and erythromycin (51.9%). Resistance to two or more antimicrobials was recorded in 74 (95%) of the isolates, while resistance to 3 or more antimicrobials was detected in 65(82.3%) of the isolates. Fifty-four (68.4%) of the isolates were methicillin resistant S. aureus (MRSA). Rate of occurrence of MRSA was more common among isolates from surgical wards (p < 0.001) compared to those from ENT ward. High level of multi-drug resistance (MDR) was detected more commonly among isolates from orthopedic ward than those from general surgical ward and patients with ear infection (p < 0.001). One of the isolate cultured from wound swab of a patient with surgical site infection from orthopedic ward was resistant to all of the 17 antimicrobials tested.

CONCLUSION

S. aureus isolates from patients in TASH exhibited resistance to majority of antimicrobials commonly employed for the treatment of staphylococcal infections which calls for urgent need of prudent use of antimicrobials and the need for implementation of effective infection control practices to hamper spread of MDR S. aureus.

Resistance of Staphylococcus aureus to antimicrobial agents in Ethiopia: a meta-analysis

Background

Emergence of antimicrobial resistance by Staphylococcus aureus has limited treatment options against its infections. The purpose of this study was to determine the pooled prevalence of resistance to different antimicrobial agents by S. aureus in Ethiopia.

Methods

Web-based search was conducted in the databases of PubMed, Google Scholar, Hinari, Scopus and the Directory of Open Access Journals (DOAJ) to identify potentially eligible published studies. Required data were extracted and entered into Excel spread sheet. Statistical analyses were performed using Stata version 13.0. The metaprop Stata command was used to pool prevalence values. Twenty-one separate meta-analysis were done to estimate the pooled prevalence of the resistance of S. aureus to twenty-one different antimicrobial agents. Heterogeneity among the studies was assessed using the I² statistic and chi-square test. Publication bias was assessed using Egger’s test. Because of significant heterogeneity amongst the studies, the random effects model was used to pool prevalence values.

Results

The electronic database search yielded 1317 studies among which 45 studies met our inclusion criteria. Our analyses demonstrated very high level of resistance to amoxicillin (77% [95% confidence interval (CI): 68%, 0.85%]), penicillin (76% [95% CI: 67%, 84%]), ampicillin (75% [95% CI: 65%, 85%]), tetracycline (62% [95% CI: 55%, 68%]), methicillin (47% [95% CI: 33%, 61%]), cotrimoxaziole (47% [95% CI: 40%, 55%]), doxycycline (43% [95% CI: 26%, 60%]), and erythromycin (41% [95% CI: 29%, 54%]). Relatively low prevalence of resistance was observed with kanamycin (14% [95% CI: 5%, 25%]) and ciprofloxacin (19% [95% CI: 13%, 26%]). The resistance level to vancomycin is 11% 995% CI: (4%, 20%). High heterogeneity was observed for each of the meta-analysis performed (I² ranging from 79.36% to 95.93%; all p-values ≤0.01). Eggers’ test did not show a significant publication bias for all antimicrobial agents except for erythromycin and ampicillin.

Conclusions

S. aureus in Ethiopia has gotten notoriously resistant to almost to all of antimicrobial agents in use including, penicillin, cephalosporins, tetracyclines, chloramphenicol, methicillin, vancomycin and sulphonamides. The resistance level to vancomycin is bothersome and requires a due attention. Continued and multidimensional efforts of antimicrobial stewardship program promoting rational use of antibiotics, infection prevention and containment of AMR are urgently needed.

Electronic supplementary material

The online version of this article (doi:10.1186/s13756-017-0243-7) contains supplementary material, which is available to authorized users.

Methicillin resistant Staphylococcus aureus in Ethiopia: a meta-analysis

Background

The burden of methicillin resistant Staphylococcus aureus is a major public health concern worldwide; however the overall epidemiology of multidrug resistant strains is neither coordinated nor harmonized, particularly in developing countries including Ethiopia. Therefore, the aim of this meta-analysis was to assess the burden of methicillin resistant Staphylococcos aureus and its antibiotic resistance pattern in Ethiopia at large.

Methods

PubMed, Google Scholar, and lancet databases were searched and a total of 20 studies have been selected for meta-analysis. Six authors have independently extracts data on the prevalence of methicillin resistant Staphylococcus aureus among clinical isolates of Staphylococcus aureus. Statistical analysis was achieved by using Open meta-analyst (version 3.13) and Comprehensive meta-analysis (version 3.3) softwares. The overall prevalence of methicillin resistant Staphylococcus aureus and its antibiotic resistance pattern were pooled by using the forest plot, table and figure with 95% CI.

Results

The pooled prevalence of methicillin resistant Staphylococcus aureus was 32.5% (95% CI, 24.1 to 40.9%). Moreover, methicillin resistant Staphylococcus aureus strains were found to be highly resistant to penicillin, ampicillin, erythromycin, and amoxicillin, with a pooled resistance ratio of 99.1, 98.1, 97.2 and 97.1%, respectively. On the other hand, comparably low levels of resistance ratio were noted to vancomycin, 5.3%.

Conclusion

The overall burden of methicillin resistant Staphylococcus aureus is considerably high, besides these strains showed extreme resistance to penicillin, ampicillin, erythromycin and amoxicillin. In principle, appropriate use of antibiotics, applying safety precautions are the key to reduce the spread of multidrug resistant strains, methicillin resistant Staphylococcus aureus in particular.

Healthcare Associated Infections of Methicillin-Resistant Staphylococcus aureus: A Case-Control-Control Study

BACKGROUND

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most widespread and dangerous pathogens in healthcare settings. We carried out this case-control-control study at a tertiary care hospital in Guangzhou, China, to examine the antimicrobial susceptibility patterns, risk factors and clinical outcomes of MRSA infections.

METHODS

A total of 57 MRSA patients, 116 methicillin-susceptible Staphylococcus aureus (MSSA) patients and 102 S. aureus negative patients were included in this study. We applied the disk diffusion method to compare the antimicrobial susceptibilities of 18 antibiotics between MRSA and MSSA isolates. Risk factors of MRSA infections were evaluated using univariate and multivariate logistic regression models. We used Cox proportional hazards models and logistic regression analysis to assess the hospital stay duration and fatality for patients with MRSA infections.

RESULTS

The MRSA group had significantly higher resistance rates for most drugs tested compared with the MSSA group. Using MSSA patients as controls, the following independent risk factors of MRSA infections were identified: 3 or more prior hospitalizations (OR 2.8, 95% CI 1.3-5.8, P = 0.007), chronic obstructive pulmonary disease (OR 5.9, 95% CI 1.7-20.7, P = 0.006), and use of a respirator (OR 3.6, 95% CI 1.0-12.9, P = 0.046). With the S. aureus negative patients as controls, use of a respirator (OR 3.8, 95% CI 1.0-13.9, P = 0.047) and tracheal intubation (OR 8.2, 95% CI 1.5-45.1, P = 0.016) were significant risk factors for MRSA infections. MRSA patients had a longer hospital stay duration and higher fatality in comparison with those in the two control groups.

CONCLUSIONS

MRSA infections substantially increase hospital stay duration and fatality. Thus, MRSA infections are serious issues in this healthcare setting and should receive more attention from clinicians.