Bacteriological Profiles, Antimicrobial Susceptibility Patterns, and Associated Factors in Patients Undergoing Orthopedic Surgery with Suspicion of Surgical Site Infection at Arba Minch General Hospital in Southern Ethiopia

Antimicrobial resistance pattern of Acinetobacter baumannii clinical isolate in Ethiopia. A systematic review and meta-analysis

BACKGROUND

Antimicrobial resistance (AMR) is a growing global health threat. Acinetobacter baumannii (A. baumannii) emerged as one of the most concerning critical priority pathogens due to its ability to develop resistance to multiple antimicrobial agents. In Ethiopia, the public health impact of AMR is increasingly significant, with A. baumannii responsible for a variety of infections. Although A. baumannii causes a range of infections in Ethiopian patients, the drug resistance status of the clinical isolates has not been thoroughly assessed. Therefore, this systematic review and meta-analysis aimed to determine the country-wide AMR of A. baumannii.

METHODS

This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted a search of articles on PubMed, Web of Science, Science Direct, Scopes electronic databases, Google Scholar search engine, and institutional repositories/libraries for studies published between 2015 and 2024. Eligible studies on A. baumannii-related infections and AMR in Ethiopia were assessed for quality using the Joanna Briggs Institute (JBI) criteria. Data on study characteristics were extracted, and statistical analyses, including heterogeneity (Invers of variance), publication bias (Eggers test), and subgroup analyses, were performed using STATA 17.0. A random effect model was used to compute the pooled prevalence of AMR.

RESULTS

This systematic review and meta-analysis of 26 Ethiopian studies (26,539 participants) found an A. baumannii prevalence of 3.99% (95% CI: 3.01-4.98%) and 9.13% of all bacterial infections (95% CI: 6.73-11.54%). The most common infections were surgical site infections, urinary tract infections, pneumonia, and sepsis. Pooled resistance to antibiotics varied, with amikacin showing the lowest resistance (20.27%) (95% CI: 11.51-29.03) and cefotaxime the highest (83.18) (95% CI: 71.87-94.48). A pooled multi-drug resistant (MDR) A. baumannii was found in 88.22% (95% CI: 82.28-94.15) of isolates, with regional and infection-type variations, particularly in higher prevalence in Oromia and Amhara regions and sepsis cases.

CONCLUSION

This systematic review underscores the alarming rise of antimicrobial resistance in A. baumannii, particularly against carbapenems. The findings highlight a high prevalence of MDR A. baumannii and widespread extended-spectrum beta-lactamase production, with notable regional variations in resistance patterns. These high resistance rates reinforce A. baumannii as a critical global health threat, necessitating urgent interventions such as enhanced antimicrobial stewardship programs, improved infection control measures, and the development of alternative treatment strategies. Healthcare professionals, policymakers, and researchers must collaborate to mitigate the clinical and public health impact of this pathogen.

PROTOCOL REGISTRATION

This systematic review and meta-analysis was registered on PROSPERO (Registration ID: CRD42024623927).

Magnitude of Health Care Associated Infections and its Clinical Predictors in Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND

Health care-acquired infections (HCAIs) are the growing global public health problems facing today requiring an immediate collaborative action of stockholders to be prevented and controlled. Thus, this study was aimed to assess the magnitude and clinical related factors of HCAIs in Ethiopia.

METHODS

Articles were extensively searched in bibliographic databases and grey literatures using entry terms or phrases. Studies meeting eligibility criteria was extracted in Ms excel and exported in to STATA version 17 software for statistical analysis. A random-effect model was used to compute the pooled magnitude of HCAIs using meta-prop. The heterogeneity was quantified by using the I2 value. Publication bias was assessed using a funnel plot and Egger's test. Sensitivity analysis, meta-regression and subgroup analysis were computed.

RESULT

Of the 1707 studies identified, 33 studies were selected for meta-analysis of magnitude of HCAIs. The overall pooled prevalence of HCAIs in Ethiopia was 37% (95% CI: 27.0-47.0%). The predominant bacterial aetiologies were E. coli. There was no single study effect and publication bias. Diabetes mellitus, comorbidities, contaminated wound, history of UTI and history of admission in ICU were statistically significant clinical predictors of HCAIs.

CONCLUSION

the pooled prevalence of HCAIs have alarmingly increased which underscores the importance of implementation of personalized infection prevention and control approach which identifies patients at risk of HCAIs from the point of admission maximizes the potential for prevention of HCAIs.

Bacterial surgical site infections: prevalence, antimicrobial susceptibility patterns, and associated risk factors among patients at Bule Hora University Teaching Hospital, Southern Ethiopia

Objectives

Surgical site infections occur within 30 days of an invasive surgical procedure in the parts of the body where the surgery is performed. Therefore, this study aimed to determine the prevalence, antimicrobial susceptibility patterns, and associated risk factors of surgical site infections at Bule Hora University Teaching Hospital, Southern Ethiopia.

Methods

An institution-based cross-sectional study was conducted with 183 consecutively enrolled participants between 1 January and 30 June 2023. Microbiological identification and antimicrobial susceptibility testing of the organisms isolated from clinical samples were performed aseptically. Data were collected using a questionnaire and analysed using SPSS version 26.

Results

The overall prevalence of surgical site infections was 15.8% (95% CI, 10.9-22). The predominant isolate was Staphylococcus aureus (n = 14; 34.1%). There were 18 (43.9%) multidrug-resistant isolates. Age group >54 (adjusted odds ratio [AOR] = 4.76, 95% CI, 1.10-20.560), hospital stay ≥10 days (AOR = 2.66, 95% CI, 1.06-6.66],), operation duration ≥2 hours (AOR = 2.64, 95% CI, 1.01-6.90), clean-contaminated wound (AOR = 3.17, 95% CI, 1.21-8.30), open surgical site (AOR = 2.64, 95% CI, 1.02-6.86), and malnutrition (AOR = 4.3, 95% CI, 1.42-12.97) were significantly associated with surgical site infections.

Conclusions

The prevalence of surgical site infections and multidrug-resistant isolates is higher compared with World Health Organisation reports or previous studies. This finding emphasises the need for routine screening and antimicrobial susceptibility testing to prevent and control site infections.

Microbiological Profile and Outcome of Surgical Site Infections Following Orthopedic Surgeries in a Tertiary Care Hospital

Surgical site infections (SSIs) are one of the most common adverse events that occur in hospitalized patients undergoing surgical procedures or in outpatient surgical measures, regardless of the advances in preventive procedures. SSI may lead to disastrous consequences in orthopedic practice as it may involve the joints and bones and is extremely difficult to get rid of the infection. The present study was designed to evaluate the rates, risk factors, microbiological profiles, and outcomes of SSIs following orthopedic procedures in patients admitted to a tertiary care hospital in Eastern India during the study period of September 2022 to March 2024. A total of 1327 patients who underwent orthopedic surgeries were followed up for the development of SSI, among whom 105 (7.9%) developed SSI, making an incidence rate of 7.9%. The incidence of SSI in different surgeries was 9.5% (34/359) in closed reduction with fixation, 8.5% (65/766) in open reduction with internal fixation, 4.4% (3/69) in hip arthroplasty, and 2.3% (3/133) in knee arthroplasty. Maximum (27.6%) patients having SSI were of the age group of 20-29 years, and 87.62% were males. The habit of smoking was found to be highly statistically significant. The common gram-positive organisms isolated were Staphylococcus aureus and Enterococcus species, which were mostly sensitive to vancomycin, linezolid, teicoplanin, and tigecycline. The common gram-negative organisms isolated were Klebsiella pneumoniae, Pseudomonas species, Escherichia coli, and Acinetobacter species, many of which were multidrug-resistant organisms and were sensitive to amikacin, amoxicillin-clavulanate, and ceftriaxone.

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.

Insights into the microbiological and virulence characteristics of bacteria in orthopaedic implant infections: A study from Pakistan

The exponential increase in the prevalence of multidrug resistant bacteria has resulted in limiting surgical treatment options globally, potentially causing biofilm-related complications, implant failure, and severe consequences. This study aims to isolate and characterize bacteria from post-surgical orthopaedic implant infections and screening for multiple antibiotic resistance. A cross-sectional study was conducted, involving isolation of forty-four dominant pathogenic bacterial isolates from 16 infected implant samples from across Islamabad and Rawalpindi. Out of forty-four, 38% cocci and 61% bacilli were obtained. Approximately 90% of isolates showed multiple antibiotic resistance (MAR) index of more than 0.2. Eleven strains were identified via 16S rRNA gene sequencing as Pseudomonas aeruginosa, Bacillus spp., Planococcus chinensis, Staphylococcus, Escherichia coli and Enterobacter cloacae. The bacterial strain E. coli MB641 showed sensitivity to Polymyxin only, and was resistant to all other antibiotics used. Maximum biofilm forming ability 0.532 ± 0.06, 0.55 ± 0.01 and 0.557 ± 0.07 was observed in Pseudomonas aeruginosa MB663, Pseudomonas aeruginosa MB664 and Bacillus spp. MB647 respectively after 24 hours of incubation. EPS production of bacterial strains was assessed, the polysaccharides and protein content of EPS were found to be in the range of 11-32 μg/ml and 2-10 μg/ml, respectively. Fourier transform infrared spectroscopic analysis of EPS showed the presence of carbohydrates, proteins, alkyl halides, and nucleic acids. X-ray diffraction analysis revealed crystalline structure of EPS extracted from biofilm forming bacteria. These findings suggest a high prevalence of antibiotic-resistant bacteria in orthopaedic implant-associated surgeries, highlighting the urgent need for ongoing monitoring and microorganism testing in infected implants.