Browsing by Author "Azerefegne,Eskedar Ferdu"

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    Assessing the Prevalence of Multidrug Resistant Gram-Negative Bacteria and Associated Factors among Gram-negative Blood Culture Isolates at Tikur Anbessa Specialized Hospital: A Retrospective Study
    (Addis Ababa University, 2023-05) Azerefegne,Eskedar Ferdu; Amogne,Wondwossen(MD, PHD)
    Background The rate of Multidrug resistant gram-negative bacteria causing bloodstream infection is increasing. The lack of control of access to antibiotics and restriction and weak antimicrobial stewardship in Sub-Saharan Africa makes antimicrobial resistance one of the current deadliest health care agendas. Continuous surveillance of the prevalence of AMR, identifying risk factors and implementing infection prevention is a priority. Objectives The aim of this study was to determine prevalence, bacteriologic profile, and associated risk factors of MDR-gram negative isolates and Carbapenem resistant gram-negative BSI admitted patients of Tikur Anbesa Specialized comprehensive Hospital, Addis Ababa, Ethiopia. Methods A single-center cross sectional retrospective study was conducted in medical wards of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia from September1,2021 until September 1, 2023. Gram-negative blood isolates of 137 patients were assessed. The clinical profiles with demographic information, underlying comorbidities, sites of admission(wards), sepsis or septic shock during admission use of instrumentations, surgical procedures, use of prior antibiotics and type, length of hospital stay, use of immunosuppressive therapy are compared to the gram-negative blood stream infection as risk factors. Furthermore, rates of multidrug resistance and carbapenem resistance are determined with related risk factors. The microbiology data for the specimens collected for culture was retrieved from the electronic record system LIS while clinical parameters were entered both from the electronic medical database and the medical cards of patients. The data was entered, and bivariate and multivariable analysis was done using SPSS Ver 26. Results A total of 137 gram-negative blood isolates from patients in the medical wards were assessed during the study period. The mean age of the patients with gram-negative blood culture and SD Age of 43.1±18.17 years. Most of the blood cultures were collected from the patients at the Emergency room (29.2%). Almost 25% percent of the study participants had prior antibiotics exposure in the preceding three months before the blood culture. One-third (33%) of the Enterobacterales isolated from the blood cultures were Escherichia coli (33%) followed by Klebsiella pneumoniae (30.1%). The Antimicrobial susceptibility testing revealed that the Enterobacterales isolates showed a higher resistance towards with E. coli resistance to third and fourth generation Cephalosporins with 96.8% (Ceftazidime), and 87.1%(Cefepime) respectively. Resistance towards Carbapenems was an alarming 58.1% (79 of 136 blood isolates tested) in our study. Enterobacterales were 52.4% resistant to Carbapenems. The overall MDR rate among the gram-negative blood isolates in our study was 81%. Most of the MDR isolates are Enterobacterales with 83.5% being MDR. The K. pneumoniae blood isolates had Carbapenem resistance rate of 77.4%, while E. coli blood isolates had 47.8%. Risk factors associated with MDR gram-negative bloodstream infection were hematologic malignancy (AOR=1.4, 95%CI=1.12, 4.27), Enterobacterales isolated from the blood (AOR 4.4, 95%CI=1.57, 34.18), blood isolates from the ICU (AOR=2.1, 95%CI=1.24, 16.56). Risk factors associated with carbapenem resistance in gram-negative BSI were immunosuppressive treatment (AOR=2.1, 95%CI=1.24, 3.78), patients having history of prior Cefepime(AOR=4.9, 95%CI=1.27, 41.24), CNS shunt device(AOR=12.4, 95%CI=4.26, 22.56) and having Acinetobacter Spp. (AOR=4.2, 95%CI=2.19, 14.63). Conclusion The study highlighted the growing prevalence of MDR and Carbapenem gram-negative bloodstream infections in a hospital with limited resources. Our findings emphasize the urgent need for effective antimicrobial surveillance and infection control measures throughout the country.