Browsing by Author "Daniel Beshah"

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    Epidemiological and Molecular Characterization of Multi-Drug Resistant Gram-Negative Bacterial Isolates from Bloodstream Infections Among Patients Admitted at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
    (Addis Ababa University, 2024-03) Daniel Beshah; Adey Desta; Tesfaye Sisay; Gurja Belay
    Bloodstream infections are the major causes of morbidity and mortality worldwide. Alarmingly, Gram-negative bacteria that produce beta-lactamase and carbapenemase are causes for the rapid global spread of multi-drug resistance (MDR), which significantly jeopardizes the efficacy of existing antimicrobial treatments. This research aimed to analyze the microbial profile, antimicrobial susceptibility, genomic diversity, and associated risk factors of Gram-negative bacteria in bloodstream infections. A cross-sectional study was conducted between September 2018 and March 2019 on 1486 bloodstream infection suspected patients. In addition to biochemical identification and antimicrobial susceptibility tests, PCR and WGS were conducted for ESBL, AmpC, MBL and carbapenemase producing resistance genes. The prevalence of bloodstream infection was 417 (28.06%), and the most prevalent bacterial species were Klebsiella pneumoniae (17.6%) and Acinetobacter spp. (11%). Culture positivity was associated with age below 6 years, ICU admission, length of admission > 5 days, temperature greater than 38 oC, instrument usage during medical care, chronic illness, and neonatal incubation. Multi-drug resistance was 95% where 56%, 32% and 7% of the isolates exhibited MDR, XDR, and PDR respectively. Klebsiella pneumoniae and Acinetobacter sp. showed the greatest rates of XDR (37%) and PDR (77%), respectively. Among the 231 phenotypically characterized isolates, 195 (84%) drug-hydrolyzing enzyme producers, 54% and 26% were ESBL and carbapenemase-producer, respectively. Again, Klebsiella pneumoniae was the highest drug-hydrolyzing enzyme-producer bacteria. 176 out of the 195 (76%) were PCR-confirmed resistant bacteria, of which ESBLs, MBLs, carbapenemase, and AmpC-BLs accounted for 53%, 22%, 20%, and 10%, respectively and blaCTX-M, blaFOXM, blaOXA-23, and blaNDM were the highest hits in Klebsiella pneumoniae, (75%), and Escherichia coli (24%). Out of the 142 whole genome sequenced isolates, 1604 genes categorized into 168 resistance classed were identified. A total of 1055 virulence genes were identified belonging to 133 types. The majority of AMR genes and virulent genes were observed in Klebsiella pneumoniae (40%) and E. coli (71%), respectively. Sul2 was the most prevalent gene (%), followed by blaCTX-M-15 (5%), and aph (3'')-Ib (5%). fimH (6%), iutA (6%), and traT (5%) were the most prevalent virulent genes. The most common ESBL producer genes were blaCTX-M-15 (7%) and blaTEM-1B (6%) and the most common AmpC genes were blaCMY-2 (2%) and blaCMY-6 (1%). The highest carbapenemase genes were blaOXA-23 (3%), blaOXA-66 (3%), blaNDM-1 (2%), and blaOXA-1 (2%). In 82 (58%) of the sequenced strains, eight types of gene mutations were identified: parC (30%), gyrA (30%), ramR (1%), rpoB (1%), ompK37 (45%), acrR (43%), and ompK36 (43%) with a total of 220 antimicrobial gene mutations and 956-point mutations. However, 22 (2%) of the mutations were frameshift mutations and the rest 934 were point mutations. Among the 142 drug-resistant strains, 103 (73%) have plasmid mlst, and 108 (76%) have plasmid genes. Resistance to disinfectants like benzalkonium chloride 77(52%) and cetylpyridinium chloride 77(52%) had OqxA 41(29%), OqxB 41(29%), and qacE 49(35%) disinfectant-resistant genes. Like other AMR genes, NICU (B6) still has the leading prevalence of disinfectant resistance genes (22%) followed by C/W (9%) and pediatric hematology (D7) (8%). The study showed AMR has become a significant health hazard of bloodstream infection that most affects neonatal and ICU patients. The alarming result of this study was 7% PDR bacteria. The NICU by ESBL and SICU, General surgery, and caesarian section units by Carbapenemase producer strains were affected. A high burden of ESBL and Carbapenemase was seen in this study The predominant ESBL, MBLs, and Carbapenemase genes were blaCTX-M, blaNDM, and blaOXA-23 respectively. Nine novel drug-resistant bacteria strains were identified. Surgical and inserted medical instruments are the main drug-resistant bacteria transmission roots. Carbapenemase and MBL drug-resistant genes were associated with NICU, general surgery, SICU, and C/S unit which needs infection prevention standard implementation.
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    Epidemiological and Molecular Characterization of Multi-Drug Resistant Gram-Negative Bacterial Isolates from Bloodstream Infections Among Patients Admitted at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia
    (Addis Ababa University, 2024-03) Daniel Beshah; Adey Desta; Tesfaye Sisay; Gurja Belay
    Bloodstream infections are the major causes of morbidity and mortality worldwide. Alarmingly, Gram-negative bacteria that produce beta-lactamase and carbapenemase are causes for the rapid global spread of multi-drug resistance (MDR), which significantly jeopardizes the efficacy of existing antimicrobial treatments. This research aimed to analyze the microbial profile, antimicrobial susceptibility, genomic diversity, and associated risk factors of Gram-negative bacteria in bloodstream infections. A cross-sectional study was conducted between September 2018 and March 2019 on 1486 bloodstream infection suspected patients. In addition to biochemical identification and antimicrobial susceptibility tests, PCR and WGS were conducted for ESBL, AmpC, MBL and carbapenemase producing resistance genes. The prevalence of bloodstream infection was 417 (28.06%), and the most prevalent bacterial species were Klebsiella pneumoniae (17.6%) and Acinetobacter spp. (11%). Culture positivity was associated with age below 6 years, ICU admission, length of admission > 5 days, temperature greater than 38 oC, instrument usage during medical care, chronic illness, and neonatal incubation. Multi-drug resistance was 95% where 56%, 32% and 7% of the isolates exhibited MDR, XDR, and PDR respectively. Klebsiella pneumoniae and Acinetobacter sp. showed the greatest rates of XDR (37%) and PDR (77%), respectively. Among the 231 phenotypically characterized isolates, 195 (84%) drug-hydrolyzing enzyme producers, 54% and 26% were ESBL and carbapenemase-producer, respectively. Again, Klebsiella pneumoniae was the highest drug-hydrolyzing enzyme-producer bacteria. 176 out of the 195 (76%) were PCR-confirmed resistant bacteria, of which ESBLs, MBLs, carbapenemase, and AmpC-BLs accounted for 53%, 22%, 20%, and 10%, respectively and blaCTX-M, blaFOXM, blaOXA-23, and blaNDM were the highest hits in Klebsiella pneumoniae, (75%), and Escherichia coli (24%). Out of the 142 whole genome sequenced isolates, 1604 genes categorized into 168 resistance classed were identified. A total of 1055 virulence genes were identified belonging to 133 types. The majority of AMR genes and virulent genes were observed in Klebsiella pneumoniae (40%) and E. coli (71%), respectively. Sul2 was the most prevalent gene (%), followed by blaCTX-M-15 (5%), and aph (3'')-Ib (5%). fimH (6%), iutA (6%), and traT (5%) were the most prevalent virulent genes. The most common ESBL producer genes were blaCTX-M-15 (7%) and blaTEM-1B (6%) and the most common AmpC genes were blaCMY-2 (2%) and blaCMY-6 (1%). The highest carbapenemase genes were blaOXA-23 (3%), blaOXA-66 (3%), blaNDM-1 (2%), and blaOXA-1 (2%). In 82 (58%) of the sequenced strains, eight types of gene mutations were identified: parC (30%), gyrA (30%), ramR (1%), rpoB (1%), ompK37 (45%), acrR (43%), and ompK36 (43%) with a total of 220 antimicrobial gene mutations and 956-point mutations. However, 22 (2%) of the mutations were frameshift mutations and the rest 934 were point mutations. Among the 142 drug-resistant strains, 103 (73%) have plasmid mlst, and 108 (76%) have plasmid genes. Resistance to disinfectants like benzalkonium chloride 77(52%) and cetylpyridinium chloride 77(52%) had OqxA 41(29%), OqxB 41(29%), and qacE 49(35%) disinfectant-resistant genes. Like other AMR genes, NICU (B6) still has the leading prevalence of disinfectant resistance genes (22%) followed by C/W (9%) and pediatric hematology (D7) (8%). The study showed AMR has become a significant health hazard of bloodstream infection that most affects neonatal and ICU patients. The alarming result of this study was 7% PDR bacteria. The NICU by ESBL and SICU, General surgery, and caesarian section units by Carbapenemase producer strains were affected. A high burden of ESBL and Carbapenemase was seen in this study The predominant ESBL, MBLs, and Carbapenemase genes were blaCTX-M, blaNDM, and blaOXA-23 respectively. Nine novel drug-resistant bacteria strains were identified. Surgical and inserted medical instruments are the main drug-resistant bacteria transmission roots. Carbapenemase and MBL drug-resistant genes were associated with NICU, general surgery, SICU, and C/S unit which needs infection prevention standard implementation.
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    Laboratory Personnel Occupational Stress, Workload and Associated Factors in Selected Public and Private Health Facility at Addis Ababa, Ethiopia.
    (Addis Ababa University, 2025-10) Abel Tsegaye; Daniel Beshah; Alemayehu Nigatu
    Background: Laboratory personnel plays a vital role in almost every aspect of patient care, from prevention to diagnosis and treatment. However, rising level of stress among them are becoming a public health concern. Heavy workload and job demand are leading to increase stress, which negatively impact job performance, satisfaction and overall well-being. Feeling of overwhelmed and anxious reduces staff ability to effectively manage their responsibilities. Objective: To assess the occupational stress, perceived workload, and associated factors in selected public and private health facilities in Addis Ababa, Ethiopia, in 2025. Method: Facility based cross-sectional study was conducted from January to April 2025 using quantitative and qualitative data from 411 laboratory professionals selected through convenience sampling. Data were collected using self-administered questionnaires and interviews. To assess occupational stress and workload, perceived stress scale measurement and NASA Task Load Index were employed respectively. Data was entered and analyzed by using the Statistical Package for Social Sciences (SPSS) program version 27. Logistic regression was employed to examine the association between dependent and independent variables. In multivariate analysis, a P-value of less than 0.05 were considered statistically significant. Qualitative data was analyzed by using thematic approach. Result: This study had a total of 411 respondents with a 97.4% response rate. The overall prevalence of occupational stress was 40.6% with 46.6% among public facility and 34.6% of private facility laboratory professionals. Gender, monthly income, and training were significantly associated with occupational stress. The overall prevalence of high workload in this study was 51.8%, with 59.2% public and 44.4% private health facilities. Work experience, and facility type were significantly associated with workload Conclusion and Recommendation: Laboratory professionals are experiencing high level of stress and workload. Improving staffing levels, using LIS, having fair inclusive risk allowances, and increasing salaries would help to reduce occupational stress and workload