Medical Microbiology

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Studies on Enteric Campylobacteriosis in Tikur Anbessa Hospital, Addis Ababa, Ethiopia
(Addis Ababa University, 1993-08) Asrat, Daniel; Ekwall, Erik(PhD); Hathaway, Audrey (PhD)
Between February 1992 and January 1993 Campylabaeter species were isolated from 86 (13.6%) of 630 patients with diarrhoea at Tikur Anbassa Hospital, Addis Ababa, Ethiopia. In the same study population, shigellae were found in 11.7% and salmonellae in 3.8%. Of the 345 paediatric patients, 72 (20.8%) and 13 (17.1 %) of the 76 controls less than 2 years of age had EPEC in their stools. No Yersinia enteroeolitiea was isolated. Campylobaeter species were found in all age groups, but the majority were isolated from children less than five years of age (68.6%). Only 2 (0.9%) of 220 controls had eampylobaeter in their stools. Of the campylobaeters that were differentiated at species level, C. j ejuni accounted for 82.4% and C. coli for 17.6% of the isolates. Serotyping of each strain was done, according to the methods of Lior, using 16 antisera against heat labile antigens; 89.3% of the C. jejuni and 75% of the C. coli were typeable. Lior serotypes 1, 2, 4. 5. 6 and 7 were the most common among the C. jejuni, while Lior serotypes I and 2 were dominant among the C.eoli isolates. These serotypes accounted for 63.2% of all isolates. More patients (53.1 %) presented for investigation of diarrhoea during the months of April through July but there was no significant difference in the isolation frequency of the enteric pathogens studied throughout the year. Concomitant isolation of Shigella or Salmonella species was achieved in 12 of the Campylobaeter infected patients. In general, eampylobaeter diaIThoea is not a severe disease . The most common symptoms and signs were watery diarrhoea in 82.4%, low grade fever in 78.4% and frequent vomiting in 45.9%. Dehydration ranging from mild to severe was observed in 25.4% of the 55 children with campylobaeter infections. VitI Of the 55 children 67.2% had signs of malnutrition and most of them (47.2%) were underweight. The antibiogram for 85 strains of the campylobacters isolated showed that all strains were sensitive to chloramphenicol, erythromycin, gentamicin, nalidixic acid, norfloxacin, sulphonamide and tetracycline. All of the strains were resistant to cephalothin, while 51 (60.0%) and 50 (58.8%) strains were resistant to ampicillin and trimethoprimsulphamethoxazole, respectively. This study indicates that campylobacters are an important cause of diarrhoea both in adults and children in Addis Ababa, and should be considered routinely in the diagnosis of patients with diarrhoea.
Aerobic Bacteria in Post-Surgical Wound Infection and Pattern of Their Antibiotic Susceptibility in Hawassa Teaching and Referral Hospital, Southern Ethiopia
(Addis Ababa University, 2001-05) Dessalegn, Lopiso; Gebre-Selassie, Solomon(PhD); Shemeles, Techalew
Background: Post-operative wound infections have been found to pose a major problem in the field of surgery for a long time. Advances in control of infections have not completely eradicated this problem because of development of drug resistance. This condition is serious in developing countries where irrational prescription of antimicrobial agents is common. Objective: To determine the distribution of common aerobic bacteria in post-surgical wound infected patients and their antimicrobial susceptibility patterns. Materials and Methods: This cross sectional study was carried out in a total of 194 patients with post surgical wound infections at Hawassa Teaching and Referral Hospital, from November 2010 to March 2011. Physicians collected data on socio-demography and clinical profiles using designed formats. Moreover, pus swabs were collected, processed and cultured using the standard bacteriological methods. Isolated organisms were tested for pattern of antimicrobial susceptibility using the standard disk diffusion method. The data were entered in to a computer and analyzed using SPSS Version-16 software. Results: The prevalence of aerobic bacteria was 71.1%, and majority of the isolates (59.3 %) were Gram-negative organisms. The most frequently isolated aerobic bacteria was S. aureus (37.3%), followed by E .coli (25.4%) and Klebsiella species (13.6%). All bacterial isolates were resistant to at least one antibiotic, and 86.4 % were resistant to more than one antibiotic (multiple drug resistance). Conclusion: Single and multiple drug resistance to the commonly used antibiotics in the study area was found to be very high leaving clinicians with a very few choices of drugs for the treatment of post surgical wound infected patients. Therefore, it is critical that use of antimicrobial agents with in hospitals, public healthcare providers as well as private ones should be reviewed and further studies to find out the overall resistance patterns and their possible causes and associated factors in the region at large need to be carried out. Key words: Aerobic bacteria, post-surgical wound, antimicrobial, susceptibility
Prevalence, Incidence and Risk Factors for Herpes Simplex Virus Type 2 Infection in Cohorts of Factory Workers, Akaki and Wonji, Ethiopia, 1997-2002
(Addis Ababa University, 2003-05) Kebede, Yenew; Dorigo, Wendelien(PhD); Mengistu, Yohannes(PhD)
Retrospective cohort study (1997-2002) was conducted to determine the prevalence, incidence and risk factors for Herpes simplex virus type 2 (HSV-2) infections among factory workers at two sites in Ethiopia. Among enrolled participants in a cohort study of HIV incidence and disease progression, 1222 (71.3%) were males and 491 (28.7%) were females. The median age was 35 years for males (range, 19-62) and 33 years (range, 19-46) for females. The serologic status of each stored plasma sample for HIV and syphilis has been routinely determined. Antibody to HSV-2 was detected by using the HerpeSelect TM 2 ELISA IgG, Focus Technologies, USA. The HSV-2 prevalence at enrollment was 41.1%, 57.2% among females and 34.6% among males (p<0.001). Seventeen-percent of females and 9.7% of males younger than 25 years had evidence of HSV-2 infection. Independent risk factors for HSV-2 seropositivity were HIV seropositivity, positive TPPA serology, older age, female sex, and ever being married. The incidence of HSV-2 during follow-up was 1.2/100 person-years (95%CI, 1.0-1.4), 2/100 person-years (95% CI, 1.2-3.2) among females and 0.9/100 personyears (95%CI, 0.7-1.3) among males (p=0.02, assuming Poisson distribution). Positive HIV serology at enrollment was an independent risk factor for HSV-2 seroconversion (adjusted hazard ratio [HR], 2.5; 95% CI, 1.1-5.6). Most of HSV-2 infections were asymptomatic or had minor symptoms, which were not recognized. The study showed high prevalence and incidence of HSV-2 infection. This large number of herpes infected individuals may continue to engage in unprotected sexual activity despite their infection facilitating the sexual transmission of HSV-2 and HIV making the vicious cycle. In the absence of protective vaccine or effective antiviral therapy, prevention of HSV-2 infection will rely on the widespread use of condoms and reduction in the number of sexual partners with emphasis to prevention of HSV-2 infection at early ages. Key words: HSV-2, incidence, prevalence, seroconversion, Ethiopia
Assessment of Bacterial Profile and Antimicrobial Susceptibility Pattern of Catheter-Associated Urinary Tract Infections in Comparison with non-Catheterized Urinary Tract Infections in Jimma University Hospital, Southwest Ethiopia
(Addis Ababa University, 2005-06) Teshager, Lule; Asrat, Daniel(PhD)
Urinary tract infections (UTIs) are among the most common bacterial infection. They have become the most common hospital acquired infections, accounting for as many as 35% of nosocomial infections, and are usually associated with catheterization. The aim of this study is to assess the bacterial profile and antimicrbial resistance pattern of catheter associated urinary tract infection in comparison with non-catheter associated UTI. One hundred and twenty urine specimens (30 from catheterized patients and 90 from non-catheterized patients with symptoms of UTI) were screened for the presence of significant bacteruria from January to March 2005. Bacteriological screening of catheterized urine and clean catch mid-stream urine revealed that 13/30 (43.3%) and 20/90 (22.3%) had significant bacteriuria, respectively (P<0.05). All samples taken from patients who have been catheterized for 2 weeks or more showed significant bacteruria. In both group the rate of infection was higher in female patients. Older patients (>50years old) were found to be the most affected age group (46%) among catheterized patients whereas most of the non-catheterized patients with significant bacteruria belonged to age group 11-12 years. Among catheterized patients, Escherichia coli and Klebsiella species were found to be the most frequently isolated pathogens (each of them accounts 23 %) followed by coagulase negative Staphylococci (15 %). The most frequently isolated species from non-catheterized patients was Klebsiella (40 %) followed by E. coli (30 %). Resistance rates (56.3 % to 100%) to Ampicillin, amoxicillin, cephalexin, carbenicillin, and Trimethoprime /sulfamethoxazole were observed in all organisms isolated from both groups. In addition, resistance rates to gentamicin, nitrofurantoin, and nalidixic acid were observed in all bacteria isolated from catheterized patients. In general, in this study, high level multidrug resistance in both groups indicated that it is time to reconsider the empirical use of the commonly used antimicrobial agents in Ethiopia. Particularly, increasing vii resistance in pathogens isolated from catheterized patients is frustrating. Because the most important risk factors for UTI is duration of catheterization indwelling urinary catheterization should be avoided or at least minimized
Characterization of Mycobacterial Isolates from Lymph Nodes of Patients with Tuberculous Lymph Adenitis in Dera Woreda, North Showa, Ethiopia
(Addis Ababa University, 2005-07) Seyoum, Berhanu; Wolde, Yimtubezanash (PhD); Aseffa, Abraham(PhD)
Tuberculosis is a major health problem throughout the world causing a large number of deaths, more than that from any other single infectious disease. Extra pulmonary tuberculosis can occur in isolation or along with a pulmonary focus as in the case of patients with a disseminated form of tuberculosis. Tuberculous lymphadenitis (TBLN) is a common form of extra pulmonary tuberculosis. Lymph nodes (cervical, axillary and inguinal) are the most common sites of involvement. Diagnosis of TBLN is a formidable challenge in developing countries where there is high rate of human immunodeficiency virus infection. The aim of this study was to identify the etiological species of Mycobacteria responsible for TBLN in Derra, rural Ethiopia, where the status of TBLN was not known. A total of 153 patients who fulfilled the inclusion criteria were included in the present study during the study period between January 2004 and February 2005. Out of 153 study participants, fine needle aspirate specimens from 145 study participants were processed and analyzed using Ziehl Neelsen staining, culture, cytology and polymerase chain reaction. Out of 145 FNA samples, 66 (45.5%) of the isolates demonstrated growth on Lowenstein - Jensen medium. Among 145 clinically suspected TBLN patients, 115 (79.3%) were confirmed as TBLN cases by the combined results of AFB smear examination, culture, cytology and PCR. Two primer sets were used to identify the etiological agent at the complex (targeting the IS6110 insertion sequence) and species level (targeting the pncA gene allelic variation). From a total of 145 clinically suspected TBLN cases, 108 (75%) were positive by PCR at the complex levels. Based on PCR for detection of allelic variation at position 169, 107/108 (99.1%) were positive for M. tuberculosis and only 1(0.9%) was positive for M. bovis. The results indicated that M. tuberculosis is the causative species for tuberculous lymphadenitis in Dera.
Characterization of Group A Streptococci Isolated from Throat of Healthy School Children in Ethiopia
(Addis Ababa University, 2005-07) Abdissa, Alemseged; Asrat, Daniel(PhD)
Post-streptococcal complications such as acute rheumatic fever (ARF) are reported to be common among Ethiopian children. Little is known, however, about the epidemiology of b-hemolytic streptococci, and Group A streptococci (GAS) in Ethiopia. A total of 937 randomly selected healthy schoolchildren residing in Addis Ababa (n=491), Gondar (n=265) and Dire-Dawa (n=181) were studied during a period November 2004 and January 2005. Throat specimens were collected and b-hemolytic streptococci were isolated on Columbia blood agar supplemented with Colistin-oxolonic acid. Gram reaction, catalase test Bacitracin susceptibility test and serological test were used to differentiate the organisms. In addition biochemical testing (API) was used to identify the species of isolates that could not be serogrouped. GAS were the predominant b-hemolytic streptococci with a proportion of 55% in Addis Ababa, 61% in Gondar, and 47% in Dire-Dawa of the serogroups. The carrier rate of GAS in healthy schoolchildren was 10.8% in Addis Ababa, 8.7% in Gondar and 9.4% in Dire- Dawa. Seven isolates that were nongroupable confirmed to be Streptococcus constellatus with API biochemical testing. Molecular (emm gene) typing was performed on 82 GAS isolates and 44 different emm types were detected. Among the 82 isolates 18 strains belonged to 13 new, previously undescribed emm subtypes. Known rheumatogenic strains accounted for 56% of isolates in Addis Ababa, 35% in Gondar and 0% in Dire-Dawa. Of the emm types prevalent in the study communities, 60% were not included in the 26 valent vaccine that was formulated for western countries. The distribution of emm types described in this study was compared with the study conducted on isolates collected 13 years ago in Addis Ababa, only 3/20 emm types identified in earlier study had been represented in the present study. Moreover, the type, which was predominant in the previous study, was not detected in the current one and the type that was predominant in our study was not detected in the previous one. x In conclusion, Group A was the most frequent serogroup among b hemolytic streptococci isolated from throat swabs of healthy schoolchildren in the selected three sites of Ethiopia and the carriage rate of GAS ranged from 8.7 to 10.8%. Tremendous diversity of emm types was observed in this first large scale emm type survey in Africa, and a significant proportion of them are known to be rheumatogenic. The association of the prevalent emm types not previously linked to rheumatic fever needs to be explored particularly in Dire-Dawa. Key Words: Beta-hemolytic streptococci, Group A Streptococci, Streptococcus pyogenes, M protein, emm typing
Microbiology of Burn Unit at Yekatit 12 Hospital, Addis Ababa
(Addis Ababa University, 2005-10) Negeri, Challa; W/Amanuel, Yimtubezinash (PhD)
Burn patients are at risk of acquiring infection because of the loss of skin barrier and suppressed immune system, compounded by prolonged hospitalization and invasive therapeutic procedures. Since specialized burn units were non-existent in Ethiopia before the establishment of one at Yekatit 12 hospital, Addis Ababa, no study was done on burn patients in the country. Hence, to study the microbiology of burn patients admitted at Yekatit 12 hospital, a prospective study was undertaken on 52 patients from March to August 2005. Periodic swabs were taken from the burn patients as well as from the patients’ attendants, attending staffs, and the burn unit environment in order to associate prevailing burn pathogens with endogenous or exogenous sources. The pattern of colonization in the burn wound changed during the hospital stay from a predominance of Gram-positive bacteria (69.8%) at admission to Gram-negative bacteria (68.6%) after the second week. On comparing infected patients (n=38) with non-infected patients (n=14), there was significant difference in age distributions (p=0.035), in burn types (p=0.017), hospital stay (p<0.0001), and total burned surface area (p=0.005) but no significant difference in the frequency of infections by sex (p=0.535). Among the 33 patients without infection on admission, 20(60.6%) developed at least 1 type of nosocomial infection with the most frequent nosocomial infection being burn wound infection (N=20; 60.6%), followed by urinary tract infection (N= 10; 30.3%), bloodstream infection (N=4; 12.1 %) and pneumonia (N=1; 3.0%). Fifty five isolates were recovered from the swabs of infected wounds, of which S. aureus accounted for 40.0% (22/55), and P. aeruginosa for 27.3 %( 15/55). All of the isolates of S. aureus were sensitive to methicillin, clindamycin and vancomycin and were moderately sensitive to chloramphenicol, cephalothin, and augmentin but highly resistant to ampicillin and penicillin G. Thirteen isolates of P. aeruginosa (86.7%) strains were designated multi drug resistant to the commonly used drugs in the burn unit and the country at large. Burn wound infection was the most common infection in the burn unit and S. aureus and P. aeruginosa with high degree of resistance to the commonly used antibiotics in the burn unit were the most commonly isolated organisms from the burn wounds. Since bacterial isolates with identical sensitivity pattern to the clinical isolates were identified from both endogenous sources and exogenous ones, it can be deduced that acquisition of the major burn pathogens was likely multifactorial.
Dilemmas in the Diagnosis of Lymph Node Enlargement in Ethiopia: A Study from Four Sites with High Notification of Lymph Node Tuberculosis
(Addis Ababa University, 2005-12) Iwnetu, Rahel
The proportion of extra-pulmonary tuberculosis has risen to over a third of the cases of tuberculosis in Ethiopia. The majority of this form of tuberculosis is reported as lymph node tuberculosis (LNTB). We evaluated the national algorithm currently in use for the diagnosis of lymph node enlargement in Ethiopia. One hundred and fifty suspected cases of lymph node tuberculosis, aged 5-65 years, with extra-inguinal lymphadenopathy were recruited following the national algorithm, from October 2004 to August 2005. Out of these individuals, 117 (78%) were diagnosed as LNTB on positive culture of fine needle (FNA) and/or biopsy specimens. FNA cytology (FNAC) and histopathology detected 88 (75%) and 105 (97%) of the culture proven LNTB patients, respectively. Eighty percent of DNA extracted from biopsy tissues gave signal for M. tuberculosis. All of the strains isolated from culture were identified as M. tuberculosis. Ziehl-Neelsen (ZN) staining of FNA and biopsy smears detected acid fast bacilli (AFB) in 28% and 25% of the patients, respectively. Macroscopic caseation in excised lymph node and aspirated material was found to be comparable with 79 (68%) of the nodes and 78 (67%) of the fine needle aspirates demonstrating caseation. Statistically significant association was found between the presence of caseation and the diagnosis of LNTB in both types of specimens (p=0.002). Combination of FNAC, ZN staining of FNA materials and macroscopic examination of aspirates detected 112 (96%) of the culture proven LNTB patients. The proportion of HIV seropositive individuals among the culture proven LNTB patients were 24%. There was statistically significant association between urban residence (p=0.002), female gender (p=0.006) and HIV in LNTB patients. There was no statistically significant association between LNTB and HIV. We found that the currently used algorithm detects a significant amount of culture proven LNTB patients even though it suffers from shortcomings. It is hoped that this will encourage wider consultation to review and revise the existing algorithm and improve LNTB diagnosis and reporting nationwide
Symbiotic and Phenotypic Diversity of Rhizobium leguminosarum var viceae Isolates (Vicia faba) from Northern Gondar, Ethiopia
(Addis Ababa University, 2006-05) Belay, Zerihun; Assefa, Fassil(PhD)
Twenty-one strains of Rhizobium leguminosarum var. viceae spp (Vicia faba) from 21 sites of North Gondar were isolated from a range of pH 5.8-7.5 to induce nodulation on “Degaga" cultivar of faba bean. Isolates were authenticated as root nodule bacteria by their ability to form nodules on their host up on re-inoculation, except AUFR13. All of the morphological features displayed by all isolates were characteristics of fast growing Rhizobium leguminosarum var viceae, except AUFR13. Almost all of the isolates grew between 150C and 350C and failed to grow at 400C, except AUFR22 and AUFR28. All isolates failed to grow at 1% NaCl, except AUFR12 and AUFR28. AUFR18 was the only osmotolerant strain capable of growing at a concentration of 5%. The isolates also grew on a wide range of moderate acidity and alkalinity but only 10% of the isolates grew at pH5.5. With the exception of gluconate, citrate, and tartarate, almost all isolates grew on 14 out of the tested carbohydrates. The Intrinsic Antibiotic Resistance (IAR) was found to be the best of all tested physiological characters to identify the heterogeneity of Rhizobium leguminosarum var. viceae, so that 95% of the tested isolate were resist erythromycin and chloromphenicol, and 14%, 24%, 38%, 38% and 43% of the isolates tolerated streptomycin, ampicillin, rifampcin, kanamycin and naldixic acid at highest concentration, respectively. The relative effectiveness expressed as percentage of shoot dry mass of inoculants over TN control, showed that 24%, 57%, 4.7% and 9.5% of the isolates were found to be highly effective, effective, lowly effective and ineffective, respectively. The highest scores of 88-100% effectiveness of symbiotic nitrogen fixation were displayed by AUFR14, AUFR15, AUFR24, AUFR28 and AUFR32. Selected strains on soil culture were found to accumulate 81-92% on Holeta soil and 90-103% on Ambagiorgis soil of their shoot dry mass compared to their respective N-fertilized controls. All isolates were also found to increase shoot dry weight by 0- 43% higher than their respective sand cultures and response of the Holetta soil to inoculation by selected effective strains was much pronounced (47-67%) than Ambaghiorgis soil (8-25%) compared to the negative (N-) controls. The lower dry matter accumulation by Holeta soil indicates that the low pH and other soil-related factors severely affected survival, nodulation and nitrogen fixation of their indigenous rhizobia and the process can be rectified by inoculation of effective rhizobia. Key words: Faba bean, Rhizobia, Phenotypic diversity, Symbiotic effectiveness.
Preliminary Investigation on Immune Response of Schistosoma Mansoni in Grivet Monkeys (Cercopithecus Aethiops Aethiops) Infected with Different Cercarial Doses
(Addis Ababa University, 2006-07) Demelash, Tariku; Hailu, Asrat(Professor)
In order to evaluate grivet monkey (Cercopithecus aethiops aethiops) as an animal model for the immune response of mansonian schistosomiasis, groups of three or four grivet monkeys were exposed individually to 100, 200, and 300 cercariae per monkey. Infection and clinical manifestations were observed; EPG of stool was determined and different cytokines (IL-12, IFN- , TNF- , IL-4 and IL-10) were measured. Infected monkeys began to release eggs 7 weeks post infection. Most of them became ill 7 to 9 weeks after initial exposure and exhibit most of the clinical manifestations typical of human acute schistosomiasis. The fecal egg count confirmed there is significant (P<0.05) variation between groups in terms of numbers of eggs released in stools, where the group that receives the lowest cercariae dose exhibiting the highest egg output. There was a significant difference in the level of cytokine production between those infected and the controls. Th1 cytokine (IL-12, INF-gamma, and TNF-alpha) levels reached their highest before their Th2 counter part (IL-4). Cytokine levels, however, were not found to be dose-dependent as anticipated. Comparison of this study with studies on related primates suggests that grivet monkey closely resemble the baboons in their immune response to Schistosoma mansoni infections. Thus, this work may underline the potential of the grivet monkey to provide a cheaper, more readily available primate model for the study of the immune response and the acute stage of infection by S. mansoni
Diversity of Arabica Coffee Populations in Afromontane Rainforests of Ethiopia in Relation to Colletotrichum Kahawae and Gibberella Xylarioides
(Addis Ababa University, 2006-07) Zeru, Arega; Asefa, Fasil (PhD); Adugna, Girma (PhD)
Coffee berry disease (CBD), caused by Colletotrichum kahawae and coffee wilt disease (CWD), which is caused by Gibberella xylarioides, are the major coffee diseases in Ethiopia. Assessment of CBD and CWD was conducted in Harena, Bonga, Birhan-Kontir and Yayu from July to September 2005. These diseases were prevalent in all surveyed forest coffee areas of Ethiopia. The mean percent incidence and intensity of CBD varied from 6.0-40.0% and 2.0-17.9% across forest coffee areas. The mean incidence of CWD varied from 2.4 to 16.9% across forest coffee areas. Seedling inoculation tests conducted on indigenous forest coffee selections from 4 different forest coffee areas revealed significant variations (P < 0.05) among the selections both in percent seedling CBD infection, inoculated with C. kahawae and in percent wilt seedlings, inoculated with G. xylarioides. Selections from Yayu, Bonga, Berhan-Kontir and Harena showed mean seedling CBD infection rate from 69.0-100%, 57.5-100%, 75.3-100% and 23.3-100% where as percent wilt seedlings varied from 58.0-97.2%, 26.2-97.3%, 72.7-100% and 0-94%, respectively. This indicated that in the course of resistant coffee variety development it is possible to get wider alternative resistant gene pool from Harena and Bonga, followed by Yayu indigenous forest coffee germplasms. These observations allow first remarks on possible CBD and CWD tolerant or resistant selections in the indigenous forest coffee of Ethiopia, which increase the value of afromontane rainforest coffee. Hence it is important to conserve and use sustainably the indigenous coffee germplasms both insitu, and exsitu, by conducting intensive selection from more diverse coffee population and evaluation for diseases resistant (priority on CBD and CWD), high yield, better quality and other characteristics. 15 representative C. kahawae isolates were obtained from forest coffee areas of Ethiopia and 2 isolates from Gera were studied based on their cultural and morphological characters. Isolates could be grouped into 3 based on their colony color manifestation on the obverse side of potato dextrose agar (PDA) and malt extract agar (MEA). The cultures exhibited lightgray, darkgray and gray mycelia forms. Mean radial colony growth rate of C. kahawae isolates ranged between 0.6 and 5.5 millimeter (mm)/24 hour (hr), and between 1.2 and 6.1mm/24 hr on PDA and MEA, respectively. Conidia width and length ranged as 3.6–4.8 μm and 12.7–15.5 μm, respectively. Highly significant (P < 0.05) variation was observed among C. kahawae isolates in their sporulation capacity, and varied between 25.93 x 104 and 253.22 x 104 conidia/ml. No race difference was observed within C. kahawae isolates; however, certain cultural, morphological variations as well as significant variation in aggressiveness were detected among them. Pathogenicity test of 12 isolates on seedlings of 4 Coffea arabica L. cultivars indicated that there was a highly significant difference (P < 0.05) among cultivars, isolates, and cultivar x isolate interactions. The resistance manifested by cultivars was horizontal or non-biotype specific. The difference in virulence and aggressiveness implies that care should be taken in while developing resistant varieties. Aggressive isolates should be used for successful screening of resistant coffee germplasms before releasing any newly developed coffee cultivar(s). Key words/phrases: Afromontane rainforest indigenous coffee, Coffea arabica, Colletotrichum kahawae, Gibberella xylarioides
Prevalence and Antimicrobial Profile of Listeria Monocytogenes in Retail Meat and Dairy Products in Addis Ababa and Its Surrounding Towns, Ethiopia
(Addis Ababa university, 2007-03) Abera, Firehiwot; Monga, DP (Professer)
Listeriosis is a disease of humans and animals, which is mostly caused by Listeria monocytogenes, as the result of food and environmental contamination as well as zoontic infections. In the world, this disease is becoming an emerging bacterial disease, with low incidence but high case fatality rate. The objective of this study was to isolate L. monocytogenes from retail meat and diary products (raw milk, cottage cheese, cream cake) and to detect their antimicrobial profile. Two hundred and forty food samples were purchased from food vendors, shops and supermarkets, using cross-sectional study design, from July to December 2006. L. monocytogenes isolation were performed according to the standard procedures using Listeria enrichment broth, Modified Fraser broth, Polymyxin Acriflavine Lithium Chloride Ceftazidime Aesculine Mannitol (PALCAM) and Oxford Agar (OXA) media as well as confirmatory broths like rhamnose, xylose, mannitol; blood agar and Christe Atkins Munch Peterson (CAMP) test. The antimicrobial profile of L. monocytogenes was also assessed by using the standard disk diffusion method (Kirby Bauer, Muller Hinton agar) and it was tested against 14 antimicrobial drugs. Out of 240 food samples tested, 66(27.5%) were positive for Listeria species. The prevalence rate of L. monocytogenes was found to be 13 (5.4%). The antimicrobial profile of L. monocytogenes was also assesed and it was found that L. monocytogenes was sensitive to most drugs except clindamycin which showed the highest resistance rate (100%) and also to certain extent, to chloramphenicol (53.9%), tetracycline (31.8%) penicillin (23.1%), and rifampicin (15.4%).
Investigation of Cutaneous Leishmaniasis Using Conventional and Molecular Methods in Silti Woreda, Ethiopia
(Addis Ababa University, 2007-05) Negera, Edessa; Aseffa, Abraham(PhD)
Man-made risk factors for leishmaniasis are increasing while knowledge of risk factors, accurate diagnosis and treatment of leishmaniasis is poor. As a result, deadly epidemics of leishmaniasis occur periodically, but tools for prediction and prevention are lacking. Hence, research is needed to address these constraints. Leishmaniasis in Ethiopia is mainly due to L. donovani and L. aethiopica, which causes visceral and cutaneous leishmaniasis respectively. Although the exact magnitude of the problem is not known, several surveys have indicated the importance of the diseases as a public health problem. A complete mapping of the diseases remains to be accomplished in view of the increasing number of patients reporting from regions hitherto unknown to be endemic. Therefore, the main aim of this work is to describe the epidemiology of the disease through identification of the causative agent using molecular epidemiological tools in Silti Woreda. The study was conducted in two Phases: in phase I, house-to-house survey was conducted and in phase II, parasitological identification was done. The treatment response of L. aethiopica to liquid nitrogen (cryotherapy) and pentostam was documented as follow up activity. The prevalence of the disease in the area was found to be 4.82% with highest prevalence among age group 10-20 years. Some plants like Adathoda shimperina and Acacia spp. and hyraxes and domestic animals were associated with increased risk of cutaneous leishmaniasis. The sole causative agent identified was L. aethiopica. The disease was found to be recently introduced in the area. In conclusion, the importance of the risk factors identified in this study should be investigated further and molecular epidemiological studies should be conducted in other areas to map the exact magnitude of the disease in the country. The clinical service in the outbreak site (Silti) needs to be prepared to provide the required care and treatment of patients who will keep coming from the area. Leishmaniasis control program has to be initiated in Ethiopia so as to prevent the disease from expanding. Keywords/Phrases: Cutaneous leishmaniasis, Risk-factor, Molecular epidemiology, Prevalence, Treatment, L. aethiopica
Validation of the Bleach Methods for the Diagnosis of Pulmonary Tuberculosis
(Addis Ababa University, 2007-07) Merid, Yared; Kumar, Raja(Professor); Aseffa, Abraham(PhD)
Bacteriological diagnosis of tuberculosis is largely dependent on direct microscopy of sputum smears. It is the most widely available diagnostic test, especially in developing countries where the other options are usually not practical due to the limited resources available. However, its sensitivity is not optimal when used in control programs, usually ranging from 8.8% to 46.4% in most African laboratories. The sensitivity of the technique is further undermined in areas with high HIV prevalence. If sensitivity could be improved, the method has the potential to become an even more valuable tool for National TB Control Programs. Treating the sputum with house bleach (NaOCl) has been reported to increase sensitivity of direct microscopy. Therefore, the aim of this study was to compare the diagnostic performance of the three different bleach methods reported so far: centrifugation, overnight sedimentation and short term bleach digestion (30 min), with conventional direct microscopy and validate against culture as a gold standard on a given group of specimens. This cross sectional study was conducted at Awassa Health Center and Bushulo Major Health Center in Awassa. Five hundred (500) consecutive new TB suspects presenting at the health facilities during July to December, 2006 were enrolled in the study. Direct smears were prepared and stained using Ziehl-Neelsen technique and specimens were decontaminated and inoculated onto Lowenstein-Jensen media for culture. The left over sputum samples were pooled, equal amount of bleach was added and then divided in three portions for the three bleach treatment techniques. Smears were prepared after centrifugation, overnight sedimentation and short term digestion. The direct and bleach treated smears were read blindly by two independent microscopists. Ten percent of the negative and 20% of all the positive smears were retained for quality control. Smears were graded using the WHO/IUATLD scale. Considering smears graded scanty (<10 Acid-fast bacilli per 100 fields) as negative, the direct smear was positive in 21%, short term digestion in 20%, overnight sedimentation in 23%, centrifugation in 31% and culture in 47%. The sensitivity of direct smear microscopy under the experimental condition was 41.9%. Among the bleach techniques, sensitivity was best for centrifugation (54.6%) followed by overnight sedimentation (43.7%) and short term digestion (38.9%). The bleach centrifugation method can clearly X increase the sensitivity of smear microscopy and would thus be a useful tool to improve case detection in the National Tuberculosis Programme. Key words: tuberculosis, diagnosis, bleach methods, validation
Prevalence of Specific Antibodies to Chlamydia Trachomatis Among Women on Routine Gynecological Visit to Jimma University Specialized Hospital, Jimma, South – West Ethiopia
(Addis Ababa University, 2008) Sahlemariam, Zewdineh; Monga, D.P. (Professor)
Genital Chlamydia trachomatis infection is a key global issue facing women’s reproductive health. The worldwide prevalence of Chlamydia trachomatis genital infection (CTGI) is estimated to be 700 million, with highest prevalences in sub-Saharan Africa. To determine the prevalence of antibodies to genital Chlamydia trachomatis infection and to assess related socio-demographic and reproductive factors, 184 women routinely visiting the gynecology out-patient department of Jimma University Specialized Hospital (JUSH) were investigated during March 2005 – February 2006. Specific IgG and IgM antibodies to Chlamydia trachomatis were detected using an Enzyme Linked Immunosorbent Assay (ELISA) system on 184 sera collected from these women. Socio-demographic information as well as gynecologic/reproductive information was collected by interviewing. Physical examination was also done for the patients. Complete data were obtained for 184 women. The majority of the women (47.3%) were in the 20-29 year age group. The minimum age of the study participants was 12 years. The prevalence of antibodies showing exposure to genital Chlamydia trachomatis was: IgG 45.6% and IgM 5.4%. Seven women (3.8%) had positive serology for both IgG and IgM. Higher prevalence of IgG antibodies was found in women in the 20-29 year and 30-39 year age groups which was 21.7% and 12.5%, respectively, although the difference in the different age groups was not significant (p>0.05). Thirty-four percent of the study subjects had a history of one or more abortion, of whom 17.4% had positive IgG serology. The minimum and mean ages of the women at first sexual intercourse were 12 years and 16 years, respectively. Physical examination revealed no symptoms of reproductive tract infection (RTI), sexually transmitted infection (STI), urinary tract infection (UTI) or other gynecologic abnormalities in 19% of the women. Evidence of Chlamydial infection was found in half of the women who were asymptomatic. The majority of the women (81%) had either one or multiple symptoms on clinical evaluation. History of previous episodes of pelvic inflammatory disease (PID) was documented in 14 women, of whom 6 showed positive IgG serology. The most frequent complaints at presentation were: lower abdominal pain/tenderness (39%), vaginal discharge (32%) and vi vaginal bleeding (18.5%). Positive serology to Chlamydia trachomatis IgG antibodies was identified in 14.1% and 16.8% of all women with vaginal discharge and lower abdominal pain, respectively. Thirty-five percent of the study subjects claimed to have had 2 or more sexual partners. Forty-nine percent of the women had their first sexual intercourse at an age of 12 – 16 years, of whom 23.4.8% had positive IgG serology. This study has highlighted high prevalence of antibodies to genital Chlamydia trachomatis and high frequency of behavioral and reproductive risk factors among the study participants. Health care providers should be aware of the high prevalence of Chlamydial infection in women. Similar population-based studies of chlamydia prevalence should be conducted in different communities to elucidate the actual burden of the problem in Ethiopia and design intervention strategies.
Prevalence of Group B Streptococcus Colonization Among Pregnant Women Attending Antenatalclinic of Hawassa Health Center, Hawassa, Ethiopia
(Addis Ababa University, 2008) Mohammed, Musa; Asrat, Daniel(PhD)
Background: Group B streptococcus (GBS) or Streptococcus agalactiae are members of the normal flora of the female genital tract. During labor GBS may infect the newborn, leading to neonatal sepsis and meningitis. GBS emerged in the 1970s as one of the most frequent causes of sepsis and meningitis in neonates and young infants. Since the mid-1960s, GBS has become the major cause of bacterial infections in the perinatal period, including bacteraemia, amnionitis, endometritis, and urinary tract infection in pregnant women. Rates of GBS colonization vary widely throughout the world due to differences in laboratory investigation methods, regional variations and racial differences. Report on prevalence of GBS among pregnant women in Ethiopia is very limited. Objectives: The objective of this study was to determine the prevalence of group B Streptococcal (GBS) colonization among pregnant women attending antenatal clinic at Hawassa Health centre, Hawassa Ethiopia and analyze risk factors related to GBS colonization. Methods: A total of 139 pregnant women were screened for GBS colonization between May and June 2010. Standard microbiological methods were used to isolate and identify GBS from vaginal and anorectal swabs obtained from study subjects. Antimicrobial susceptibility test was performed for all GBS isolates according to the criteria of the National Committee for Clinical Laboratory Standards by disk diffusion method. Results: A total of 29 out of 139 pregnant women studied (20.8%) were colonized by GBS. No statistically significant association was observed for GBS colonization with any of sociodemographic characteristics of the study subjects including age, occupation, type of contraceptive used, types of gravida, number of antenatal clinic visits etc. All GBS strains were susceptible to penicillin, ampicillin, vancomycin and gentamicin, Low level of resistance (<60%) were observed against erythromycin, tetracycline, ceftriaxone, chloramphenicol, ciprofloxacin and norfloxacin. Conclusion and recommendations: this study including 139 pregnant women, confirmed the prevalence of GBS colonization to be around 21%. This prevalence was compared with findings reported from developed and developing countries and have reached comparable level. However, further epidemiological investigations should be conducted in different parts of the country in order to know the actual GBS colonization rate in pregnant women and consider implementation of prevention plans using intrapartum antibiotics prophylaxis to prevent early onset GBS-neonatal diseases. Key words: Group B Streptococcus (GBS), risk factors, Antibiotic susceptibility, Ethiopia.
Serological and Molecular Characterization of Hepatitis B, C and D Viruses Infections Among Health Professionals in Ras Desta and Tikur Anbessa Hospitals, Addis Ababa, Ethiopia
(Addis Ababa University, 2008) Yimer, Kedir; Asrat, Daniel(PhD)
The risks for occupational infection with blood-borne pathogens (HBV, HCV, and HIV) have been a source of concern among health professionals because of their frequent and often substantial exposures to patient blood and body fluids and all of which are associated with significant morbidity and mortality. A cross sectional study was conducted in order to assess the prevalence of HBV, HCV, and HDV infections among HCW’s (n=267) and risk factors associated with these viral infections. After each volunteer study subject has completed a standardized questionnaire, 10 ml of venous blood was collected from each individual for serological and molecular processing. ELISA method was used to detect HBs and HBe antigens, antibodies to HBc, HBs, HDV and HCV in the serum samples. Molecular methods were used to detect HBV DNA and HCV RNA. One hundred and eight (40.4%) of the health professionals use gloves consistently, 221 (82.3%) had at least a one time history of cutaneous exposure to blood ungloved, 165 (61.8%) of health care workers had at least a one time history of cutaneous exposure to any of the body fluids, 162 (60.6%) had splashed blood or body fluids in their faces, 158 (59.2 %) had sustained needle stick injury and 83 (31.1%) sustained sharp injury. The overall prevalence of HBV infection was found to be 51.3% (95% CI: 45-57%) and the infection prevalence increases with age (p<0.01). HBsAg was detected in 9.7 % (95% CI: 6-13.2%) of HCW’s. Absence of vaccination was the only risk factor associated with hepatitis B infection (p=0.001). Though only a single individual had HBeAg (4.5%; 95% CI: 2-7%), HBV DNA was detected by PCR in serum sample from 17 of the 24 subjects (71%). The hepatitis B vaccination rate was found to be 13%. Ninety three percent of individuals who were vaccinated with a single dose of HBs vaccine had achieved protective antibody. ‘Anti-HBc only’ positive cases were detected in 6 (2.2%; 95% CI: 0.004-3.96%) individuals however HBV DNA was not detected in any of the samples tested. HCV infection was detected in 1 (0.37%) study subject. None of the HBsAg positive individuals had marker of HDV infection. Our data suggest that occupational exposures to blood and body fluids occur frequently with low universal precaution practice and vaccination coverage. Hepatitis B infection is widespread and characterized by high level of immunity through natural infection and the presence of continuous horizontal transmission. Absence of vaccination is the only risk factor associated with hepatitis B infection. In this study HCV and HDV infection prevalence is very low. Serologic response rate to a single dose of viii hepatitis B vaccine was much higher than experiences from other countries. HBeAg negative serological status and low viral replication levels characterize chronic hepatitis B virus-infected health professional. ‘Anti-HBc only’ is found in the health professionals but none of the subjects had detectable HBV DNA. This suggests the need to do future study in ‘Anti-HBc only’ case
Surgical Wound Infection in Tikur Anbessa Hospital with Special Emphasis on Pseudomonas Aeruginosa
(Addis Ababa University, 2008-04) Tekie, Kassaye; Mengistu, Yohannes(PhD)
Pseudomonas aeruginosa surgical site infection is a serious infection with significant patient mortality and health-care costs. The emergence of multidrug resistant strains of Pseudomonas aeruginosa has complicated treatment decisions and leads to treatment failures. In Ethiopia, few studies were conducted and even those studies were done generally on gram-negative bacteria not specifically on Pseudomonas aeruginosa from surgical sites despite the fact that P.aeruginosa is becoming serious cause of opportunistic infection in immunocompromised and hospitalized post operative patients. Nevertheless, the relationship between appropriate antimicrobial treatment and clinical outcome is not well established in Tikur Anbessa hospital. This is a prospective study of surgical wound infection on surgical patients operated from April to July 2006 in Tikur Anbessa hospital. A total of 173 patients were enrolled and clinical samples collected for analysis. Demographic data and laboratory analysis test on the occurrence of Pseudomonas aeruginosa wound infection rate and antimicrobial susceptibility patterns has been conducted in the first 30 days postoperatively. Among the patients, there were 97(56%) male patients and 76(44%) female patients. The mean age of the patients was 37.3(range: 1-80 years). The infection rate was 10.3%, 13.6%, 22.7% and 36.8% for clean, clean-contaminated, contaminated and dirty wounds respectively. The rate of surgical site infection was 17.9% with Pseudomonas aeruginosa being 14.4% of all the isolates. On comparing infected patients (n=31) with non-infected patients (n=142), there was no significant difference in the frequency of infection by sex (p= 0.11). Pseudomonas aeruginosa was the third dominant isolates following Staphylococcus aureus and coagulase negative Staphylococci respectively. The prevalence of drug resistance to Amikacin, Azeotronam, Ceftriaxone, Ceftazidime, Chloroamphenicol, Ciprofloxacine, Gentamicin, Imipene, Piperacillin, Tetracycline and Trimethoprim Sulfamethoxazole was evaluated. The minimum resistance rate was 25% for Amikacin and Imipenem and the highest resistance rate obtained was for Chloroamphenicol which was 100%. 87% of the isolates of P.aeruginosa were multidrug resistant. The outcome of this research emphasizes the use of first line drug therapy rather than random prescription of antibiotics with out susceptibility 9 testing. This will aggravate the ever increasing resistance not only to Pseudomonas aeruginosa but also to other microorganisms. Policies governing the use of antimicrobials in many institutions are lacking. Such policies must be implemented in order to limit the spread of resistance.
Bacterial Nosocomial Infections and Their Antimicrobial Susceptibility Patterns in Surgical Wards and Surgical Intensive Care Unit (SICU) Of Tikur Anbessa University Hospital Addis Ababa, Ethiopia
(Addis Ababa University, 2008-08) Endalafer, Nigatu; Gebre-Selassie, Solomon(PhD); Kotisso, Berhanu(PhD)
Background: Nosocomial infections are defined as infections which are not present or not incubating when the patient is hospitalized and are acquired during hospital stay. Sign and symptoms of the infection may be evident during hospitalization or after discharge related to the length of the incubation period. It is usually defined as an infection that is identified at least 48-72 hours following admission to health institution. Infections acquired in hospital are likely to complicate illness, cause anxiety and discomfort, and can lead to death. Nosocomial infection is a global problem with multi facet out comes. The problem is well pronounced in developing countries. Epidemiological and etiological characteristics of nosocomial infections show variations among countries and even among different hospitals in the same country. Many of these infections are associated with micro-organisms that are resistant to multiple antibiotics and can easily spread on the hands of personnel. The most frequent types of nosocomial infections are urinary-tract infection, surgical-wound infection, pneumonia, and bloodstream infection. At present, the emergence of resistance to antimicrobial agents is a global public health problem, particularly in pathogens causing nosocomial infections. Antimicrobial resistance results in increased morbidity, mortality and health-care costs. Objective: To determine the prevalence, etiological agents and drug susceptibility pattern of nosocomial infections at Tikur Anbessa University Hospital. Methods: A cross-sectional study was conducted from June 2007 to April 2008 at Tikur Anbessa University Hospital, Addis Ababa, Ethiopia. During the study, all adult patients admitted to surgical wards and SICU with suspected of nosocomial infection were included. Among 854 patients admitted to surgical wards and SICU, 215 patients selected based on their clinical ground, after a careful clinical examination. Clinical samples were collected from the study subject and analyzed accordingly. Results: Eight hundred fifty four patients admitted to surgical ward and SICU between June 2007 and April 2008 to Tikur Anbessa University Hospital in Addis Ababa were studied for prevalence of nosocomial infections. A total of 215(25.2%) patients, were selected based on their clinical grounds from surgical wards (n=161) and SICU (n=54). The mean hospital stay from the date of admission until sample collection was 16.72 days with a range of 3 to 66 days. Of the 215 patients, 130(60.5%) were males and 85 (39.5%) were females. A total of nine percent (77/854) patients were confirmed to have nosocomial infections. Of the 77 patients, 51(66.2%) were males and 26(33.8%) females. The distribution of nosocomial infections among positive cases was surgical site infection 38(49.4%), urinary tract infections 23(29.8%) and blood stream infection 16(20.8%). The Gram-positive and negative bacteria accounted for 23/84(23.4%) and 61/84(72.6%) respectively. A total of 84 bacterial pathogens (strains) were isolated, E. coli accounted for 19.0% of the total isolates followed by S. aureus and Klebseiella spp. More than one bacteria etiologic agent was isolated from 7/77(9.1%) of the patients with nosocomial infection. Gram positive bacteria showed 100% resistance to penicillin, ampicillin, tetracycline, chloramphenicol, and trimethoprim sulphamethoxazole; while gram negative bacteria showed 100% resistance to amoxicillin, Tetracycline and Trimethoprim-sulphamethoxazole. Conclusion: The prevalence of nosocomial infection at Tikur Anbessa University Hospitals decreased from the previous study (16.4% and 13%) in the same hospital. Gram-positive bacteria isolated from nosocomial infection were 100% resistance to Ampicillin, Tetracycline, Trimethoprim-sulphamethoxazole and Chloramphenicol. In addition, gramnegative bacterial isolates were 100% resistance to Amoxicillin, Tetracycline and Trimethoprim-sulphamethoxazole. Due to the presence of high level drug resistance bacteria, empirical treatment to nosocomial infections may not be effective. Therefore, treatment should be based on the result of culture and sensitivity. Keywords: Nosocomial infection, Surgical Site Infection, Blood Stream Infection, Urinary Tract Infection, Intensive Care Unit
Neonatal Sepsis: Bacterial Etiologic Agents and Their Antibiotic Susceptibility Pattern in Tikur Anbessa University Hospital, Addis Ababa, Ethiopia
(Addis Ababa University, 2008-10) Shitaye, Demissie; Asrat, Daniel (Associate professor); W/Amanuel, Yimtubezinash (PhD)
BACKGROUND: Neonatal sepsis is one of the most common reasons for admission to neonatal units in developing countries. It is also a major cause of mortality in both developed and developing countries. The type and pattern organisms that cause neonatal sepsis changes over time and vary from one hospital to another hospital, even in the same country. In addition the causative organisms have developed increased drug resistance for the last two decades. Maternal, neonatal and environmental risk factors have contributed for the development of sepsis. OBJECTIVES: This study was undertaken to determine the pattern of bacterial agents causing neonatal sepsis and to assess their susceptibility pattern to various antimicrobial agents in the Ethiopian setting. An attempt has been also made to identify the possible maternal and neonatal risk factors responsible for neonatal septicemia. METHODS: During the period of October 2006 and March 2007 a cross-sectional prospective study was conducted at the Department of Pediatrics and Child Health, Ethio- Swedish Children’s Hospital, Addis Ababa, Ethiopia. Blood cultures were performed from newborn babies (n=302, age: 0-28 days) admitted to the hospital with a clinical diagnosis of neonatal sepsis. Antimicrobial susceptibility testing was performed for all blood culture isolates according to the criteria of the National Committee for Clinical Laboratory Standards by disk diffusion method. RESULTS: Of the 302 patients, 46.4% were males and 53.6% were females (p >0.05) resulting in an overall male to female ratio of 0.8:1. The mean age of the neonates was 1.23 ± 8.96 days and 70.2% of neonates were below age of 1 day. A total of 298 (98.7%) neonates presented with early-onset sepsis (EOS) and four (1.3%) presented with late-onset sepsis (LOS). Out of the 302 neonates, 57.3% were preterm and 62.7% had low birth weight. The most prevalent clinical features of sepsis were hypothermia (84.8%), respiratory distress (72.8%), failure to feed (71.5%) and lethargy (30.1%). Among the 302 neonates admitted with suspected cases of sepsis, 59 (19.5%) had abnormal white blood cell count (high and low). Immature/total neutrophil ratio > 0.2 and <0.2 was observed in 58.0% and 42.0% peripheral blood smear examined respectively. Of the 302 neonates investigated for sepsis, 135 (44.7%) were positive for blood culture. The Gram-positive and negative bacteria accounted for 43.7% and 56.3% respectively (p> 0.05). The most common isolated organisms were Klebsiella spp. (39.2%) and Staphylococcus aureus (22.2%). Neonatal risk factors such as prematurity, low birth weight, abnormal WBC count (high and low) and I:T ratio > 0.2 were strongly associated with culture proven neonatal sepsis. No maternal risk factors were identified. In general both gram positive and negative bacteria isolated from blood culture showed low resistance rates (<60%) to ciprofloxacin, doxycycline, kanamycin, streptomycin, trimethoprim-sulphamethoxazole and tetracycline. Gram-negative bacteria showed high-level resistance (>80%) to ampicillin, ceftriaxone, cephalothin, chloramphenicol, and gentamicin. Ciprofloxacin was the most effective drug against the tested gram-positive and gram-negative bacteria. Multiple resistance (resistance to two or more drugs) was observed in 45.7% and 84.2% gram positive and gram negative bacteria respectively (p<0.05). CONCLUSION AND RECOMMENDATIONS: Klebsiella spp. and S. aureus were the most common organisms causing neonatal sepsis. Prematurity, low birth weight, abnormal WBC counts and I: T ratio > 0.2 were strongly associated with blood culture proven neonatal sepsis. Gram-negative bacteria showed high level of resistance to commonly used antibiotics. Ciprofloxacin was the most effective drug when compared to other drugs tested against the gram-positive and gram-negative bacteria. Multi-drug resistance detected in 67.4% isolates. The detection of multi-drug resistant isolates may further limit therapeutic options. Routine bacterial surveillance and the study of their resistance patterns must be an essential component of neonatal care. A knowledge of these patterns is essential when local polices on the uses of antibiotics are being devised. Key words: Neonatal sepsis, clinical features, bacterial pathogens, risk factors, antimicrobial susceptibility pattern, Ethiopia

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