Medical Microbiology

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Analysis of Serum for Antibodies to Cytomegalovirus in Individuals with Schizophrenia and Bipolar Disorder
(Addis Ababa University, 2010-02) Yared Tedla ; Woldeamanuel Yimtubezinash; Asrat Daniel; Shibre Teshome; Assefa Abrham
Background: Several evidences suggest that Cytomegalovirus (CMV) may play anetiological role in some case of schizophrenia and bipolar disorder. Studies have reported that some individuals experiencing initial episodes of major mental disorders have increased levels of immunoglobulin G(IgG) to CMV. Objective: To determine the magnitude of CMV infection in individuals with schizophrenia, bipolar disorder and healthy controls by using serologic diagnostic methods. Materials and Methods: A case control study conducted from March to May of 2009. A total of 844 serum samples were analysed for the presence and level of IgG to CMV using enzyme linked immunosorbent assay (ELISA).Serawere collected from 216 individuals with schizophrenia, 199with bipolar disorder and 429close relatives and their healthy controls, recruited from Butajira district.Seropositivity summarized using percentage and antibody level was summarized using mean. Logistic regression was used for cross tabulated data and linear regression for comparing antibody level among groups. All test of significance was two tailed and ,p < 0.05 is considered significant. Results:99.3% of tested serawere positive for IgG to CMV. However, serum levels of IgGto CMV in individuals with schizophrenia[β = 0.21; 95% CI (0.03, 0.38)]and bipolar disorder [β = 0.20; 95% CI (0.02, 0.37)]were higher compared to healthy controls. Younger individuals with schizophrenia (<20 years) had higher level of IgG to CMV compared to matched healthy controls[β = 0.64;95% CI (0.10, 1.19)]. Conclusion: This study provided serologic evidence that infection with CMV may be associated with some cases of schizophrenia and bipolar disorder. Additional studies should be directed at further analysis of antibodies to CMV in the sera and CSF of individuals with recent onset of psychosis.
Analysis of Serum for Antibodies to Toxoplasma Gondii in Individuals with Schizophrenia and Bipolar Disorders
(Addis Ababa University, 2010-02) Tadele Geletta; Aseffa Abraham
Background: Schizophrenia and bipolar disorders are serious neuropsychiatric diseases of unknown etiology. Recent studies indicated that infectious agents such as Toxoplasmagondii may contribute to some cases of schizophrenia and other mental disorders. In this study we determined the prevalence of T. gondi infection and IgGtitersagainst Toxoplasmain schizophrenia and bipolar disorder patients and control subjects which comprise first degree relatives of the patients and some individuals from neighborhoods. Methods: 214 cases of schizophrenia, 171 patients of bipolar disorders and 363 controlsrecruited fromMeskan and Mareko (Butajira)district forgenetic study in 2001and theirstored sera were analyzed for IgG antibody against T. gondii by using enzyme-linkedimmunoassay (ELISA)for a period of March to May 2009. Results: Overall prevalence of IgG antibodies in all study subjects was 95.2%. The prevalence of the antibodies increased with age in cases and control subjects. Theseroprevalence of T. Gondii infection was 97.7% in patients with schizophrenia,95.3% in bipolar disorder cases and93.7% in control subjects. There was significantly increase inseroprevalence of IgG antibodies toT. gondii in schizophrenia cases compared with control groups (p=0.031) but, the difference in seroprevalence of IgG antibodies was not statistically significant between bipolar disorder cases and controls group(p=0.427). In addition, there was no significant difference in IgGtiters between the cases and their close relative controls and/or non-relatives controls recruited from neighborhoods. Conclusions and recommendations: patients with schizophrenia had a significantly higher prevalence ofT. Gondii infection than the control group. Thus, this study gives additional information to the hypothesis that exposure to Toxoplasma may be risk factor for schizophrenia. Further studies may be required to determine anti-Toxoplasma antibody level in first episode psychosis and in the same individuals in chronic course by follow up to speculate decrease in antibodies level caused by antipsychotic or mood stabilizer drugs, which might improve the clinical course in the patients.
Symptomatic and Asymptomatic Bacteriuria and Drug Susceptibility Pattern of Urinary Tract Infections among Diabetic Patients Attending at Tikur Anbessa Specialized University Hospital, Addis Ababa.
(Addis Ababa University, 2010-02) Yeshitela Biruk; Gebre-Selassie Solomon; Feleke Yeweynehareg
Background: The risk of developing infection in diabetic patients is higher and urinarytract is the most common site for infection. Urinary tract infection (UTI) may besymptomatic or asymptomatic. The etiology of UTI and the antibiotic resistance of uropathogens have been changing over the past years. In Ethiopia, there are some published information concerning community acquired and hospital acquired UTIs, butno study was conducted in asymptomatic bacteriuria and antimicrobial susceptibility pattern for UTIs in Ethiopian diabetic patients. Objective: The aim of the study was to identify the prevalence of symptomatic and asymptomatic bacteriuria, to isolate the bacterial pathogens and determine drug susceptibility pattern of urinary tract infections among diabetic patients attending Diabetic referral clinics at Tikur Anbessa Specialized University Hospital, Addis Ababa. Methods: A cross sectional survey was conducted by systematic sampling technique by taking every other diabetic patient coming to diabetic referral clinics and admitted to medical wards and medical Intensive Care Unit (ICU). A total of 413 diabetic patients were selected during the study period from June 2009to August2009. Results: ine (13.6%) of the symptomatic DM patients had bacteriuria compared with thirty six(10.4%) of asymptomatic DM patient. The overall prevalence of UTI in both groups was 45(10.9%).The bacterial pathogens isolated were predominantly gramnegative and two isolates were gram positive. Of the gram negative isolates the most common organism was Escherichia coli, 6% and 28% followed by Klebsiellapneumoniae, 2% and 6% in the symptomatic and asymptomatic DM patientsrespectively. The other gram negative organisms found in small numbers were Pseudomon as aeruginosa, 1(0.2%) and Enterobacter clocace, 1(0.2%). The only isolatefrom gram positive was Entrococcusspp.2 (0.5%).The susceptibility testing results of the isolates showed that over 85%Escherichia colistrains were sensitive to ciprofloxacin, Amoxicillin-Clavulanic acid, ceftizadine, nitrofuranton, ceftiraxone, norfloxacin and kanamycin(85.3–94.1%),but there was a higher rate of resistant to both ampicillin (67.6%), tetracycline (64.7%) and Trimethoprim -sulphamethoxazole (64.7%).Klebsiella pneumoniaewere 100% sensitiveto ciprofloxacin, ceftazidime, ceftiraxone and over 85% sensitive to gentamycin (87.5%)butshowed a high rate of resistance(75%) to ampicillin, tetracyclin and Trimethoprim-sulphamethoxazole.The frequency of multiple resistances for two or more drugs amongthe urinary pathogenswere found in thirty three(71.7%) of the isolates. Conclusion:The prevalence of urinary tract infection in this study ishigh in women thanmen and also pyuria and glucosuria can be considered as strong association withbacteriuria.Escherichia coli was the most commonbacterial pathogen isolated in bothsymptomatic and asymptomaticbacteriuria. Remarkablyover (60%) of all isolates were resistances to ampicillin, tetracycline and Trimethoprim-sulphamethoxazolehave beenfound in this study. Therefore, the investigation of bacteriuria in diabetic patients by screening for urinary tract infection is very important as it enables to treat properly andprevent the development of renal complications and eventually severe renal damage andfailure.
Functional and Molecular Characterization of Potential Bacterial Pathogens in Akaki River and its Toxicogenomics Effects on Model Organisms, Ethiopia
(Addis Ababa University, 2021-06) Yitayew Berhanu; Woldeamanuel Yimtubezinash ; Olsson Per-Erik
Background: Persistence and dissemination of pathogenic bacteria and antibiotic resistance genes (ARGs) in aquatic environments remain a serious public health issue. The aquatic environment may serve as a key transmission pathway for pathogenic bacteria and ARGs to and from humans. Continual faecal discharge into the environments, together with high levels of chemical and pharmaceutical pollutants are creating conditions favourable for the persistence and spread of antibiotic resistant pathogens. The aim of the study was to investigate the distribution of ARGs, and functional and molecular characteristics of potentially pathogenic bacteria in the Akaki river that flows through Addis Ababa, Ethiopia, and its toxicogenomic effect in model organisms. Methods: Water and sediment samples were collected from five sites along the Akaki river system for isolation of potential bacterial pathogens and detection of ARGs. The diversity and abundance of 84 ARGs and 116 clinically important bacteria were evaluated using DNA qPCR analysis. Potential bacterial pathogens were isolated using selective agar techniques and identified by MALDI-TOF. Isolates were analyzed for their resistance to different classes of antibiotics and further characterized by PCR and whole-genome sequencing. The toxicogenomic effect of the Akaki river water was also assessed by gene expression analysis of selected genes in exposed Caenorhabditis elegans and Pseudomonas aeruginosa PAO1. Results: Genes associated with fluoroquinolone, aminoglycoside, β-lactamase, macrolide, multidrug resistance efflux pumps, tetracycline efflux pumps, and vancomycin resistance were detected in the water and sediment samples. The majority of ARGs were identified from sites in close proximity toanthropogenic activities such as hospitals, irrigation systems, and industries. Aminoglycoside acetyltransferase (AAC(6)-Ib-cr), aminoglycoside adenylyl transferase (aadA1), β-lactamase (blaOXA-10), quinolone resistance S (qnrS), macrolide efflux protein A (mefA) and tetracycline resistance (tetA) genes were detected at all sampling sites. Surprisingly, much fewer ARGs were detected in the associated sediments, and the sediment collected from the hospital site had the highest diversity and level of resistance genes. Genes such as blaOXA-10 , blaOXA-2 , aadA, ermC and oprM were persistent in all sediment samples. There was significant variation in the abundance of ARGs between study sites, with those near the hospitals having the highest abundance in both waters and sediments. Escherichia coli strains isolated from the Akaki river were most frequently resistant to erythromycin (97%), doxycycline (78.5%), tetracycline (75.6%), and amoxicillin (75.6%). The overall prevalence of resistance to cephalosporin and carbapenem was 7.9% and 5%, respectively and 80.9% of E. coli isolates were MDR. Most E. coli isolates (70.8%) harbored enteroaggregative heat-stable toxin 1 (EAST1) gene, whereas the heat-labile toxin (LT) was detected in only 34 (20.2%) of the isolates. The prevalence of Shiga toxin-producing E. coli was 7.7%. The E.coli isolates belonged to 20 different sequence types, with ST10, ST69 and ST361 being predominant. The β-lactamase genes were the commonly detected resistance genes in E. coli. The most prominent plasmid sequence replicons detected were from the IncF family (65%), Col (10%), and IncX3 (7.5%). The Aeromonas spp. isolated from the Akaki river were resistant to a wide range of antibiotics with the highest being resistant to amoxicillin (144, 100%), ampicillin (142, 99%), amoxicillin/clavulanate (117, 81%), imipenem (75, 52%), ertapenem (132, 92%) and doxycycline (134, 93%). The heat-labile cytotonic enterotoxin (alt) was the predominant toxin gene detected, followed by a heat-stable cytotonic enterotoxin (ast). Almost all Aeromonas isolates in the current study were new sequence types. Paeruginosa isolates detected in the Akaki river were resistant to different classes of antibiotics and resistance is mediated by diverse group of ARGs with the majority were multi-drug efflux systems. Akaki river water induced a significant change in gene expression in exposed Celegans and P. aeruginosa PAO1. Although the levels of almost all analyzed metals were below the permissible limit, the compiled effect resulted in transcriptional changes at the molecular level. A significant spatial variation was observed between the sampling points in the expression of certain genes. Conclusion: The findings suggest that the water phase, rather than the sediments in the Akaki river, are a potential conduit for the spread of ARGs and thus antibiotic resistant bacteria. The occurrence of antibiotic resistance in E. coli, Aeromonas spp. and P. aeruginosa isolated from Akaki river provides evidence for the need to develop prevention and control strategies to limit the spread of antibiotic-resistant bacteria in the aquatic environment. The presence of virulent E. coli and Aeromonas spp. in the water could be posing a serious health risk to the public. The Akaki river water has selection pressure in bacteria and elicits a toxic effect in C. elegans at the molecular level result in a higher risk of infectious disease.
Isolation and Antimicrobial Susceptibility Profile of Shigella and Salmonella Species from Children with Acute Diarrhoea in Mekelle Hospital and Semen Health Center ,Tigray, Ethiopia.
(Addis Ababa University, 2012-06) Gebreegziabher Gebremichael; Asrat Daniel; W/Amanuel Yimtubezinash ; Hagos Tesfalem
Background: Diarrhoea and acute gastroenteritis are among the leading causes of illnesses and deaths in infants and children throughout the world, especially in developing countries. Globally, Salmonella and Shigella remain the major contributors to acute enteric infections and diarrhoea. Emergence and spread of antimicrobial resistance to newer and more potent agents used in treatment have been described for Salmonella and Shigella species. Objectives: To isolate and determine the antimicrobial susceptibility pattern of Salmonella and Shigella species from children with acute diarrhoea in Mekelle Hospital and Semen Health Center. Materials and Methods: A cross sectional study was conducted among 260 children with acute diarrhoea in Mekelle, from November 2011 to March 2012. Results: Out of the 260 study participants 145 (55.8%) were males and 115 (44.2%) were females. Majority of the patients (44.2%) were children under five years of age. A total of 120 enteropathogens were isolated. The frequency of isolation was 19 (7.3%), 18 (6.9%) and 83 (31.9%) for Salmonella species, Shigella species and intestinal parasites respectively. Most of the Shigella isolates were resistant to ampicillin (88.9%), Tetracycline (77.8), cotrimoxazole (55.6%) and chloramphenicol (55.6%). Among the Salmonella isolates highest resistance was observed to ampicillin (89.5%), Tetracycline (89.5%), chloramphenicol (78.9%) and cotrimoxazole (57.9%). Multi-drug resistance was noted in 19 (100%) and 16 (88.9%) of Salmonella and Shigella species respectively. Conclusion and recommendation: Shigella and Salmonella are still challenging pathogens in children < 5 years of age. High antibiotic resistance was observed among both isolates to ampicillin, tetracycline, chloramphenicol and cotrimoxazole. Ciprofloxacin, norfloxacin and ceftriaxone were effective for all isolates. To reduce the incidence of these enteropathogens, improving personal and food hygiene has to be strengthened. The establishment of antibiotic policy and treatment guideline are recommended based on the susceptibility profile.
Isolation and Anti-Microbial Susceptibility Testing of Salmonella Species from Foods of Cattle Source in Merkato, Addis Ababa, Ethiopia.
(Addis Ababa University, 2012-06) Lemma Ayalew; Gebre-Selassie Solomon
Back ground: Infectious diseases are diseases that are transmitted mainly through foodand still remain a common and persistentpublic healthproblem resulting high morbidityand occasional mortality in both developed and developing countries. Foods obtainedfrom animals play an important role for food borne diseases particularly in developing countries like Ethiopia. Food borne diseases arecaused by a variety of bacteria, viruses, parasites and fungi. Salmonellosis is one of those food borne diseases caused by Salmonella species which is becoming resistant to antimicrobials and causing serious diseases especially in developing countries because of consumption of raw foods such as meat, milk and cheese. Objective: This study is aimed to determine the prevalence of Salmonella species from foods of cattle source and perform their anti-microbial susceptibility tests. Materials and Methods: A cross-sectional study was conducted over a period of 4monthsfrom November, 2011 to February, 2012 in Merkato, Addis Ababa Ethiopia. Inthis study, a total of 384 samples from meat, milk and cheese were collected randomly from the Market and transferred to the laboratory following the ISO-6597, 2002procedure. In order to isolate Salmonella species, conventional culture method such aspre-enrichment, enrichment and selective plating were performed. Then, to confirm theidentification ofisolated coloniesasSalmonella Species, TSI, motility and API 20E tests were used. Finally, anti-microbial susceptibility testing following the standard procedure was performed in order to know the pattern of drug resistant for each isolate and the results were analyzed and interpreted by using SPSS 16.0,2007 computer Software. Results: Out of 384 food samples consisting of 128 meat, 128 milkand 128 cheesesamples, 13 (3.39%) were positive forSalmonella spp.Of the 128 meat, 128 milkand128 cheese samples, 9 (7.03%), 3(2.34%) and 1 (0.78%) yielded Salmonella spp.respectively.Assay of antimicrobial resistance revealed that 100% of Salmonellaisolateswere resistant to one or more of the 10 antimicrobials tested. Generally,resistance for 9different antimicrobial drugs was recognized. However, all of the isolates were sensitiveto ciprofloxacin. The most common resistance was observed to amoxicillin(100%)followed by ampicillinand tetracycline (76.9%) and most of Salmonella spp.isolates aremulti-drug resistance(84.6%). Conclusions and Recommendations:The findings of the present study ascertain thatSalmonellaspp. is isolated in food samples ofcattle sources particularly in retail meatsamples and all of them have developed resistance for routinely prescribed antimicrobialdrugs and this may be a considerable risk to the consumers. So,prudent antimicrobialusage, adequate heat treatment, improvement of standards of hygiene and developmentand enforcement of suitable legislation which safeguard consumers are urgentlyinstituted and must be practiced to combat the ever increasing situation of anti microbial resistance.
Prevalence and Drug Susceptibility Pattern of Neisseria Gonorrheaamong Symptomatic Women Attending Gynecologic OPD in Hawassa Referral Hospital.
(Addis Ababa University, 2011-02) Hailemariam Mengistu; Abebe Tamerat; Mihret Adane
Background: Gonorrheae is asexually transmitted diseasecaused by the bacterium Neisseriagonorrhea for which humans are the only natural host. It is fastidious Gram-negative cocci transmitted by human-to-human contact. Gonococcal infection highly adapted to the genital tractandoften causing asymptomatic and undetected infection in females in which the highest rates are found mainly in female’s of reproductive age group. There are a number of antibiotics for treatment of gonorrhea in which the preferences vary with the local situation. Objective: To determine the prevalence and drug susceptibility pattern of Neisseria gonorrheaamong symptomatic women attending gynecologic OPD in Hawassa Referral Hospital. Methods: A cross-sectional study was conducted from December 2010 to February 2011 at Hawassa University Referral Hospital Hawassa, Ethiopia. During the study period, all women patients visited to gynecologic OPD with suspected of gonococcal infection were included. The inclusion criteria for the selection of215 women of reproductive age group was based on any sign and symptoms for STD up on clinical examination of symptom aticpatients at gynecologic OPD. Endocervical swab were collected by the attending physician. The Presence of gonorrhea was confirmed by culture, Gram staining and biochemical tests. Antimicrobial sensitivity test was performed using disc diffusion method and the result was interpreted accordingly. Result:Of the total 215 patients examined, 11 (5.1%) were confirmed to have gonococcal infection. The highest prevalence was observed in age group 20-24 which is 5/11 (45.5%) andthere is no statistical significant association (p>0.05). The susceptibilitypatterns were done against 11 antimicrobial agents by the agar disc diffusion technique. Low level of susceptibilityto quinolones (ciprofloxacin 55%, ofloxacin 64% & lomefloxacin 64%) was reported. Conclusion:The findings from this study indicate that gonococcal infection was moderately higher combined with high Neisseria gonorrhearesistance.
Longitudinal Bacteriology of Burn Patients at Yekatit 12 Hospital Burn Center, Addis Ababa, Ethiopia.
(Addis Ababa University, 2011-04) Deribie Awoke; Abebe Tamrat ; Mihret Adane; Demisie Yohannes
Introduction: Burn is one of the most common, devastating and a very painful form of trauma.Significantburn injuries induce a state of immunosuppression that predisposes burn patients toinfectious complications. Sepsis and the resultant multi-organ failure are the leading causes ofdeath in intensive burn care units. Rapidly emerging nosocomial and community acquiredpathogens and the problem of multidrug resistance necessitates periodic review of isolationoutline and their antibiotic susceptibility pattern in burn centers.Objective:Theaim of this study was to determine longitudinal bacteriology of burn patients atY ekatit 12 hospital burn center, Addis Ababa. Methods and materials: A prospective hospital based study was carried out from Dec 2010 toFeb 2011.Wound swab and blood samples were collected on 0,7th,and 14th, days of hospital stay and processed by conventional culture and biochemical identification procedures. Onceidentified, isolates were tested against commonly used antibiotics in the hospital by Modified Kirby-Bauerdisc diffusion method. Data was analyzed by SPSS version 17.0for Windows. Results: Forty onepatients were enrolled in the study from both burn unit (BU) and outpatient(OPD). The mean total burned surface area (TBSA) was 11.9%. From 104 pus cultures 101isolates were identified during the study period. In the first pus culture S. aureus was predominated, 15(46.9%) but later on Pseudomonas spp was increasing. Both spp together accounted 87.1% of the total isolates. Regarding blood culture isolates there was no significant change on time.Of 92 blood cultures 15 gram positive isolates were recognized. Coagulasenegative Staphylococci (CoNS) noted with the largest percentage, 8 (53.3%) followed by S.aureus6 (40%).Staphylococcus aureusshowed moderate degree of resistance to the commonly used antibiotics. Majority of isolates were susceptible for clindamycin and vancomycin. But Pseudomonasspp were resistant for most of antibiotics used in the hospital. However, it was found more sensitive to norfloxacineas it was evidenced by only 15% resistance. Conclusion: Every treatment facility has microorganisms unique to it and these might change with time. It is therefore of paramount importance to have an in-depth knowledge of the resident organisms and their antibiotic sensitivity pattern so that infection related morbidity and mortality will improved. The nature of microbial wound colonization and flora changes should be taken into consideration in empirical antimicrobial therapy of burned patients.
Molecular Epidemiology and Drug-resistance Pattern of Mycobacterium Tuberculosis Isolates from Amhara, Gambella and Benishangul-Gumuz Regions of Ethiopia
(Addis Ababa University, 2022-03) Yenew Bazezew; Erku Woldaregay; Kebede Abebaw
Background: Globally, tuberculosis (TB) has affected human beings for thousands of years and the emergence of drug-resistant tuberculosis has been a major obstacle to control the disease, especially in developing countries including Ethiopia. Objective: The study investigated the molecular epidemiology and drug resistance pattern of M. tuberculosis circulating in the Amhara, Gambella and Benshangul-Gumuz regions of Ethiopia. Methods: A cross-sectional study was conducted using 128 MTBC isolates that were obtained from presumptive TB/MDR-TB patients. A total of 127 recovered isolates were used to investigate drug resistance patterns with the indirect proportion method using the MGIT 960 system and the genotypic method at the Ethiopian Public Health Institute. Further, identification of mycobacterial strain types and mycobacterial lineages was done using spoligotyping. Data were managed using the Epi-info, SPSS version 25, SITVIT2, MIRU-VNTRplus and TBInsight databases. Results: Of the 127 recovered mycobacterial isolates, 100 (78.7%) were sensitive to the four firstlineanti-TB drugs, but 27 (21.3%) were resistant to at least one anti-TB drug,20 (15.7%) were poly-resistant, 17 (13.4%) were multi-drug resistant and 2 (10.5%) were Pre-XDR. The highest gene mutations associated with INH and RIF resistance were observed in the katG MUT1 gene (S315T1) [20 (76.9%)] and rpoB gene (S531L) [10 (52.6%)], respectively. Further, the two preXDR cases showed mutations in the gyrA gene. Among the 127 spoligotyped isolates, 119 generated 43 different spoligotyping patterns; 87 (73.1%) generated 26 distinct spoligotype patterns; and 31 (26.0%) generated 17 different spoligotype patterns. The predominantly identified strains, family, lineages and sublineages were the SIT149 (19, 15.9%), T family (54, 45.4%), EuroAmerican (72,60.5%) and CAS1-Delhi (24, 20.2%), respectively. Additionally, Mycobacterium Africanum (12,10.1%) was identified. Furthermore, drug resistance was significantly associated with previous TB history(X2=46.59; p<0,001) and previous TB treatment outcome (X2=47.677;p<0.001). Conclusion: The study identified a significant proportion of drug resistant TB (monoresistance, MDR, Pre-XDR) which could imply the drug resistant TB is a major public health problem in the country. Although a diversified mycobaterium lineages were observed in this study, the Euro American lineage and East-African-Indian lineages were the predominant lineages with the respective CAS1-Delhi and T3-ETH sublineages that are strongly associated with the druresistant TB. Consequently, the country should focuse on the strategies that help for early detection and treatment of drug-resistant TB to halt the transmission of the disease. We recommend further molecular characterization of the unknown mycobacterial isolates, particularly using sequencing platforms and phenotypic drug susceptibility testing to first- and second-line drugs. Besides, the country’s tuberculosis control program should monitor patient adherence to ensure the patients complete the full course of treatment.
Isolation of Bacterial Pathogens from Patients with Post Operative Surgical Site Infection and Possible Sources of Infection at University of Gonder Hospital, North West Ethiopia
(Addis Ababa University, 2011-05) Gelaw Aschalew; Gebre-Selassie Solomon
Background: Hospital environment is a potential reservoir of bacterial pathogens since it housesboth patients with diverse pathogenic microorganisms and a large number of susceptible individuals. The increased frequency of bacterial pathogens in hospital environment is associated with a background rise in various types of nosocomial infections. Surgical site infection is one of the most frequent types of nosocomial infections in developing countries. The infection follows interference with the skin barrier, and is associated with the intensity of bacterial contamination of the wound at surgery or later in wards during wound care. Bacterial pathogens isolated from hospital environments are also known to develop resistance to multiple antimicrobial agents. The emergence of multi-drug resistant organisms in hospital results in difficulty to treat nosocomialinfections. Objective: The aim of this study was to isolate and identify bacterial pathogens from hospital environments& patients with postoperative surgical site infections and assess the antimicrobial susceptibility patterns of the isolates. Methods: A cross sectional study was conducted at the University of Gondar Teaching Hospital from November 2010-February 2011. In order to address the specified objectives, 220specimens of pus, nasal, hand and surfaces swabs were collected using sterile cotton tippedswabsmoistened with normal saline. Colony characteristics and Gram’s technique were used to differentiate the organisms. Biochemical tests were done to confirm the species of the organisms. Antimicrobial sensitivity tests were done on the isolates using the disk diffusion method. Result: A total of 268 bacterial pathogens were recovered from all specimens processed in the study. Most of the isolates,142(52.9%) were from the environments. The rest,77(28.8%) and49(18.3%) were recovered from the health professionals and patients, respectively. The organisms associated with postoperative surgical site infections were S. aureus 11(22.4%)followed by Klebsiella species 10(20.4%) and Proteus species 9(18.4%), Escherichia coli6(12.2%), Enterobacter species and coagulase negative staphylococci each 4(8.2%),Pseudomonasaeruginosa3(6.1%) and Citrobacterspecies 2(4.1%). Gram negative rods isolatedfrom different sample sources were deemed highly resistant to ampicillin 72(90%),cotrimoxazole, 68 (85%), doxycycline, 66 (82.5%), tetracycline, 63(78.8%),chloramphenicol, 48(60%), nalidixic acid, 46 (57.5%)and gentamicin, 38 (47.5%).S. aureusdemonstrated high level of resistance to nalidixic acid and tetracyclinewhile, ceftriaxone and ciprofloxacin were found tobe relatively effective to all the isolates. Conclusion: The predominant causes of postoperative surgical site infections were S. aureus,Klebsiellaandproteus species. Medical equipment, environmental surfaces, air and hands ofhealth personnel were found to be contaminated with various types of bacterial pathogensofnosocomial importance. It is imperative that all professionals should take an active role in infection control within their organization and more resources should be provided to encourage good antibiotic practice and good hygiene in the hospital.
Phenotypic Detection of Extended Spectrum Beta Lactamase in Uropathogens Among Pregnant Women Attending Antenatal Care in Alert Hospital, Addis Ababa, Ethiopia.
(Addis Ababa University, 2019-03) Getie Molla; Gebre-Selassie Solomon; Getu Yemeserach
Background: Nowadays magnitude of Extended Spectrum β- Lactamases (ESBL) producing bacteria which cause urinary tract infection is the most worrying issue in the world. The occurrence of ESBL producers especially in pregnant women can result in life threatening condition and morbidity for both the mother and the newborn due to unavailability of diagnostic method and very limited drug options for treatment of these pathogens in our country. Therefore, evidence regarding the magnitude of ESBL producers among pregnant women is demanding. Objectives: To determine Extended Spectrum Beta Lactamase in uropathogens and antimicrobial susceptibility pattern of Gram negative bacilli isolates among pregnant women attending antenatal care in ALERT hospital, Addis Ababa, Ethiopia. Methods: A cross sectional study was conducted from July to September 2018 on a total of 177 pregnant women with and without symptoms of urinary tract infection at ALERT hospital, Addis Ababa, Ethiopia. All urine samples were inoculated onto Cysteine Lactose Electrolyte Deficient medium (CLED) and MacCkonkey agar. Colonies were counted to check the presence of significant bacteriuria. Pure isolates of bacterial pathogen were characterized and identified at species level by colony morphology, gram-stain and standard biochemical procedures. All Gram negative isolates were put into Muller-Hinton agar plates for antibiotic susceptibility test by Kirby-Bauer disc diffusion technique. ESBL was detected using double disk synergy methods on Muller Hinton agar. The data were double entered into EPI INFO and analyzed using Statistical Package for Social Science (SPSS) version 26. Results: The overall prevalence of UTI among pregnant women was 14.7% (n=26/177). K. pneumoniae was the predominant bacterial etiologic agent of UTI (26.9% (n=7/26)). The prevalence of ESBL among gram negative isolates was 50% (n=6/12). Among ESBL producing isolates all (100%) were resistance to Amikacin, Gentamicin and Ceftriaxone while intermediate level resistance rate of 66.7% was observed among Trimethoprim sulphamethoxazole and Cefixime. They were susceptible for some limited drugs and these were Nitrofurantoin (83.3%) and Chloramphenicol (83.3%). Conclusions:- Majority of ESBL producing isolates exhibited co-resistance to other commonly prescribed antibiotics. This indicates that the option of treatment for these pathogens rapidly decreased from time to time which results serous life threating conditions especially in mother and newborn unless the appropriate measure is taken.
Epidemiology and Molecular Characterization of Mycobacterium Bovis in Humans and Cattle and Assessment of its Zoonotic Importance in Central Ethiopia
(Addis Ababa University, 2021-11) Gizat Almaw; Mihret Adane ; Abebe Tamrat
Mycobacterium bovis (M. bovis) is a member of the Mycobacterium tuberculosis complex (MTBC) and causes tuberculosis in humans (zoonotic tuberculosis-zTB) and animals, mainly in cattle (bovine tuberculosis-bTB). There were limited studies on zTB in Ethiopia but also a reliable estimate of bTB prevalence in cattle in central Ethiopia is missing. In addition no whole genome sequencing (WGS) based M .bovis studies had been performed in Ethiopia before this study. Also, there has been a limited effort in search for an alternative diagnostic method to culture to detect M. bovis in clinical specimens. Therefore, due to these research gaps, this study, which combined bTB and zTB, was conducted from 2018 to 2021 in central Ethiopia (Addis Ababa, Sebeta, Holeta, Sululta, Sendafa and Bishoftu) with the objective of generating epidemiological and molecular data to update our understanding on bTB/zTB. The bTB study in cattle involved a cross sectional one-stage cluster sampling survey of dairy farms in central Ethiopia using tuberculin skin testing and the collection of additional data by questionnaire to estimate the prevalence of bTB and identify potential risk factors contributing to bTB transmission. For the zTB part, surveillance of TB in humans was carried out among individuals working in bTB infected dairy farms, patients presented at selected health centers, and exposure to risk factors was assessed using questionnaire. From consenting TB suspected individuals, demographic and clinical information was collected by questionnaire. Sputum and Fine Needle Aspirates (FNA) samples were collected from suspected cases. In addition, isolation of M. bovis was done from raw milk collected from tuberculin skin test positive cows and from cattle tissue lesions. The genetic diversity of M. bovis isolates was examined using spoligotyping and whole genome sequencing (WGS) analysis. Furthermore, in this study the performance of a TaqMan real time PCR (RT-PCR) assay as an alternative diagnostic method to culture was evaluated. Two hundred ninety-nine (n=299) dairy herds in the six study areas were randomly selected, from which 5,675 cattle were tested. The overall prevalence of bTB after standardisation for herd-size in the population was 54.4% (95% CI 48.7-60%) at the herd level, and it was 24.5% (95% CI 23.3-25.8) at the individual animal level. A Generalized Linear Mixed Model (GLMM) was used to explore risk factors association with bTB status. We found that herd size, animal age, bTB history at farm, and breed were significant risk factors. With regard to zTB, among 110 DFWs in 73 bTB infected dairy farms, 41 had at least one of the symptoms that are typical for TB. Three DFWs had swollen nodes at their neck, a symptom typical for TB lymphadenitis. In assessment of risk factors: raw milk consumption was practiced by more than two thirds of theDFWs with symptoms of TB (68.2%) and over half of DFWs with symptoms did not think TBcould be transmitted via raw milk consumption. Overall in the surveillance of zTB (active and passive), a total of 167 specimens (sputum=131; FNA=36) were collected from 161 TB suspected individuals for the isolation of M. bovis. Of these processed specimens, three samples with M. bovis were detected in total (1.8%, n=167). And of these three, one M. bovis isolate was sequenced and the genotype was spoligotype SB1476 which was previously reported from cattlein Ethiopia suggesting possible zoonotic transmission. With regard to isolation and characterization of M. bovis from cattle, out of 827 cattle (abattoirs and dairy farms), 76 of them(9.2%) had tuberculous lesion. From these tuberculous lesions, 62 isolates (n=137 samples) from42 animals were confirmed to be M. bovis. Similarly out of 975 milking cows which were tuberculin skin test positive (37.8%, n=2582), 490 composite raw milk samples were collectedand of these 11 (2.2%) yield M. bovis isolates showing evidence that raw milk is not safe and can be a source of infection for human TB due to M. bovis. The genetic diversity of 74 M. bovisisolates (one being a human isolate) was assessed and ten different spoligotypes were recorded. In cattle spoligotype SB1176 was the most prevalent type (n=31, 44.3%) followed by SB0133(n=11, 15.7%). Our WGS analysis with a total of 55 M. bovis isolates sequenced (one being ahuman isolate) showed three clonal complexes clearly segregating in the phylogeny: African 2(Af2; n=47), European 3 (Eu3; n=7) and Unknown8 (n=1). In addition, the present study reported for the first time clonal complex European 3 (Eu3) from Ethiopia. With regard toTaqMan assay performance evaluation - the assay performance on 440 clinical samples was variable for different specimens and overall performed well for sputum samples for all targets. In conclusion, this study recorded high prevalence of bTB in dairy cattle in central Ethiopia. M.bovis prevalence in humans in central Ethiopia was low; however, further investigation is neededin all regions at national level given bTB is endemic in cattle in Ethiopia. Knowledge gap onbTB and M. bovis isolation from milk, showed that there is a clear potential for zoonotic transmission and needs further investigation. The TaqMan RT-PCR assay is a promising methodology for the diagnosis of zTB and bTB, but with further validation works needed usingdifferent targets and specimens.
Prevalence of Glucose–6–Phosphate Dehydrogenase Deficiency and Distribution of its Genetic Variants Among Malaria Suspected Patients in Metehara Health Center, Eastern Ethiopia
(Addis Ababa University, 2021-12) Tefera Tassew; Kebede Tadesse ; Hailu Asrat
Introduction: Glucose-6-phosphate dehydrogenase is a cytosolic enzyme that has a vital role in the functioning and integrity of red blood cells. Lower activity of this enzyme leads to the occurrence of acute hemolytic anemia after exposure to oxidative stressors like primaquine. Although primaquine is important for the radical cure of Plasmodium vivax and blocking the transmission of Plasmodium falciparum, thereby enhancing malaria elimination, there is a need to distinguish glucose-6-phosphate dehydrogenase deficient individuals and/or administer the drug with special care due to its hemolytic side effects. Objective: To determine the prevalence of Glucose-6-Phosphate dehydrogenase deficiency among individuals suspected of malaria during their outpatient visit to Metehara Health Center, Eastern Ethiopia. Materials and Methods: A cross-sectional study was conducted from 01 September 2020 to 30 September 2021. A structured questionnaire was used to collect the socio-demographic and clinical information of the study participants. Capillary and venous blood samples were collected based on standard procedures for onsite screening tests, DBS preparation, and malaria microscopy. Data was recorded and analyzed by using SPSS version 23 software. Result: A total of 498 patients participated in the study; 62% (309) of them were males. According to the results of the biosensor screening test, the overall prevalence of glucose-6-phosphate dehydrogenase deficiency was 3.6% (18/498). There was a significant association between sex and history of previous malaria infection with glucose-6-phosphate dehydrogenase deficiency, P-value 0.032 and 0.02 respectively. Eleven out of the 17 (64.7%) Glucose-6-phosphate dehydrogenase deficient samples by bio-sensor screening test had confirmed mutations using sequencing. The G267+119C/T, A376T, and ChrX: 154535443 mutation types were detected. Conclusion and Recommendation: Phenotypically, the prevalence of glucose-6-phosphate dehydrogenase deficiency was low. G267+119C/T is the predominant glucose-6-phosphate dehydrogenase variant. In Metehara, Malaria patient management using the drug primaquine under close follow up for developments of any adverse effects is recommended.
Prevalence of Mycobacterium Tuberculosis, its Rifampicin-Resistance Pattern an Associated Factors Among Presumptive Pulmonary and Extra Pulmonary Tuberculosis Patients at Madda Walabu University Goba Referral Hospital Southeast Ethiopia
(Addis Ababa University, 2021-07) Taye Wakuman; G/Selassie Solomon; Mitiku Mesay
Background: Drug resistant Mycobacterium tuberculosis is one of the serious public health trouble that intimidating progress made in tuberculosis cases and control in several countries including Ethiopia. Rifampicin resistance is an indicator for drug-resistant Mycobacterium tuberculosis, because it disclose the existence of more than 90% Isoniazid resistance. Early detection of drug-resistant tuberculosis is crucial for patient management and infection control. Objective: This study was designed to assess the prevalence of My cobacterium tuberculosis, its Rifampicin-resistance pattern and associated factors among presumptive Pulmonary and Extra Pulmonary Tuberculosis patients at Madda Walabu University, Goba Referral Hospital, Southeast Ethiopia. Methods: Hospital based cross-sectional study design was carried out from October 22, 2020 to February 7, 2021. Detection of Mycobacterium tuberculosis and resistance to Rifampicin pattern was determined by using Gene pert MTB/RIF assay. Data were entered and analyzed by SPSS version 23.0. Bivariate and multivariate analyses were used to examine the relationship between dependent and independent variables. Less than 0.05 P-value was used to show significance. Results: A total of 301 presumptive tuberculosis patients were included in the study; of these, 46 (15.3%) of them were identified as having Mycobacterium tuberculosis by the GeneXpert MTB/RIF assay, 2/46 (4.35%) were resistant to Rifampicin and 4/46 (14.8%) patients were TB/HIV co-infected. From the total of M. tuberculosis detected 40 (16.7%) were identified in pulmonary and 6 (9.8%) were in extra-pulmonary presumptive patients. Rifampicin-resistant M. tuberculosis was detected in 2 patients who had a history of taking Anti tuberculosis drugs and no in new patients. Conclusion and recommendation: Previous history of tuberculosis treatment and having close contact history with tuberculosis patients were found as an important associated factors that enhance the prevalence of tuberculosis. This indicates the mandate to make better and oversee the treatment protocol to control the burden of tuberculosis.
Isolation and Antimicrobial Resistance Determination of Escherichia coli O157:H7 from Raw Meat in Selected Abattoirs and Butcher Shops, Addis Ababa, Ethiopia.
(Addis Ababa University, 2021-08) Misker Nahom; Abegaz Woldaregay ; Lakew Matios
Background: Foodborne illness and death due to foodborne diseases caused by highly dangerous pathogens is common in the world; especially it is widespread in developing nations. In Ethiopia, the consumption of meat as a raw is well practiced among the people, which is a potential cause of foodborne illness. Cattle are considered as reservoir of pathogens like the highly virulent Escherichia coli O157:H7 (E. coli O157:H7). Low standard of meat handling and safety practices, lack of protecting personal hygiene among workers of meat supply chain and lack of awareness about E. coli O157:H7-caused infection are major problems in Ethiopia. Furthermore, there is paucity of information regarding the epidemiology of the pathogen along the beef carcass supply chain at Addis Ababa Abattoir Enterprise (AAAE). Therefore, the purpose of this study was to isolate E. coli O157: H7 and determine the site of contamination of raw beef meat at AAAE and its carcass supply chain of butcher shops in Yeka sub-city, Addis Ababa, Ethiopia Methodology: A total of 210 samples from carcass swab, raw minced beef meat and pooled environmental sources were collected along the supply chain. Collected samples were cultured to isolate E. coli O157: H7 and identified using biochemical tests and Biolog bacterial identification system. Antimicrobial susceptibility tests were performed on E. coli O157: H7 isolates using the Kirby-Bauer disk diffusion method on Muller-Hinton agar. Observation was used to assess the overall hygiene and sanitation of the beef-selling environment, and a questionnaire was used to assess the workers' knowledge, attitude, and practice. Following data entry into an Excel spreadsheet, the data was exported to and analyzed using statistical software (SPSS version 26.0). Descriptive statistics and the Chi-square (X2) test were used, and a p-value (p< 0.05) was considered statistically significant. Result: The overall prevalence of E. coli O157:H7 was 2/210 (0.95%) and the two isolates were detected from knife swab sample at slaughter house and sample from minced raw beef meat at butcher shop. In the case of the antimicrobial susceptibility test, both isolates were susceptible to ciprofloxacin, gentamicin, meropenem, chloramphenicol, amoxicillin clavulanate and cefotaxime, but resistant to sulfamethoxazole + trimethoprim, amoxicillin, streptomycin and ampicillin. Conclusion: Overall, although the prevalence of E. coli O157:H7 was low, the results indicated that the contamination detected from raw beef meat from butcher shop and the utensil in the abattoir is a matter of concern that calls for an effort to improve the hygienic status. Hence, to ensure the hygienic quality of meat, everyone involved in carcass slaughter, distribution and serving to the customers in the chain should be trained for sanitary and hygienic practices of these meat supply services including providing basic trainings to the personnel involved in the industry.
Molecular Identification and Characterization of Pathogenic Leptospira from Asymptomatic Humans, Livestock and Water Sources in Peri-Urban Areas of Addis Ababa: A one Health Concept
(Addis Ababa University, 2021-07) Marrigje Jacoba; Abegaz Woldaregay
Background Leptospirosis is a neglected zoonotic disease caused by spirochetes, pathogenic Leptospira. It can give a severe disease in humans. Many domestic animals can carry pathogenic Leptospira and Leptospira can survive in environmental water sources. There are barely studies done to investigate the presence of Leptospira in humans, animals or water sources in Ethiopia. Objectives: Identification of the presence of pathogenic Leptospira in asymptomatic humans, livestock and environmental water sources and assessment of knowledge, attitude and practice concerning leptospirosis among households in peri-urban areas of Addis Ababa. Methodology: Urine was collected from asymptomatic humans and livestock in peri-urban areas of Addis Ababa. Water samples were taken from the same areas. After DNA-extraction, real-time PCR and melting curve analysis were performed. Knowledge, attitude and practice (KAP) was assessed with help of a questionnaire. Results: In total, 105 human urine samples, 194 animal urine samples and 32 water samples were collected from 85 households. Pathogenic Leptospira were found in 3 of the 194 animal urine samples (1.5%), characterized as Leptospira borgpetersenii and detected in urine of cattle. No pathogenic Leptospira were found in the human urine samples and in the water samples. Majority (97.6%) of the respondents had never heard about leptospirosis, but knew that water, animals’ urine and rat urine could contain pathogens. Multiple risk factors for the presence of Leptospira were found in the studied households: walking through wet areas without adequate protection (48.2%), rats in (66.3%) or around (63.8%) the house and garbage stored inside the compound (56.1%). No significant relationship was found between risk factors and the positive. Leptospira samples in this study. Conclusion: This study has shown that pathogenic Leptospira are present in peri-urban areas of Addis Ababa. Risk factors for the presence of pathogenic Leptospira and other zoonoses were widespread in the study area. These findings highlight the need to create awareness among livestock-keeping households concerning leptospirosis using a “One Health” concept.
Occult Hepatitis B Virus Infection Among Blood Donors at National Blood Bank of Ethiopia, Addis Ababa, Ethiopia.
(Addis Ababa University, 2021-06) Gemechu Gizachew; Abegaz Woldaregay ; Mihret Adane; Mulu Andargachew
Background: Occult hepatitis B infection (OBI) is a persistent Hepatitis B virus infection in which serological test fails to detect surface antigen, but viral DNA is detectable at a low level. The HBV screening for blood transfusion is still based only on HBsAg. As a result, OBI remains a potential threat for blood safety. Thus far, there is no data on the magnitude of occult hepatitis among blood donors. Therefore, this study sought to determine the magnitude of occult hepatitis B virus among apparently healthy blood donors in Ethiopia. Objectives: To study the magnitude of OBI and associated risk factors among blood donors at National Blood Bank, Addis Ababa, Ethiopia. Methods: Cross-sectional study was conducted from December 2020 to April 2021 to determine the prevalence of OBI among blood donors. A total of 973 HBsAg negative plasma samples were collected from National Blood Bank. The samples were tested for anti-HBc using an ELISA and viral DNA using quantitative real time PCR [Abbot m2000rt]. Along with plasma samples, demographic data were also retrieved from donor‟s database. Both descriptive and inferential statistics was employed for the analysis of data by SPSS 15. P-value less than (0.05) were considered as statistically significant. Results: Of the total 973 apparently healthy blood donor study participants, 445 (45.7%) were females and mean age was 26.5 years. A total of 144 of the 973 blood samples were anti-HBc reactive (14.8%). Four (0.41% of all and 2.7% of anti HBc+ donations) samples were confirmed as OBI by DNA detection. The mean viral load was 31IU/ml with +/- 12 SD suggesting true occult hepatitis BV infections. Age was found to be risk factors for anti-core positivity and statically significant at (p=0.0001). Conclusion: About 4 in 1000 apparently healthy blood donors screened negative for HBsAg had occult HBV infection. This shows that there is a risk of HBV transmission through blood transfusion in Ethiopia. Therefore, there is a need for further investigation and action to revise blood screening strategy including anti-HBc and HBV nucleic acid testing.
Prevalence and Antimicrobial-Resistance Patterns of Pseudomonas Aeruginosa Among Burn Patients Attending Yekatit 12 Hospital Medical College Addis Ababa, Ethiopia.
(Addis Ababa University, 2021-08) Alemu Fedasan; Erku Woldearegay ; Abrha Alem
Background:-Burns are one of the most common and devastating forms of trauma globally. Patients with burn wounds are at higher risk for infections due to multiple factors. P. aeruginosa plays a prominent role as an etiological agent involved in serious infections among burn patients, which varies by geographical location. There is a paucity of information about the specific prevalence and antimicrobial resistance patterns of P. aeruginosa among burn patients in Ethiopia. Objective:-This study was designed to assess the prevalence and antimicrobial-resistant patterns of P. aeruginosa among burn patients attending Yekatit 12 Hospital Medical College in Addis Ababa, Ethiopia Methods:-Hospital-based cross-sectional study was conducted at Yekatit 12 Hospital Medical College among patients attending burn clinic from November, 2020 to April, 2021. Detection and identification of P. aeruginosa were performed using conventional culture, Biochemical tests, and Gram staining. Antimicrobial resistance testing was done using Kirby-Bauer disc diffusion method. Logistic regression analysis was computed to determine the associated factors for P. aeruginosa infection. Results:-From the total of 210 burn wound cultures, 27 (12.86%) were found positive for P. aeruginosa. All the isolates showed greater than 70% susceptibility for the tested antibiotics except Gentamycin (29.63%), Ceftazidime (59.3%) and Ciprofloxacin (66.67%). Imipenem was the most effective drug (89%) in inhibiting the growth of P. aeruginosa isolates. In addition, 33.33% of P. aeruginosa isolates were Multidrug-resistant (MDR). Admission type, Hospital stay time and total body surface area (TBSA) had a statistically significant positive association with P. aeruginosa infection (all with P-value >0.05). Conclusion:-The overall, prevalence of P. aeruginosa among burn patients in the current study is almost 13%. P. aeruginosa isolates were most sensitive to Imipenem, while they were most resistant to Gentamycin. One-third of P. aeruginosa isolates were multidrug-resistant. This suggests the need to improve and monitor the treatment of infection with the pathogen to limit the possibility of the emergence of multidrug-resistant isolates in burn treatment centers.
Catheter Associated Vancomycin Resistant Enterococci (VRE) Among Patients Admitted to Yekatit 12 Hospital Medical College in Addis Ababa, Ethiopia
(Addis Ababa University, 2021-07) Derebe Ayelign; G/Selassie Solomon; Abrha Alem
Background: Catheter associated urinary tract infections (CA-UTIs) are common cause of hospital acquired infections. The emergence of Vancomycin-resistant Enterococcus (VRE), poses a significant problem in the management of CA-UTI. There is scarcity of information on the prevalence and drug resistance pattern of VRE among catheterized patients in the current study setting. Objective: To determine the magnitude & prevalence of CA-UTI and CA-VRE in catheterized patients and to assess the knowledge and practice of health professionals on CA-UTI. Methods: A hospital based cross-sectional study was conducted on 270 catheterized patients admitted to Yekatit 12 Hospital Medical College from December 2020 to June 2021. A total of 121 health professionals were also assessed for their KAP on CA-UTI. Urine samples were collected and inoculated on to blood and MacConkey agars, incubated at 35-37°C for 24 hours aerobically. Phenotypic identification was carried out by biochemical tests. Vancomycin resistance for Entrococcus was performed by E-test. Data on level of knowledge and practice on CA-UTI was collected from health professionals using questionnaire and analysed by using SPSS version 20.P-value < 0.05 was used as statistically significant. Result: CA-UTI was detected in 31.9% of the study participants. E.coli was the most prevalent isolate (9.3%) followed by Enterococci (7.4%).The Enterococcus isolates showed highest resistance for penicillin (95%) followed by Doxycycline (55%) and erythromycin(50%). In contrast, lower resistance was documented for Ciprofloxacin (25%), Meropenem (20%) and Vancomycin (20%).The prevalence of CA-VRE among the Enterococcus isolates was 20%. Among health professionals participated in the study, 94.2% had knowledge on CA-UTI. Only 34.7% had awareness on CA-VRE and 19.8% had knowledge on bacterial biofilm formation. Conclusion: The overall prevalence of CA-UTI and CA-VRE was 31.9% and 20% respectively. Medical ward, intermittent catheterization and previous UTI have strong association with CAUTI, <0.05. Health professionals have little knowledgeon VRE and bacterial biofilm formations. Adherence to safety practice and periodic AMR screening in hospital can decrease the prevalence of CA-VRE and improve treatment outcome of hospitalised patients.
Human papillomavirus in Women with Pre-Cancerous Lesion and Cervical Cancer: the Use of Urine as an Alternative Specimen
(Addis Ababa University, 2021-05) Firdawoke Ededia; Abebe Tamrat; Teka Brhanu
Background: In a country where the coverage cervical cancer screening is low optimization of the uptake is critical. The implementation of high precision test is advocated by WHO. To augment the implementation human papillomavirus (HPV) based screening in Ethiopia we compared the performance urine HPV DNA test with cervical swab. Methods: Paired samples (n=103) of first void urine and cervical swab were collected from patients Gynecology Clinic of Tikur Anbessa Specialized Hospital (TASH). After extraction of DNA using QIAamp® DNA Mini Kit (Qiagen) the HPV infection, coinfection and type-specific HPV distribution was determined using the Anyplex HPV28 DNA genotyping kit (Seegene, Seoul, Korea) and CFX96 IVD (In Vitro Diagnostic) Real-Time PCR System. The kit simultaneously detects, differentiate, and semi-quantify 28 HPV genotypes 19 high risk (Hr)-HPV types; HPVs 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 69, 73 and 82 and 9 LR-HPV types; HPVs 6, 11, 40 ,42, 43, 44, 54, 61 and 70. Additionally, blood sample was collected to detect HPV16 L1 anti-capsid antibody using Prevo-check ® (Abvirus Germany GmbH). It is immunologic rapid test that directs against a protein that is produced by HPV 16 infected cells which interferes with cell division. Pap smear was done by a pathologist and histology results was collected from the chart of the patients and a clinical form was used to collect basic information from the patients by the attending midwife nurses. Result: Of the 103 paired samples, HPV infection prevalence was 83.5% in cervical and 77.7% in urine samples. HPV 16 is the most prevalent in both samples with 56.8% in cervical swab and 54.6% in urine sample followed by HPV 18 (5.8%) in cervical swab and HPV 18 and HPV 39 (6.2%) in urine samples. Multiple infection rate (infection more than one type of HPV) was 22.4% in urine samples and 32.0% in cervical swab. The agreement in the detection of HR-HPV between urine and cervical samples was moderate with a kappa value of 0.57 at 95% CI. Using the cervical HPV results as a reference, the anaylitical sensitivity of urine HPV testing was 88.4% (76/86) and specificity of 76.5% (13/17) and ROC area of 0.82 with (0.7-0.9) 95% CI. The Prevo-check HPV16 L1 antibody test has detected antibody from seven patients have a low clinical sensitivity but specificity of 100%. Of 93 histology result; 69.9% of the participants were diagnosed with SCC. HR-HPV detected in 76.2% and 79.7% from cervical and urine samples. Conclusion: In a country with low cervical cancer screening uptake collection of urine specimen can be considered as an alternative sample since the sample is easy to obtain, showed good diagnostic performance and may increases uptake of cervical cancer screening in Ethiopia. HPV16 and 18 were the predominant HPV detected from women with CIN2+ and above patients.

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