Bacterial isolates, their antimicrobial susceptibility pattern, and associated factors of external ocular infections among patients attending eye clinic at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia

Abstract

Background External eye infection caused by bacteria can lead to reduced vision and blindness. Therefore, pathogen isolation and antimicrobial susceptibility testing are vital for the prevention and control of ocular diseases. Objective The main aim of this study was to assess bacterial isolates, their antimicrobial susceptibility pattern, and associated factors of external ocular infection (EOI) among patients attended eye clinic at Debre Markos Comprehensive Specialized Hospital (DMCSH), Northwest Ethiopia. Methods We conducted a cross-sectional study in patients with external ocular infections from January 1, 2021, to June 30, 2021, at DMCSH. Socio-demographic and clinical data were collected using semi-structured questionnaires. Following standard protocols, external ocular swabs were collected and inoculated onto blood agar, chocolate agar, MacConkey agar and mannitol salt agar (MSA). Finally, bacterial isolates were identified by Gram stain, colony morphology, and biochemical tests. Antimicrobial susceptibility testing was done by using the modified Kirby-Bauer disk diffusion technique according to Clinical and Laboratory Standards Institute (CLSI) guideline. Cleaned and coded data were entered into EpiData version 4.2 software and exported to Statistical Packages for Social Sciences (SPSS) version 22 for analysis. Bivariate logistic regression was applied to investigate the association between predictors and outcome variables. P-values ≤ 0.05 with 95% confidence interval were considered statistically significant. Results Two hundred seven study participants were enrolled in this study. More than half of them (57.5%, 119/207) were males, and 37.7% (78/207) of them were ≥ 65 years old. A total of 130 (62.8%) bacterial isolates were identified, with Gram-positive bacteria accounting for 78.5% (102/130) of the isolates. Staphylococcus aureus was the most common isolate with a 46.2% (60/130) prevalence. Ciprofloxacin was comparatively effective against Gram-positive and Gram-negative bacteria. The prevalence of culture-confirmed bacteria was significantly associated with age groups 15–24 (AOR: 9.18, 95%CI: 1.01–82.80; P = 0.049) and 25–64 (AOR: 7.47, 95%CI: 1.06–52.31; P = 0.043). Being farmer (AOR: 5.33, 95% CI: 1.04–37.33; P = 0.045), previous history of eye surgery (AOR: 5.39, 95% CI: 1.66–17.48; P = 0.005), less frequency of face washing (AOR: 5.32, 95% CI: 1.31–7.23; P = 0.010) and face washing once a day (AOR: 3.07, 95% CI: 1.13–25.13; P = 0.035) were also significantly associated with the prevalence of culture-confirmed bacteria. Conclusion The prevalence of culture-confirmed bacteria among patients with EOI was high in the study area. A considerable proportion of bacterial isolates exhibited mono and/or multi-drug resistance. Age (15–64 years), being farmer, previous history of eye surgery and less frequency of face washing were significantly associated with the prevalence of culture-confirmed bacteria. Bacterial isolation and antibiotic susceptibility testing should be routinely performed in the study area to combat the emergence of antibiotic resistance.

Prevalence and antimicrobial susceptibility profile of bacteria isolated from the hands of housemaids in Jimma City, Ethiopia

“…The majority of S. aureus was sensitive to chloramphenicol (98.6%), followed by gentamycin (64.8%) and tetracycline (59.2%). This result is higher compared to the results reported in the UoGRH with sensitivity to chloramphenicol (76.9%) ( 13 ), the Addis Ababa regional laboratory with sensitivity to chloramphenicol (53.7%) ( 60 ), and DMCSH with sensitivity to chloramphenicol (66.7%) ( 19 ). Regarding resistance, isolates of S. aureus were resistant to tetracycline (28.2%).…”

“…However, the result is lower than the study performed in Sudan (71.8%) ( 24 ), Iran (46%) ( 25 ), Nigeria (68.9%) ( 58 ), Eritrea (63.1%) ( 59 ), and Ethiopia; Addis Ababa Regional Laboratory (50.0%) ( 60 ) and Ethiopia’s Debre Markos Comprehensive Specialized Hospital (DMCSH) (46.2%) ( 19 ), but higher than the study conducted in Alexandria, Egypt (22%) ( 56 ), Eastern India (3.44%) ( 5 ), and Ethiopia; University of Gondar (16%) ( 14 ); Debre Markos (5%) ( 17 ); Gondar Town (16.5%) ( 61 ), and Jimma University main campus (23.5%) ( 15 ). The discrepancy in the isolation rate of S. aureus might be due to differences in the sociodemographic characteristics, the study periods, the study settings and participants, the working environment, and the sample size.…”

“…The result is lower than the study performed in Iran (29.2%) ( 51 ), Nigeria (25.0%) ( 58 ), and Jimma University Specialized Hospital (JUSH) (25.4%) ( 20 ). However, the result is higher compared to previous studies conducted in Mauritius (0.5%) ( 26 ), in the ICUs of United States medical centers (7.1%) ( 57 ), and in the different parts of Ethiopia: Jimma University (10.9%) ( 15 ), Gondar Town (3.1 and 1.9%) ( 1 , 61 ), Debre Markos (2.7%) ( 17 ), UoGRH (5.9%) ( 13 ), University of Gondar (2.67%) ( 14 ), DMCSH (3.9%) ( 19 ), and Addis Ababa Regional Laboratory (3.6%) ( 60 ). The isolation of E. coli illustrates the concept of fecal contamination in the hands of housemaids.…”

“…A study conducted in the JUSH showed that E. coli isolates were resistant to ceftriaxone (73%) and ceftazidime (65%) ( 20 ). Another study carried out in DMCSH revealed that E. coli was resistant to tetracycline (44.4%), chloramphenicol (22.2%), and ceftazidime (33.3) ( 19 ). Escherichia coli were sensitive to chloramphenicol, which might be due to decreased levels of acetyl coenzyme A incat-expressing CM2555 cells in the presence of chloramphenicol ( 63 ).…”

Molecular Characterization of Bacterial Agents Causing External Ocular Infections Isolates of Patients in a Third Level Hospital

“…This group of pathogens are constituted by lactose-fermenting and non-fermenting bacteria, such as K. pneumoniae, Proteus, Citrobacter, and P. aeruginosa [19]. In relation to antimicrobial resistance, bacteria have been identified as resistant to multiple drugs that are used in the therapy of eye infections, such as those belonging to the β-lactam families, aminoglycosides, phenicols, quinolones, tetracyclines, macrolides, and lipopeptides [9,20]. This shows the risk associated with failure of antimicrobial therapy and, consequently, fatal conditions due to excessive pathogen proliferation, which can lead to visual organ loss.…”