Bacterial profile, antimicrobial susceptibility patterns, and associated factors of community-acquired pneumonia among adult patients in Gondar, Northwest Ethiopia: A cross-sectional study

Abstract

Introduction Community-acquired pneumonia is associated with higher morbidity, hospitalization, and mortality in adults. Likewise, antimicrobial resistance has increased in recent decades in Ethiopia. Therefore, this study was aimed to determine the bacterial isolates, their antimicrobial susceptibility patterns, and factors associated with community-acquired pneumonia among adult patients in Gondar, Northwest Ethiopia. Materials and methods This institutional-based cross-sectional study was conducted from April to June 2021. Sociodemographic, clinical, and other relevant data were collected using a pre-tested questionnaire. A total of 312 sputum specimens were collected using sputum cups and inoculated into blood agar, chocolate agar, mannitol salt agar, and MacConkey agar plates, which were then incubated at 37°C for 24 hours. The bacterial isolates were identified based on Gram staining, colony characteristics, and biochemical tests. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method. Inducible clindamycin resistance among the S. aureus isolates was detected by the D-test. Data were entered using EPI data version 4.6 and analyzed using SPSS version 20. P-value ≤ 0.05 at 95% CI was considered statistically significant. Results Of 312 cases, 39.4% (n = 123; 95% CI: 34.1%–44.9%) were found to have culture-confirmed pneumonia. The most common isolates were K. pneumoniae (31.0%, n = 39), S. pneumoniae (26.2%, n = 33), and S. aureus (20.6%, n = 26). The gram-positive bacteria were susceptible to chloramphenicol (100%) and clindamycin (96.6%). Gram-negative bacteria were susceptible to gentamicin (87.5%), azithromycin (87.1%), ciprofloxacin (86.6%), and ceftriaxone (79.0%) but highly resistant to ampicillin (100%), followed by tetracycline (87.1%), doxycycline (86.4%), co-trimoxazole (80.6%), and amoxicillin-clavulanic acid (79.0%). Overall, 72.2% of the isolates were multi-drug resistant to K. pneumoniae (94.9%, n = 37), E. coli (93.8%, n = 15), and S. pneumoniae (72.7%, n = 24). Only, 7.7% of S. aureus isolates showed inducible clindamycin resistance. Aging (AOR: 3.248, 95% CI: 1.001–10.545, p = 0.050), a history of pneumonia (AOR: 7.004, 95% CI: 3.591–13.658, p = 0.001), alcohol use (AOR: 6.614, 95% CI: 3.399–12.872, p < 0.001), and overcrowded living conditions (AOR: 4.348, 95% CI: 1.964–9.624, p = 0.001) were significantly associated with culture-positive sputum. Conclusion and recommendations This study found a high prevalence of bacteria-caused community-acquired pneumonia among adults and low susceptibility to ampicillin, tetracyclines, and amoxicillin-clavulanic acid. Therefore, culture-based bacterial identification and local antibiotic susceptibility testing should be performed regularly. Additionally, new insights into vaccine coverage against highly multi-drug resistant bacteria, particularly K. pneumoniae, are necessary.

Inducible Clindamycin-Resistant Staphylococcus aureus Strains in Africa: A Systematic Review

“…The phenotypic analysis of the inducible resistance in S. aureus to clindamycin was demonstrated through the D -test across African countries. In this review study, the prevalence of inducible clindamycin resistance among the S. aureus isolates was found to be 19.8%, ranging from 2.9 to 44.0% [ 12 – 33 ]. Various studies have reported a comparable proportion of inducible clindamycin resistance among S. aureus isolates obtained from human sources such as studies in Odisha state, eastern India, 22.0% [ 7 ]; Nepal, 23.4% [ 34 ]; Malaysia, 22.1% [ 35 ]; and Israel, 20.0% to 25.0% [ 36 ].…”

“…Similarly, the overall prevalence of the iMLSB phenotype in MRSA was calculated by adding all the number of iMLSB phenotypes and dividing it by the total number of MRSA isolates, which was 26.8% (279/1041). Studies were conducted between 2007 and 2021 from different areas of the country [ 12 – 33 ].…”

“…Inducible clindamycin resistance was first reported in 2007 in Libya among burn patients [ 12 ]. The prevalence range of inducible clindamycin resistance among the S. aureus isolates was 2.9–44% [ 12 – 33 ] ( Figure 3 ). The highest peak prevalence of inducible clindamycin resistance among S. aureus isolates documented on the continent was 44.0% in 2017 in Egypt [ 21 ] and the minimum prevalence was 2.9% from Côte d'Ivoire [ 24 ].…”

Multi-drug resistant gram-negative bacterial pneumonia: etiology, risk factors, and drug resistance patterns

“…Pneumonia is one of the leading causes of death among Ethiopian children under the age of five, accounting for 28% of all deaths [ 33 ]. Previous reports in Africa showed GNB prevalence in CAP with 49.7% to 56.7% in Ethiopia [ 4 , 37 , 38 ], 83.1% in Tanzania [ 39 ], and 76.2% in Sudan [ 40 ].…”

Association of Respiratory Tract Infections causing Alterations in Lung Parenchyma and Pulmonary Vasculature with Body Electrolyte Imbalance

“…The samples were tested for saliva, mucus, blood, and mucoid material 10 . Sample Processing: Electrolytes were performed on Alinity 11 , Sputum culture was performed by inoculating sputum on blood, chocolate and MacConkey agar 12 . AFB was tested by GeneXpert 13 .…”