Sepsis: emerging pathogens and antimicrobial resistance in Ethiopian referral hospitals

Abstract

Background Sepsis due to multidrug resistant (MDR) bacteria is a growing public health problem mainly in low-income countries. Methods A multicenter study was conducted between October 2019 and September 2020 at four hospitals located in central (Tikur Anbessa and Yekatit 12), southern (Hawassa) and northern (Dessie) parts of Ethiopia. A total of 1416 patients clinically investigated for sepsis were enrolled. The number of patients from Tikur Anbessa, Yekatit 12, Dessie and Hawassa hospital was 501, 298, 301 and 316, respectively. At each study site, blood culture was performed from all patients and positive cultures were characterized by their colony characteristics, gram stain and conventional biochemical tests. Each bacterial species was confirmed using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI TOF). Antimicrobial resistance pattern of bacteria was determined by disc diffusion. Logistic regression analysis was used to assess associations of dependent and independent variables. A p-value < 0.05 was considered as statistically significant. The data was analyzed using SPSS version 25. Results Among 1416 blood cultures performed, 40.6% yielded growth. Among these, 27.2%, 0.3% and 13.1%, were positive for pathogenic bacteria, yeast cells and possible contaminants respectively. Klebsiella pneumoniae (26.1%), Klebsiella variicola (18.1%) and E. coli (12.4%) were the most frequent. Most K. variicola were detected at Dessie (61%) and Hawassa (36.4%). Almost all Pantoea dispersa (95.2%) were isolated at Dessie. Rare isolates (0.5% or 0.2% each) included Leclercia adecarboxylata, Raoultella ornithinolytica, Stenotrophomonas maltophilia, Achromobacter xylosoxidans, Burkholderia cepacia, Kosakonia cowanii and Lelliottia amnigena. Enterobacteriaceae most often showed resistance to ampicillin (96.2%), ceftriaxone (78.3%), cefotaxime (78%), cefuroxime (78%) and ceftazidime (76.4%). MDR frequency of Enterobacteriaceae at Hawassa, Tikur Anbessa, Yekatit 12 and Dessie hospital was 95.1%, 93.2%, 87.3% and 67.7%, respectively. Carbapenem resistance was detected in 17.1% of K. pneumoniae (n = 111), 27.7% of E. cloacae (n = 22) and 58.8% of Acinetobacter baumannii (n = 34). Conclusion Diverse and emerging gram-negative bacterial etiologies of sepsis were identified. High multidrug resistance frequency was detected. Both on sepsis etiology types and MDR frequencies, substantial variation between hospitals was determined. Strategies to control MDR should be adapted to specific hospitals. Standard bacteriological services capable of monitoring emerging drug-resistant sepsis etiologies are essential for effective antimicrobial stewardship.

Clinical Profile of Patients Presenting With Sepsis to the Emergency Department of a Tertiary Care Hospital in Wardha During the COVID Pandemic (June 2020-June 2021)

“…Patients with methicillin-resistant Staphylococcus aureus had the greatest mortality rate, 47.5%, which was strongly associated with a higher chance of dying [ 22 ]. Similar study was done by Legese et al and found Klebsiella pneumoniae (26.1%), Klebsiella variicola (18.1%), and Escherichia coli (12.4%) as the major causative agent in 1416 blood culture [ 23 ]. Our study showed Staphylococcus aureus (14.0%) as the major causative organism, followed by Pseudomonas (8.0%) and then Klebsiella pneumoniae and Escherichia coli, both 2.0%, each amongst the blood culture positive plates.…”

Analysis of Anti-Infective Treatment of 9 Neonates with Raoultella ornithinolytica Sepsis

“…The diagnostic criteria were positive blood bacterial culture, clinical symptoms and signs of bacterial infection, and abnormal laboratory test results (blood routine, C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6) and other infection indicators) [ 8 ].…”

“…e subjects of this study were children diagnosed with Raoultia ornithine septicemia in the department of neonatology of our hospital from July 2020 to December 2021. e diagnostic criteria were positive blood bacterial culture, clinical symptoms and signs of bacterial infection, and abnormal laboratory test results (blood routine, C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6) and other infection indicators) [8].…”

Transitioning to Automated Microbiologic Era: Blood Culture Isolates in Children and Adults in Federal Teaching Hospital in Gombe, North East Nigeria 2016-2020

“…In a non nationally representative data from Mozambique, S. aureus, E. coli and non-typhoidal salmonella dominated [78], and in Ethiopia [79] with a positive culture yield of 40.6% with Klebsiella and E. coli being the commonest, while Staph aureus and Klebsiella predominated in a Uganda report [80].…”