Magnitude of extended-spectrum ß-lactamase and carbapenemase producing Enterobacteriaceae among commonly vended street foods in Arba Minch town, southern Ethiopia.

BACKGROUND: The rising prevalence of extended-spectrum beta-lactamase and carbapenemase-producing Enterobacteriaceae (ESßL-PE) in street foods poses a significant risk to human health due to its epidemiological significance. Thus, the aim of this study was to determine the magnitude of foodborne Enterobacteriaceae that produce carbapenemase and ESßL, as well as their patterns of antibiotic resistance, in the studied area. METHODS: A community-based cross-sectional study was carried out from January 1st, 2023, to February 30th, 2023. One hundred randomly chosen street-vended food items (one hundred grams of each food item) were aseptically collected, and aliquots of 0.1 ml from the homogenized (25 g of samples into 225 ml of buffered peptone water (BPW)) were inoculated on MacConkey agar and Xylose Lysine Deoxycholate Agar (XLD). Enterobacteriaceae isolates were identified using various biochemical tests. ESßL and carbapenemase were first screened by indicator cephalosporins and carbapenem antibiotics, respectively. ESßL and carbapenemase were confirmed by a double-disc synergy test and modified carbapenem inactivation methods, respectively. Kirby-Bauer disc diffusion method was used for the antimicrobial-resistant test. RESULTS: A total of 112 Enterobacteriaceae belonging to six different genera were isolated. E. coli was attributed 39 (34.8%), followed by Citrobacter spp. 22 (19.6%) and K. pneumoniae 18 (16.1%), with only 8 (7.1%) isolated Salmonella spp. About 15.2% (n = 17) and 8.9% (n = 10) of Enterobacteriaceae were phenotypically confirmed to be extended-spectrum beta-lactamase (ESßL) and carbapenemase producers, respectively. The highest percentage of ESßL-producing isolates was attributed to K. pneumoniae (n = 5), E. coli (n = 4), and Enterobacter spp. (n = 3). Proteus spp. and Salmonella spp. isolates were carbapenemase-negative. All carbapenemase-positive isolates were found to be ESßL-producers. 70.6% (12/17) of ESßL-producing Enterobacteriaceae were found to be multidrug-resistant (MDR). CONCLUSION: A considerable number of multidrug-resistant ESßL and carbapenemase-producing Enterobacteriaceae were identified, suggesting that street foods may be a potential source of MDR foodborne infections. Consequently, it is important to conduct routine examinations of street food items and track trends in medication resistance.

Role of Erythropoiesis Stimulating Agents in the Treatment of Anemia: a Literature Review.

BACKGROUND: Erythropoiesis stimulating agents are exogenous erythropoietin medications that are used to stimulate the bone marrow red blood cells' production for the management of anemia of chronic kidney disease, some anticancer drugs, myelodysplastic syndrome, and others. Currently, there are different erythropoiesis stimulating agents accessible in the market. The objective of this narrative literature review is to summarize the role of some erythropoiesis stimulating agents in the treatment of anemia. METHODS: The following method was used to prepare this narrative literature review. The comprehensive computerized search of literatures was carried out using PubMed, Cochrane library, Google scholar, and Science direct. Keywords such as recombinant human erythropoietin, epoetin, darbepoetin, continuous erythropoietin receptor agonist, pegzyrepoetin alfa, erythropoiesis stimulating agents in combination with anemia/anaemia were used. The pertinent original and review full articles which are written in the English language were included in this narrative review. RESULTS: From the discussions of the literature, erythropoiesis stimulating agents that are produced by different biosimilar manufacturers have different clinical characteristics and stabilities as a result of their chemical modifications. The chemical modifications of erythropoiesis stimulating agents like glycosylation and polyethylene glycosylation determine the half-life, affinity to erythropoietin receptor, and immune response of the agents. Erythro-poiesis stimulating agents are categorized as short-acting and long-acting agents due to their chemical structures that influence the clinical efficacy and safety of the agents. CONCLUSIONS: The effectiveness of the agents is different in different patients depending on the individual characteristics and etiologies of anemia. The agents not only have the benefits but also, they have the risks for the patients. Hence, the risks and benefits of erythropoiesis stimulating agents must be given special consideration in the managements of anemia to get maximum efficacy for anemic patients. The treatment is dependent on hemoglobin levels of individual patients. The physician must follow the patients during and after therapy using erythropoiesis stimulating agents.

Hematological predictors of preeclampsia among pregnant women attending ante-natal clinic at Arba Minch General Hospital, South Ethiopia: A comparative cross-sectional study.

Background: Preeclampsia is a kind of pregnancy-related hypertension that affects 5.47 % of pregnancies in Ethiopia and 18.25 % of pregnant women who visit Arba Minch public health facilities for antenatal care. This study sought to identify hematological preeclampsia markers in pregnant women who received prenatal care at Arba Minch General Hospital. Methodology: An institution-based comparative cross-sectional study was done from July 22 to October 30, 2021 at Arba Minch General Hospital. A total of 136 pregnant women were included in the study (46 with preeclampsia and 90 without preeclampsia). Epidata version 4.4. was used to enter data, and SPSS version 25.0 and Stata version17 were used for analysis. An independent sample t-test was used to examine the hematological parameter differences between study groups. Potential hematological markers were determined using receiver operating characteristic (ROC) analysis of the area under the curve (AUC). Statistical significance was defined if P value less than 0.05. Results: A total of 136 pregnant women were studied. The complete blood count analysis showed that there were means differences in Red Cell Distribution (RDW) (p < 0.036), neutrophil-to-lymphocyte ratio (NLR) (p < 0.016) and relative lymphocyte count (Lymp%) (p < 0.047). The ROC analysis of the AUC for RDW, NLR and Lymp% resulted in 0.607, 0.609, 0.600 respectively. Conclusion: RDW, NLR and Lymphocyte count could be potential candidate tools for the diagnosis and screening of preeclampsia. However, the robustness of the markers should be tested with prospective studies assessing changes present in each trimester.

Anemia and its predictors among adult non-dialysis chronic kidney disease patients in Southern Ethiopia: a cross-sectional study.

BACKGROUND: Anemia is an adverse outcome and common complication in chronic kidney disease patients. This is usually associated with iron deficiency, inflammation and blood loss. However, little is known about the prevalence of anemia and its predictors among chronic kidney disease patients in Southern Ethiopia. This study aimed to determine anemia and its predictors among adult non-dialysis chronic kidney disease patients in Southern Ethiopia. METHODS: A cross-sectional study was conducted on 384 chronic kidney disease patients from February to April 2019. Socio-demographic and clinical data were collected using questionnaires and medical records. Adjusted hemoglobin was taken to define anemia using the level of Hgb <13 mg/dL for males and <12 mg/dL for females; and blood films and serum ferritin were done for anemic participants. SPSS version 25.0 was used for data analysis. Frequency distribution tables and graphs were used to describe descriptive statistics. A bivariate logistic regression model was used to determine the predictors; p <.05 was considered statistically significant. RESULTS: Overall prevalence of anemia was 44.0% (95% CI: 39.0%, 48.9%); of which 7.1%, 62.1% and 30.8% of anemic patients had mild, moderate and severe anemia, respectively. The prevalence of anemia increased from 20.6% in stage 2 to 100% in stage 5. Morphologically, normocytic normochromic anemia was the most predominant type. Cardiovascular disease (AOR = 2.37, 95% CI: 1.35, 4.16), diabetes mellitus (AOR = 2.77, 95% CI: 1.08, 7.14), stage 3b chronic kidney disease (AOR = 2.74, 95% CI: 1.31, 5.73) and stage 4 and 5 chronic kidney disease patients (AOR = 7.11, 95% CI: 3.22, 15.72) showed significant association with anemia. CONCLUSION: Anemia was a severe public health problem and associated with cardiovascular disease, diabetes mellitus and stages of chronic kidney disease. Thus, early diagnosis, treatment and prevention of anemia are recommended.

Drug-Resistant Aerobic Bacterial Pathogens in Patients with Crocodile Bite Wounds Attending at Arba Minch General Hospital, Southern Ethiopia.

Background: A polymicrobial infection containing a diverse range of drug-resistant bacteria worsens the success of treatment for crocodile bite wound infection. However, there is a dearth of data in Ethiopia, where crocodile bite injuries are relatively common, particularly in the area around Lake Abaya and Lake Chamo in southern Ethiopia. Methods:  A hospital-based cross-sectional study was conducted from May 1st, 2021, to April 30th, 2022, at Arba Minch General Hospital. Eleven consenting patients with crocodile bite wounds were enrolled in this study. Wound swabs were collected aseptically following microbiological procedures. The diversity and type of aerobic bacterial pathogens, and drug-resistant patterns were used to determine and characterize the nature of crocodile bite wound infections. Results: Among 11 patients with crocodile bite wounds, 72.7% (8/11) of wound samples were found to be culture-positive, with a total of 21 aerobic bacterial isolates. Gram-negative bacterial isolates were found in 57.1% (12/21). Triple-bacterial isolates were found in 62.5% (5/8) of wound samples, followed by 37.5% (3/8) of double bacterial isolates. Pseudomonas aeruginosa (n = 5), followed by Citrobacter spp. (n = 4), and coagulase-negative Staphylococci (CoNS) (n = 4) were frequently isolated bacteria. Methicillin resistance (MR-CoNS) was found in 75% of isolated CoNS. 6.7% of the isolated Enterococcus faecalis was vancomycin-resistant (VRE), while 60% of the isolated P. aeruginosa were piperacillin-resistant. Overall, 85.7% (18/21) of the isolates were found to be multidrug-resistant (MDR), with 55.6% (10/18) of them being Gram-negative MDR bacterial isolates. Conclusion: Numerous aerobic bacteria that are resistant to the majority of common antibiotics have been associated with infections in crocodile bite wounds. Thus, the key to providing empirical therapy for such wounds is detecting the drug-resistant pattern of bacterial isolates.

Prevalence and associated factors of urinary tract infections among diabetic patients in Arba Minch Hospital, Arba Minch province, South Ethiopia.

OBJECTIVE: Urinary tract infection (UTI) is a common and grave health problem in the world. In fact, patients with diabetes mellitus have an immense risk for developing UTI. The development of resistance among uropathogens to antibiotics is a major crisis which limits the use of drug of choice for the treatment of UTI. On this view point, the aim of the present study is to elucidate the prevalence of UTI, associated factors, causative agents and their antimicrobial susceptibility amongst diabetic patients attending Arba Minch Hospital, Arba Minch, Ethiopia. MATERIAL AND METHODS: A facility based cross-sectional study was carried out in diabetic patients visiting the Internal Medicine Unit of Arba Minch Hospital (AMH) during the study period (March to May 2016). Pre-tested structured questionnaire was used for collecting the data pertaining to socio-demographic characteristics and possible risk factors. In order to quantify the uropathogens, midstream urine samples were collected in sterile leak proof culture bottles and streaked onto diverse bacteriological media. All the positive urine cultures showing significant bacteriuria as per the Kass count (>105 organisms/mL) were further subjected to biochemical tests. The antimicrobial susceptibility test was performed to determine the resistance/susceptibility pattern of isolated uropathogens. Data entry and analysis were done using Statistical Package for Social Services, version 20. RESULTS: In total, 239 diabetic patients were included in the study of which 60.2% (n=144) were females. A total of 81 (33.8%) diabetic patients had positive urine cultures. Sixty-eight (83.9%) female diabetic patients had significant bacteriuria (p=0.000). Fifty-two (64.1%) participants had drinking habit and 79 (97.5%) of respondents had higher glucose levels (≥126 mg/dL) (p=0.004 and p=0.003), respectively. According to the biochemical tests, in a total of 90 isolates from patients with significant bacteriuria, eight species of uropathogens such as Escherichia coli, Klebsiella sp., Proteus sp., Citrobacter spp., Staphylococcus aureus, Coagulase negative Staphylococcus (CNS), Enterococcus faecalis and yeast isolates were identified. The antibiogram evidenced that 79.6% (n=51) of Gram-negative bacteria were invariably resistant to amoxicillin and penicillin whereas 73.4% (n=47) and 65.6 % (n=42) of them were resistant to trimethoprim, erythromycin and chloramphenicol, respectively. Regarding the Gram-positive bacteria, high degree of resistance was exhibited towards penicillin and trimethoprim (100%, n=24) followed by amoxicillin (83.3%, n=20) and gentamicin (62.5%, n=15). Invariably, all the Gram-positive cocci and Gram-negative bacilli were susceptible (100%) to amikacin, doxycycline, ceftriaxone and nitrofurantoin. CONCLUSION: The prevalence of UTI is higher in diabetic patients. Results revealed that the predominant pathogens of UTI were Gram-negative bacilli (Enterobacteriaceae), particularly E. coli. Significant bacteriuria had an association with the consumption of alcohol, gender and glucose level. Based on the results of antimicrobial susceptibility tests, it might be inferred that the antibiotics such as amikacin, doxycycline, ceftriaxone and nitrofurantoin are the drugs of choice for the management of both Gram-negative and Gram-positive uropathogenic bacteria in the study area.