Comparison of syndromic versus laboratory-confirmed diagnosis of Neisseria gonorrhoeae and Treponema palladium, infections at the selected health centers in Addis Ababa, Ethiopia.

BACKGROUND: Sexually transmitted infections (STIs) are major infectious diseases worldwide. Around one million people get STIs every day and among them a high burden of the diseases seen in Sub-Saharan African countries. In most developing countries, including Ethiopia, STIs are diagnosed only using syndromic methods, although there seems to be no consensus between syndromic and laboratory-based research. OBJECTIVE: To compare the effectiveness of a syndromic versus laboratory-based approach in the diagnosis of sexually transmitted infections, especially Neisseria gonorrhoeae (NG) and Treponema palladium (TP), infections among those attending a public health center in Addis Ababa, Ethiopia. METHODS: a cross-sectional study was conducted from April 2019 to March 2020, at selected health centers STIs clinics in Addis Ababa, Ethiopia. A total of 325 study participants were involved. From each participant after having socio-demographic data, additional blood, urethral and vaginal discharge was collected. Then serological, Gram stain, culture, and biochemical tests were performed. SPSS version 23 was used to enter and analyze data. All relevant bodies provided ethical approval, and each study participant gave written informed consent. RESULTS: Among the total participants 167 (51.4%) were males; 177 (54.5%) between ages of 26 and 35; and 178(54.8%) single. Of the total 325 NG, and 125 TP syndromic managed suspected cases, only 163 (50%) and 38 (30.4%) were laboratory- confirmed positive cases respectively. However, there was no statistically significant difference between NG and TP syndromic versus laboratory diagnostic confirmed cases (P-value > 0.005). CONCLUSION: The present study indicated that even if, there were no statistical differences between syndromic versus Laboratory diagnosis confirmed NG and TP cases, more than half of syndromic cases could not be confirmed by laboratory diagnosed tests. Thus, to strengthen the present findings, further large-scale studies are recommended.

Sexually transmitted infections (STIs) are the leading infectious diseases worldwide, and the majority of cases are recorded in developing countries, including Ethiopia. However, diagnosis of STIs in most developing countries done syndromic based, since the laboratory-based tests are relatively expensive, need skilled manpower, and time taking. Therefore regular assessments on how closely related STIs syndromic versus laboratory-based diagnosis should be done, for the proper management of the diseases. In this regard, the present study demonstrated that there was no statistically significant difference between syndromic versus laboratory-based diagnosis of some certain STIs infections; Neisseria gonorrhoeae (NG) and Treponema pallidum (TP), in selected public health centers in Addis Ababa, Ethiopia. However, more than half of syndromic cases could not be confirmed by laboratory diagnosed tests. Thus, to narrow the gap between the two diagnostic approaches, regular training, updates, and similar studies need to cascade in the country. In the meantime, in other developing countries too, regular assessment on STIs syndromic versus laboratory-based diagnosis should be done, to control and prevent STIs infections worldwide.

Catheter-associated urinary tract infections in adult intensive care units at a selected tertiary hospital, Addis Ababa, Ethiopia.

BACKGROUND: Catheter-associated urinary tract infection is the leading cause of hospital-acquired infections. They remain the second most common healthcare-associated infection in critically sick patients. OBJECTIVE: To determine the prevalence of catheter-associated urinary tract infection, the spectrum of etiological agents, antibiotic sensitivity profile of bacterial pathogens among adult patients admitted to intensive care units. MATERIALS AND METHODS: Patients admitted to the intensive care unit of hospitals in Addis Ababa who were on urethral indwelling catheters for >48 hours from October 2020 to September 2021 were included in the study. Urine specimens were aseptically collected and processed as per standard protocols. Microorganisms were isolated, identified, and subjected to antibiotic susceptibility testing. RESULTS: In all 220 pateints included in the study development of significant bacteriuria/candiduria was not affected by sex, age, and prior antibiotic therapy. However, the length of stay in the intensive care unit was significantly associated with bacteriuria /candiduria (P-value < 0.001). The overall prevalence of bacteriuria/candiduria was 51.4% among which 21.0%, 19.1%, and 11.4% were bacteriuria, candiduria, and polymicrobial infections, respectively. About 138 organisms were recovered of which 79 (57.25%) were bacteria and 59 (42.75%) were yeast isolates. Acinetobacter species, Pseudomonas species, Klebsiella species E. coli, and Enterococcus species were the dominant bacterial isolates. Candida. albicans, Candida. krusei and Candida. tropicalis were the commonest yeasts. Many gram-negative bacterial isolates were resistant to ceftriaxone 36(94.7%), ampicillin 21(91.3%) followed by cefotaxime34(89.5%), amikacin (16.0%), nitrofurantoin (17.4%), meropenem (20.0%) and imipenem (20.0%). Out of 79 bacterial pathogens, 52(65.8%) were multiple antibiotic resistant of which 37(71.0%) were Gram-negative bacteria and 15(29%%) were Gram-positive bacteria. About 13(86.7%) isolates of Acinetobacter, all isolates of Klebsiella species (100%) and E. coli (100%) were multiple antibiotic-resistant. Out Of 18,10(55.56%), isolates of Enterococcus were multiple antibiotic-resistant. CONCLUSIONS: A very high prevalence of bacteriuria/ candiduria was demonstrated in this study. This warrants the establishment of multidimensional infection control approach on catheter associated urinary tract infection in ICU. In addition to high prevalence of candiduria, recovery of non-albicans candida species almost in equal proportion with candida albicans in the present study was an important finding as non-albicans candida species distinct to C. albicans are intrinsically resistant to the commonly used azole antifungal drugs in Ethiopia. The prevalence of rate MDR bacteria in our ICU particularly of E. coli, Klebsiella spp, Pseudomonas and Acetobacter spp was very high. In order to combat this problem, proper antibiotic policies should be formulated.

Perforation of the cecum from ingested foreign body in a 14 year old adolescent with autism spectrum disorder and epilepsy: A case report.

INTRODUCTION AND IMPORTANCE: Although foreign body ingestion is a common medical issue, intestinal perforations following foreign body ingestion are rare. Diagnosing foreign body ingestion is challenging especially in children with neurodevelopmental disorders such as Autism Spectrum Disorder (ASD). It is believed that approximately 80-90% of ingested foreign bodies pass through the gastrointestinal tract without causing any luminal damage, and only approximately 1% of foreign bodies are known to remain lodged within the bowel and cause luminal erosion and perforation. CASE PRESENTATION: A 14-year-old boy, diagnosed to have Autism Spectrum Disorder was brought in by his parents to our hospital with right lower quadrant (RLQ) abdominal pain and fever. On examination, he was tachycardic and there was direct tenderness over the RLQ of the abdomen. Acute appendicitis was entertained and the patient was examined with ultrasound. The ultrasound reported, "The tip of the appendix was dilated (0.62cm) and there is minimal RLQ intra-peritoneal fluid collection". With the impression of acute appendicitis, the patient was explored and he was found to have a cecum perforation due to an ingested foreign body (twig). Initially we did tube cecostomy but later we did right hemicolectomy because the cecostomy tube had leaked. CONCLUSION: Foreign body ingestion should be taken into account during the evaluation of children and adolescents with neurodevelopmental disorders who presented with acute abdominal pain. Since diagnosis is difficult clinicians who are involved in acute care medicine should take a thorough history with a high index of suspicion for foreign body ingestion.

Multidrug resistance pattern of Acinetobacter species isolated from clinical specimens referred to the Ethiopian Public Health Institute: 2014 to 2018 trend anaylsis.

BACKGROUND: Acinetobacter species have been a leading cause of nosocomial infections, causing significant morbidity and mortality over the entire world including Ethiopia. The most important features of A. baumannii are its ability to persist in the hospital environment and rapidly develop resistance to a wide variety of antibiotics. This study aimed to determine trend of antimicrobial resistance in Acinetobacter species over a five years period. METHOD: A retrospective data regarding occurrence and antimicrobial resistance of Acinetobacter species recovered from clinical specimens referred to the national reference laboratory was extracted from microbiology laboratory data source covering a time range from 2014 to 2018. Socio-demographic characteristics and laboratory record data was analyzed using SPSS 20. RESULTS: A total of 102 strains of Acinetobacter species were analyzed from various clinical specimens. Majority of them were from pus (33.3%) followed by blood (23.5%), urine (15.6%) and body fluid (11.7%). Significant ascending trends of antimicrobial resistance was shown for meropenem (12.5% to 60.7%), ceftazidime (82.1% to 100%), ciprofloxacin (59.4% to 74.4%), ceftriaxone (87.1% to 98.6%), cefepime (80.0% to 93.3%) and pipracillin- tazobactam (67.8% to 96.3%). However, there was descending trend of antimicrobial resistance for tobramycin (56.5% to 42.8%), amikacin (42.1% to 31.4%) and trimethoprim-sulfamethoxazole (79.0 to 68.2%). The overall rate of carbapenem non-susceptible and multidrug resistance rates in Acinetobacter species were 56.7% and 71.6%.respectively. CONCLUSION: A five year antimicrobial resistance trend analysis of Acinetobacter species showed increasing MDR and resistance to high potent antimicrobial agents posing therapeutic challenge in our Hospitals and health care settings. Continuous surveillance and appropriate infection prevention and control strategies need to be strengthened to circumvent the spread of multidrug resistant pathogens in health care facilities.