Epidemiology, antimicrobial resistance profile and management of carbapenem-resistant Klebsiella pneumoniae among mothers with suspected sepsis in Ethiopia.

BACKGROUND: Early detection and proper management of maternal sepsis caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) can significantly reduce severe complications and maternal mortality. This study aimed to describe the epidemiology, antimicrobial resistance profile, and management of carbapenem-resistant K. pneumoniae among sepsis-suspected maternal cases in Ethiopia. METHODS: A prospective cross-sectional study was conducted in five tertiary hospitals from June 2021 to December 2023. Isolation, identification, and antimicrobial susceptibility testing of the isolates were carried out following standard microbiological procedures as stated in the CLSI guidelines. Data on socio-demographics, risk factors, and management strategies were collected with structured questionnaires. Associations between variables were determined using logistic regression analysis in STATA-21. A p-value of less than 0.05 was statistically significant. RESULTS: Of the 5613 total women suspected of having maternal sepsis, 609 (10.8%) of them were infected with K. pneumoniae. The prevalence rates of MDR, XDR, and PDR K. pneumoniae strains were 93.9%, 24.3%, and 10.9%, respectively. The resistance rates for the last-resort antibiotics; amikacin, tigecycline, carbapenem, and third-generation cephalosporin were 16.4%, 29.1%, 31.9%, and 93.0%, respectively. The combination of carbapenem with tigecycline or amikacin therapy was used to manage maternal sepsis caused by cephalosporin-and carbapenem-resistant strains. Sepsis associated risk factors, including septic abortion [AOR = 5.3; 95%CI:2.2-14.4]; extended hospitalization [AOR = 3.7; 95%CI: 1.6-19.4]; dilatation and curettage [AOR = 2.2; 95%CI:1.3-13.4]; cesarean wound infection [AOR = 4.1; 95%CI:2.0-9.2]; indwelling catheterization [AOR = 2.1;95%CI: 1.4-6.2]; ICU admission [AOR = 4.3; 95%CI:2.4-11.2]; post abortion [AOR = 9.8; 95%CI:5.7-16.3], and recurrent UTI [AOR = 3.3; 95%CI: 1.6-13.2] were significantly associated with maternal sepsis caused by K. pneumoniae. CONCLUSIONS: The prevalence of maternal sepsis caused by carbapenem- resistant K. pneumoniae is high and serious attention needs to be given to combat transmission. Therefore, improving awareness, early diagnosis, IPC, integrated maternal surveillance, improved sanitation and efficient antimicrobial stewardship are crucial to combating bacterial maternal sepsis.

Evaluation of Antibacterial Activity of Essential Oils and Their Combination against Multidrug-Resistant Bacteria Isolated from Skin Ulcer.

BACKGROUND: Emerging of multidrug-resistant bacteria can compromise the effectiveness of antibiotics used to treat skin infections. Those bacteria imposed public health problems and questioning medical care in the 21st century. In this circumstance, essential oils of medicinal plants origin are supreme sources of structural and functionally divergent compounds, which inhibited the growth of common wound colonizing MRSA and ESBL producing P. aeruginosa. The aim of this study was to evaluate the combined antibacterial activity of essential oils extracted from Rumex abyssinicus, Cucumis pustulatus, and Discopodium penninervium against multidrug-resistant (MDR) isolates of skin ulcers. METHODS: Essential oils (EOs) were extracted from aerial parts of R. abyssinicus, C. pustulatus, and D. penninervium with steam distillation. A mixture of each oil (1 : 1) was adsorbed to a disc and placed on Mueller Hinton Agar. Then, minimum zone of inhibition and bactericidal concentration of EOs was measured after incubeted for 18-24 hours at 37 °C. Their combined antibacterial effect was determined by the fractional inhibitory concentration index. RESULTS: The antibacterial activity of mixed oil varied in their doses and bacteria species, of which a mixture of essential oil of R. abyssinicus and D. penninervium had inhibition zone (32 mm); its MIC and MBC values range from 1-2 µl/ml against MRSA. It had an inhibition zone (36 mm), MIC value 4 µl/ml, and MBC (8 µl/ml) against ESBL producing P. aeruginosa, whereas combined effects of R. abyssinicus and C. pustulatus had MIC values ranging from 2-8 µl/ml for E. coli and K. pneumoniae and 2 µl/ml for MRSA. There was a strong synergistic effect between R. abyssinicus and D. penninervium and promising antibacterial effect more specifically on MRSA and P. aeruginosa. Conclusion. This in vitro study of the combined effect of EOs has significant antibacterial activity on wound colonizing bacteria and reduces delaying wound healing as that of modern drugs tested in parallel. Hence, further structural elucidation of active compounds helps us to properly design or synthesis of topical antibiotics for wound care.

Antimicrobial activities evaluation and phytochemical screening of some selected medicinal plants: A possible alternative in the treatment of multidrug-resistant microbes.

BACKGROUND: Four out of five individuals rely on traditional medicine for their primary healthcare needs. Medicinal plants are endowed with diverse bioactive compounds to treat multidrug-resistant (MDR) microbes. So far, a less thorough examination has been made in this regard. This study aimed to evaluate antimicrobial activity and phytochemical screening of selected medicinal plants against MDR microbes. METHODS: In vitro experimental study was carried out to evaluate antimicrobial effects and phytochemical screening of Rumex abyssinicus, Cucumis pustulatus, Discopodium penninervium, Lippia adoensis, Euphorbia depauperata, Cirsium englerianum, and Polysphaeria aethiopica against MDR bacteria and fungi. Aqueous and 80% methanolic extraction methods were employed for extraction. The susceptibility test, minimum inhibitory concentration, and minimum bactericidal or fungicidal concentration were measured using disc diffusion or broth micro-dilution as per the CLSI protocols. RESULT: The 80% methanolic extraction method was a preferred method to aqueous. The phytochemical constituents identified were alkaloids, flavonoids, saponins, phenolic, tannins, terpenoidss, and cardiac glycosides. The hydroalcoholic extract demonstrated an appreciable antimicrobial role against MDR microbes with an MIC value of 1.0-128.0µg/ml and 11-29mm inhibition zone (IZ) in diameter. Extracts obtained from C. englerianum and E. depauperata showed a significant IZ ranged of 26-29mm on MRSA and Streptococcus pyogenes. MDR E. coli and K. pneumoniae showed 12-25mm and 23-28mm IZ in diameter, respectively. T. mentagraphytes was susceptible to all tested extracts. Moreover, S. pyogenes and K. pneumoniae were found the most susceptible bacteria to C. englerianum. Cirsium englerianum, L. adoensis, D. penninervium, and R. abyssinicus demonstrated remarkable antifungal effect against C. albicans and T. mentagrophytes, while R. abyssinicus showed the leading antifungal effect with 32 to 64µg/ml MIC values. CONCLUSION: The plant extracts have shown appreciable antimicrobial activities comparable to the currently prescribed modern drugs tested. Accordingly, further studies on clinical efficacy trial, safety, toxicity and affordability analyses have to be instigated promptly, so as to head to the final step to synthesize precursor molecules for new effective antimicrobials.

Antimicrobial activity of medicinal plants used for urinary tract infections in pastoralist community in Ethiopia.

BACKGROUND: Medicinal plants have wide medicament application used to prevent and management of many ailments. These plants are used for primary health care in pastoralist communities who are deprived of modern medical care. They possess extensive therapeutics bioactive coupled with varied chemical structures. However, scientific validation of efficacy and safety of plants used to treat the urinary tract infections haven't been fully exploited. The aim of this study was to evaluate antimicrobial activity and screening phytochemicals of medicinal plants used to treat urinary tract infections. METHODS: In-vitro experimental study was carried out to evaluate the antimicrobial effect and screening phytochemical of Rumex abyssinicus, Cucumis pustulatus, Discopodium penninervium, Lippia adoensis, Euphorbia depauperata, and Cirsium englerianum. Against drug resistance microbes. 80% methanol was used for extraction of the plant parts. The susceptibility tests were investigated using disc diffusion and broth micro-dilution methods. RESULTS: The majority of tested extracts showed antimicrobial activity on two or more drug-resistant bacteria with MIC value (1.0-128.0 µg/ml) and 9-27 mm inhibition zone in diameter. Extracts obtained from C.englerianum and E. depauperate showed more potent antibacterial activity on MRSA and Enterococcus faecalis with IZ 25 and 27 mm respectively. E. coli and K. pneumoniae were inhibited by those extracts with IZ ranging 9-25 mm and 11-27 mm respectively. E.faecalis and K. pneumoniae were more susceptible bacteria to the respective extracts. R. abyssinicus showed promising antifungal effect with had 21 mm IZ and MIC range 16-32 µg/ml on C.albicans. Alkaloids, flavonoids, phenolic and terpenoid were common phytochemical characterized in majority of screened plants. CONCLUSION: Tested extracts exhibited significant antibacterial and antifungal activity. Hence, further structural elucidation of bioactive that inhibited the growth of microbes aforementioned plants may be used as precursors for the synthesis of new antibiotics in the future.

Prevalence and factors associated with intestinal parasitic infection among under-five children in and around Haro Dumal Town, Bale Zone, Ethiopia.

BACKGROUND: Intestinal parasitic infection is diversified illness and diseases caused millions morbidity among under-five children lives in developing countries particularly vulnerable rural communities. Deworming coverage in such community is low. The aim of this study was to determine the prevalence and associated risk factors of intestinal parasitic infections (IPIs) among under-five children live in and around Haro Dumal Town. METHODS: Community-based cross-sectional study was conducted in 561 randomly selected under-five children from June to August, 2018. The stool samples were collected and examined by basic parasitological techniques. Data related to socio-demographic and risk factors were collected using a self administered questionnaire. Statistical data analysis was done using SPSS version 21 and the bivariate and multivariate logistic regression used to compute the association between variables. P-value of < 0.05 was statistical significance. THE RESULTS: Of the 561 total under-five children, 216 (38.5%) were found to be infected with intestinal parasites. E.histolytica/dispar (15.3%) was the most prevalent parasite, followed by hook worm (14.4%) and T.trichuria (13.9%). Regarding risk factors, geo-phage [(AOR = 4.7; 95%CI: 2.0-10.4), P < 0.001], tungiasis [(AOR = 3.1; 95%CI: 1.1-6.6), P < 0.001], eating raw vegetable [(AOR = 1.3; 95%CI: 1.4-3.3), P < 0.001] were significantly associated with intestinal parasitic infections. CONCLUSION: Intestinal parasitic infections (IPIs) were found to be highly prevalent in the study area. Hence, improving sanitation, controlling ecto-parasite such as tungiasis, provision of safe water and successful mass-deworming are important.

Combined antibacterial effect of essential oils from three most commonly used Ethiopian traditional medicinal plants on multidrug resistant bacteria.

BACKGROUND: An alarm increase the rate of emerging and re-emerging of multidrug resistant bacteria have been caused great public health concern in the worldwide. They have been resisting for most or majority of currently available and affordable antibiotics and imposed socioeconomic catastrophe at global scale. As a result, there is utmost important to discover new or modify currently available antibiotics. The aim of this study was to evaluate combined antibacterial effect of essential oils obtained from Blepharis cuspidata, Boswellia ogadensis and Thymus schimper against multidrug resistance (MDR) Escherichia coli, Klebsiella pneumoniae and Methicillin resistant S. aureus. METHODS: Essential oil (EO) was extracted from the aerial part of B. cuspidata, B.ogadensis and T. schimper by steam distillation and stored in brown bottles at 4 °C. There were mixed in 1:1 ratio and adsorbed to disc and placed on MHA and measured their minimum inhibitory zone seeded with E. coli, K. pneumoniae and MRAS after 18-24 H. minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were measured by broth micro-dilution method. The interaction between EOs was determined by fractional inhibitory concentration index. RESULTS: The antibacterial potential of mixed oil depends on the doses and type of the EOs and bacteria species. The combined EOs of B.cuspidata and T.schimperi had inhibition zone (39 mm), its MIC and MBC value was 0.39 µl/ml against MRSA. It had inhibition zone (28-35 mm), MIC value 0.39-6.25 µl/ml and MBC (0.78-12.5 µl/ml) against MDR E. coli and K. pneumoniae. Whereas, combined effects of B. cuspidata and B. ogadensis had MIC values ranges from 0.78-6.25 µl/ml for E.coli and K. pneumoniae and 1.56 µl/ml for MRSA. There was strong synergistic effect between the combination of B.cuspidata and T.schimperi. This study revealed that gram negative bacteria were slightly less susceptible than gram positive. CONCLUSIONS: This in vitro study of combined EOs has significant antibacterial effect than using each of them and even it was more potent antibacterial effect on MDR as compare to modern antibiotics. Hence, it can be applied to a pharmaceutical composition as modulator or adjuvant or precursor for synthesis of new antibiotic in future activities.