Prevalence of multidrug resistance Salmonella species isolated from clinical specimens at University of Gondar comprehensive specialized hospital Northwest Ethiopia: A retrospective study.

BACKGROUND: Multidrug resistance Salmonellosis remains an important public health problem globally. The disease is among the leading causes of morbidity and mortality in developing countries, but there have been limited recent studies about the prevalence, antimicrobial resistance, and multidrug resistance patterns of Salmonella isolates from various clinical specimens. OBJECTIVE: Aimed to assess the prevalence, antimicrobial resistance, and multidrug resistance patterns of Salmonella isolates from clinical specimens at the University of Gondar Comprehensive Specialised Hospital, northwestern Ethiopia. METHOD: A retrospective hospital-based cross-sectional study was conducted to determine the prevalence, antimicrobial resistance, and multidrug resistance patterns of isolated from all clinical specimens at the University of Gondar Salmonella Comprehensive Specialised Hospital from June 1st, 2017 to June 3rd, 2022. A total of 26,154 data points were collected using a checklist of records of laboratory registration. Clinical specimens were collected, inoculated, and incubated for about a week with visual inspection for growth and gram staining. The isolates were grown on MacConkey agar and Xylose Lysine Deoxycholate agar. Pure colonies were identified with a conventional biochemical test, and those unidentified at the species level were further identified by the analytical profile index-20E. Then, antimicrobial susceptibility was determined by the Kirby-Bauer disc diffusion technique. The multidrug resistance Salmonella isolates was identified using the criteria set by Magiorakos. Finally, the data was cleaned and checked for completeness and then entered into SPSS version 26 for analysis. Then the results were displayed using tables and figures. RESULTS: Of the total 26,154 Salmonella suspected clinical samples, 41 (0.16%) Salmonella species were isolated. Most of the Salmonella isolates, 19 (46.3%), were in the age group of less than 18 years, followed by the age group of 19-44 years, 11 (26.8%). In this study, S. enterica subsp. arizonae accounts for the highest 21 (51%), followed by S. paratyphi A 9 (22%). Of the Salmonella isolates, S. typhi were highly resistant to ampicillin (100%), followed by tetracycline and trimethoprim-sulfamethoxazole, each accounting for 83.3%. Furthermore, S. paratyphi A was resistant to ampicillin (100%), tetracycline (88.9%), and chloramphenicol (88.9%). The overall multi-drug resistance prevalence was 22 (53.7%; 95% CI: 39.7-61). Accordingly, S. paratyphi A was 100% multidrug-resistant, followed by S. typhi (66.6%). CONCLUSION: A low prevalence of Salmonella species was observed in the past six years. Moreover, most S. typhi and S. paratyphi strains in the study area were found to be resistant to routinely recommended antibiotics like ciprofloxacin and ceftriaxone, compared to what was reported earlier. In addition, all isolates of S. paratyphi A and the majority of S. typhi were multidrug resistant. Therefore, health professionals should consider antimicrobial susceptibility tests and use antibiotics with caution for Salmonellosis management.

Household drinking water quality and its predictors in flood-prone settings of Northwest Ethiopia: A cross-sectional community-based study.

Globally, the deterioration of drinking water quality is a major public health problem that contributes to the spread of disease and causes death. Therefore, it is important to have regular quality control monitoring. This study aimed to assess the level of physicochemical and bacteriological quality of household drinking water and its contributing factors in flood-prone settlements of South Gondar Zone, Ethiopia. A community-based cross-sectional study was conducted in flood-prone settings of Northwest Ethiopia from January 17 to March 30, 2021. Structured questionnaires were used to gather the sociodemographic, environmental, and behavioral data. A total of 675 drinking water samples were collected from water storage containers of selected households. Logistic regression models were used for both univariate and multivariable studies. The survey included a total of 675 households. The mean values of pH (5.9 ± 1.03), turbidity (6.7 ± 2.21 NTU), and free residual chlorine (0.02 ± 0.01 mg/l) did not meet the WHO recommended limits for drinking water. The prevalence of fecal contamination of drinking water in the study area was 62.2% with [95% CI (53-60%)]. Family size [AOR = 2.205, 95% CI (1.375-3.536), absence of latrine [AOR = 3.449, 95% CI (1.349-8.823)], and lack of a separate container to draw water from its storage [AOR = 0.454, 95% CI (0.249-0.827)] were significant predictors for fecal contamination of household drinking water. In conclusion, the water quality in terms of pH, turbidity, residual chlorine, and bacteriological parameters was poor and not suitable for consumption. High prevalence of fecal contamination of water was found, and it was significantly associated with family size, the absence of a latrine, and the lack of a separate cap to take water from the storage. Therefore, continuous chlorination and monitoring its concentration, educating the community on how to use stored water, educating the advantage of having a latrine, and promoting point-of-use treatments such as filtration and boiling are needed.

Quality assessment of raw and pasteurized milk in Gondar city, Northwest Ethiopia: A laboratory-based cross-sectional study.

Milk is a complete and highly nutritious source of food for human beings. However, in many developing countries, including Ethiopia, the quality of milk products has become a major health concern for consumers, particularly for infants and children. Therefore, the aim of the present study was to assess the quality of raw and pasteurized milk marketed in Gondar city, Northwest Ethiopia. A laboratory-based cross-sectional study was conducted on 90 milk samples. The samples were chosen using a simple random sampling technique. For statistical analysis, ANOVA and the Pearson correlation coefficient were used. The specific gravity of pasteurized milk, farm milk, and milk vendors were found to be 1.021, 1.027, and 1.026, respectively. Farm milk, milk vendors, and pasteurized milk had fat contents of 3.38%, 3.22%, and 3.09%, respectively. The total bacterial count in pasteurized milk, farm milk, and milk vendors was found to be 7.08, 6.73, and 6.94 log10 CFU/mL, respectively. In raw milk, hydrogen peroxide (7.7%), formalin (7.7%), and water (3.8%) were found, whereas in pasteurized milk, hydrogen peroxide (50%), formalin (50%), and water (19.8%) were found. Based on the findings of this study, the quality of both raw and pasteurized milk was found to be poor as per the milk quality standards. This may cause significant public health-related problems. Therefore, an appropriate intervention should be conducted to improve the quality of milk.

Seroprevalence of Hepatitis B Virus, Hepatitis C Virus, Syphilis and Associated Factors Among Female Sex Workers in Gondar Town, Northwest Ethiopia.

Background: Sexually transmitted infections (STIs) are a public health problem worldwide. Hepatitis B virus infection (HBV), hepatitis C virus infection (HCV), and syphilis are among the STIs. Female sex workers (FSWs) continue to be a high-risk group for STIs due to a variety of factors, including exposure to unsafe sexual practices. Therefore, this study determines the seroprevalence of HBV, HCV, Treponema palladium, and associated factors among FSWs in Gondar town, Northwest Ethiopia. Methods: A cross-sectional study was conducted on 194 FSWs from March to June 2021 in Gondar town. Socio-demographic and behavioral data were collected using a questionnaire. Five milliliters (5mL) of venous blood was collected and tested for hepatitis B surface antigens, anti-hepatitis C antibodies, and anti-syphilis antibodies using an enzyme-linked immunosorbent assay. Logistic regression, univariate, and multivariate analyses were carried out. A p-value of < 0.05 at a 95% confidence interval was considered statistically significant. Results: A total of 194 FSWs were included in the study. The seroprevalence rates of HBV infection, HCV infection, and syphilis were 23 (11.9%), 13 (6.7%), and 22 (11.3%), respectively. All three infections were statistically associated with inconsistent condom use (AOR = 1.72, 95% CI: 1.95-5.07, p = 0.03); (AOR = 10.51, 95% CI: 1.62-68.26, p = 0.014); and (AOR = 17.3, 95% CI: 4.55-65.6, p = 0.001). Whereas sex stimulant drug use (AOR = 9.4, 95% CI: 1.002-88.14), intravenous drug use (AOR = 15.53, 95% CI: 1.9-127.99, p=0.011), and sex while having a vaginal ulcer (AOR = 5.72, 95% CI: 1.13-28.9, p=0.035) were all statistically associated with HCV infection. Conclusion: The prevalence of HBV infection, HCV infection, and syphilis was comparatively higher. Regular screening, health education, and other preventative strategies are advised to lower the STI burden among FSWs.

Prevalence and antimicrobial resistance pattern of Clostridium difficile among hospitalized diarrheal patients: A systematic review and meta-analysis.

BACKGROUND: Clostridium difficile is the leading cause of infectious diarrhea that develops in patients after hospitalization during antibiotic administration. It has also become a big issue in community-acquired diarrhea. The emergence of hypervirulent strains of C. difficile poses a major problem in hospital-associated diarrhea outbreaks and it is difficult to treat. The antimicrobial resistance in C. difficile has worsened due to the inappropriate use of broad-spectrum antibiotics including cephalosporins, clindamycin, tetracycline, and fluoroquinolones together with the emergence of hypervirulent strains. OBJECTIVE: To estimate the pooled prevalence and antimicrobial resistance pattern of C. difficile derived from hospitalized diarrheal patients, a systematic review and meta-analysis was performed. METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed to review published studies conducted. We searched bibliographic databases from PubMed, Scopus, Google Scholar, and Cochrane Library for studies on the prevalence and antimicrobial susceptibility testing on C. difficile. The weighted pooled prevalence and resistance for each antimicrobial agent was calculated using a random-effects model. A funnel plot and Egger's regression test were used to see publication bias. RESULTS: A total of 15 studies were included. Ten articles for prevalence study and 5 additional studies for antimicrobial susceptibility testing of C. difficile were included. A total of 1967/7852 (25%) C. difficile were isolated from 10 included studies for prevalence study. The overall weighted pooled proportion (WPP) of C. difficile was 30% (95% CI: 10.0-49.0; p<0.001). The analysis showed substantial heterogeneity among studies (Cochran's test = 7038.73, I2 = 99.87%; p<0.001). The weighed pooled antimicrobial resistance (WPR) were: vancomycin 3%(95% CI: 1.0-4.0, p<0.001); metronidazole 5%(95% CI: 3.0-7.0, p<0.001); clindamycin 61%(95% CI: 52.0-69.0, p<0.001); moxifloxacin 42%(95% CI: 29-54, p<0.001); tetracycline 35%(95% CI: 22-49, p<0.001); erythromycin 61%(95% CI: 48-75, p<0.001) and ciprofloxacin 64%(95% CI: 48-80; p< 0.001) using the random effect model. CONCLUSIONS: A higher weighted pooled prevalence of C. difficile was observed. It needs a great deal of attention to decrease the prevailing prevalence. The resistance of C. difficile to metronidazole and vancomycin was low compared to other drugs used to treat C. difficile infection. Periodic antimicrobial resistance monitoring is vital for appropriate therapy of C. difficile infection.

Bacterial Etiologies of Ear Infection and Their Antimicrobial Susceptibility Pattern at the University of Gondar Comprehensive Specialized Hospital, Gondar, Northwest Ethiopia: A Six-Year Retrospective Study.

BACKGROUND: An ear infection is responsible for up to 40% of preventable hearing impairment; one of the reasons for frequent and unwise antibiotic usage, especially in the developing world. Since the incidence of antibiotic resistance is increasing, especially in resource-limited countries, up-to-date knowledge on the susceptibility of ear-discharge isolates to antibiotic is important for better patient treatment. Therefore, this study aimed at determining the bacterial etiologies and their antibiotic susceptibility profiles among patients suspected with ear infections. METHODS: We collected retrospective data from bacteriological results of ear discharge samples from 2013 to 2018. Sample collection, culture preparation, and bacterial identification were performed using standard microbiological techniques. Antimicrobial susceptibility testing was performed following Clinical and Laboratory Standard Institute (CLSI) guidelines. We extracted and inputted the data using Epi-info version 7 and exported it to SPSS version 20 for analysis. RESULTS: The overall ear-discharge culture positivity rate was 283/369 (76.7%) (95% CI = 72.4-81.3), with 14/283 (4.95%) mixed infections. Staphylococcus aureus (27.9%), Proteus spps (20.8%), Streptococcus spps (10%), and Pseudomonas spps (8.92%) were the main isolates. High-level resistance rates for tetracycline (77.6%), penicillins (67.2%), erythromycin (52.6%), and co-trimoxazole (52%), and low-level resistance rates for fluoroquinolones (23.3%), aminoglycosides (23.7%), and cephalosporins (29.8%) were observed. More than 45% of isolates, with 50.9% of Gram-negative and 37.3% of Gram-positive, were multidrug-resistant. CONCLUSION: Staphylococcus aureus, Proteus mirabilis, Proteus vulgaris, Escherichia coli, and Pseudomonas aeruginosa were the leading cause of ear infections. The presence of high number of multidrug-resistant strains calls for the need for periodic and continuous follow-up of antibiotic usage in the study area. Further studies are recommended to explore the types of ear infections, with their etiologic agents and possible risk factors.

Staphylococcus aureus, ESKAPE Bacteria Challenging Current Health Care and Community Settings: a Literature Review.

BACKGROUND: Staphylococcus aureus is a gram-positive coccus forming grape like clusters performing both aerobic and anaerobic respiration. Most strains of S. aureus ferment mannitol and they form characteristic golden yellow colonies. They produce catalase, coagulase, and extracellular cell clumping factor. Some strains can also produce capsules. It is a major commensal bacterium and a human pathogen that causes a wide range of clinical infections including abscesses of various organs, pneumonia, osteomyelitis, endocarditis, arthritis, and sepsis. S. aureus is the key organism for food poisoning and it is the third most important cause of food borne disorders in the world. METHODS: We reviewed all the relevant literature available on PubMed, Web of Science, and Google Scholar. We selected different scientific studies and reports published in English language which addressed prevalence, pathogenesis, burden and laboratory diagnosis methods of S. aureus to compile the current review. RESULTS: Staphylococcus aureus has an outstanding ability to acquire resistance to most classes of antimicrobial agents. This successful and adaptable resistance has made treatment and control of staphylococcal infections increasingly difficult. Expression of virulence factors of S. aureus is controlled by bacterial cell density and many environmental factors such as pH, oxygen, and carbon dioxide. There are different mechanisms that microorganisms use to prevent attack by antimicrobial agents. These include limiting uptake of the drug, modification of the drug target, inactivation of the drug, and active efflux of the drug. Specimens collected for diagnosis of S. aureus infection depend on the type of infection. The samples for diagnosis are pus, sputum, blood, feces, vomit and the remains of suspected food, and nasal swab for the detection of carriers. Gram stain, culture, biochemical tests, serological tests and molecular techniques are the common laboratory diagnosis methods. CONCLUSIONS AND RECOMMENDATIONS: Multidrug resistant S. aureus strains are emerging and current antibiotics are not efficacious against such strains. Both active and passive immunization strategies have thus far failed to show efficacy in humans. Therefore, infection preventive measures, and further research is required to develop vaccines and antibiotics to target this pathogen.

Knowledge, attitude and practices on cervical cancer screening among undergraduate female students in University of Gondar, Northwest Ethiopia: an institution based cross sectional study.

BACKGROUND: Cervical cancer is a major public health problem. In the world, cervical cancer is the fourth most common cancer among women and it is one of the leading causes of cancer mortality in females. It is the second most common women cancer in Ethiopia with almost 6300 new cases and 4884 deaths annually. Despite the high burden of new cases and deaths, there is a scarcity of data on knowledge, attitude and practices (KAP) towards cervical cancer screening among female university students in Ethiopia particularly in the study area. Therefore, the present study was aimed to assess the KAP of undergraduate female students towards cervical cancer screening. METHODS: An institution based cross-sectional study was conducted in April 2018 at the University of Gondar, College of Medicine and Health Sciences undergraduate female students. Pretested, self-administered questionnaire was used for data collection. Four hundred and three female students were recruited by a simple random sampling method and the data were entered and analyzed using SPSS version 20 statistical packages. Descriptive data analysis was used to report the results. RESULTS: More than half of the respondents (59.3.3%) had good knowledge, whereas nearly 67.7% of the respondents had favorable attitude towards cervical cancer. However, less than 1% of the respondents had been screened for cervical cancer. CONCLUSION: Although undergraduate female students had apparently good knowledge and favorable attitude, their practices on cervical cancer screening were quite low. Therefore, the health sectors and the gender streaming office of the university mobilize students to strengthen the uptake the cervical cancer screening practice.

Bacteriological profile, antimicrobial susceptibility patterns of the isolates among street vended foods and hygienic practice of vendors in Gondar town, Northwest Ethiopia: a cross sectional study.

BACKGROUND: There are numerous advantages offered by street vended foods, but evidence exists that foods exposed for sale on the road side may be contaminated by pathogenic microorganisms. However, information on the bacteriological profile, bacterial load and antimicrobial susceptibility patterns of bacterial isolates from street food in Gondar town are lacking. The aim of this study was to assess bacterial profile, bacterial load, and antimicrobial susceptibility patterns of bacterial isolates among street vended foods and also the hygienic practice of vendors in Gondar town, Northwest Ethiopia. METHODS: Socio-demographic characteristics and the hygienic practices of 24 vendors were collected using structured questionnaire. A total of 72 food samples from four different food items were analyzed and counted by standard aerobic plate count method. Ten grams of each food sample was transferred in to 90 ml of buffered peptone water and homogenized. The homogenates were serially dilute and a volume of 0.1 ml dilution was spread on solid media and incubated at 35-37 °C for 24 h. Antibiotic susceptibility testing was done for isolated species using Muller Hinton agar and data was entered and analyzed by using SPSS version 20.0. RESULTS: Seventy two food samples of street vended food were analysed for bacterial pathogens. 44/72 tested positive, a total of 63 isolates were identified as 19 samples contained two pathogens. The total mean aerobic bacterial count was 6.64 × 104 CFU/g which is varied from 1 × 104-1.86 × 105 CFU/g. S. aureus is the most frequent isolate 34 (53.96%) followed by E.coli 15(23.8%), Enterobacter species 10(15.87%) and Citrobacter species 4(6.3%). Gentamycin, chloramphenicol, tetracycline, ciprofloxacin, and trimethoprim-sulfamethoxazole were found to be the most effective antimicrobials against all isolates but the enterobactereaceae were resistant to ampicillin and Ceftaziidime and S.aureus were resistant to penicillin. CONCLUSION: The results of this study showed that, the majority of street-vended food items in Gondar were contaminated with one or more different pathogenic bacteria. The presence of these bacteria in foods could lead to potential health problems for consumers. Therefore, health education as well as training in food safety and hygienic handling is required for food handlers to minimize contamination and the likelihood of people falling ill.

Seroprevalence of Hepatitis B Virus and Associated Factors among Health Professionals in University of Gondar Hospital, Northwest Ethiopia.

INTRODUCTION: Hepatitis B virus infection is one of the commonest occupational risks in healthcare workers. However; there is limited evidence regarding the prevalence of hepatitis in health professionals in Ethiopia. OBJECTIVE: This study was aimed at assessing the prevalence of hepatitis B and associated factors in health professionals. METHODS: Institution based cross-sectional study was conducted among health professionals at University of Gondar Hospital from January to February, 2015. Self-administered questionnaire was used to collect sociodemographic variables and blood sample was also taken to determine hepatitis B virus sero-status. Chi square test with 95% confidence interval (CI) was computed to assess the associations of different factors with hepatitis B infection. RESULT: A total of 332 health professionals (with a response rate of 92.2%) participated in the study. Most (98.5%) of health professionals were not vaccinated for hepatitis B. The prevalence of hepatitis B in health professionals at UOG hospital was found to be 4.52% (95% CI: 2.4, 6.5). Hepatitis B infection was more common among males (P value =0.0299). Conclusion. The prevalence of hepatitis B in health professionals in this study was comparable with other studies done in Ethiopia among health professionals. Males were more affected than females for hepatitis B infection. Hepatitis B virus vaccine, treatment for the infected, and training on infection prevention should be more available for healthcare workers.

Rifampicin-resistant Mycobacterium tuberculosis among tuberculosis-presumptive cases at University of Gondar Hospital, northwest Ethiopia.

BACKGROUND: Various studies have reported that the emergence of drug-resistant tuberculosis poses a significant threat to tuberculosis-control programs worldwide. Rifampicin resistance is a surrogate marker of multidrug-resistant tuberculosis, since it reveals the presence of greater than 90% isoniazid resistance. Evidence on rifampicin-resistant Mycobacterium tuberculosis is scarce in the literature. OBJECTIVE: To determine the prevalence of rifampicin-resistant M. tuberculosis among tuberculosis-presumptive cases at the University of Gondar Hospital. MATERIALS AND METHODS: A retrospective study was conducted at the University of Gondar Hospital from January 2013 to August 2015. Data were collected from registration books using a data-extraction format after securing ethical approval and checking the completeness of necessary information. Data were double-entered and rechecked to ensure accuracy and analyzed using SPSS version 20. Results were summarized using descriptive statistics. Associations were assessed using Fisher's exact test, and P<0.05 was considered statistically significant. RESULTS: A total of 1,820 M. tuberculosis-presumptive patients were included in the study. The majority of the study participants were males (59.2%). The mean age of the participants was 36.6±15.8 years. The preponderant age-group was 24-30 years, with 477 (23.5%) patients. The overall prevalence of M. tuberculosis-confirmed cases was 448 (24.6%, 95% CI 0.23-0.27). Of the 448 M. tuberculosis-confirmed cases, 71 (15.8%, 95% CI 1.12-1.19) were resistant to rifampicin. Rifampicin-resistant M. tuberculosis was observed among HIV seropositives (14 [18.7%]), males (45[17.3%]), and previously treated tuberculosis patients (61 [16.5%]), although no significant association was found in this study. CONCLUSION: The overall prevalence of M. tuberculosis and rifampicin resistance was found to be high in tuberculosis patients in this study. Therefore, early detection of drug-resistant M. tuberculosis should be strengthened for management of tuberculosis patients.