Dessie Tewodros, Jemal Mohabaw, Maru Minwuyelet, Tiruneh Moges
Amhara Public Health Institute, Dessie Branch, P.O. Box 686, Dessie, Ethiopia.
University of Gondar, College of Medicine and Health Sciences, School of Biomedical and Laboratory Sciences, Department of Medical Microbiology, P.O. Box 196, Gondar, Ethiopia.
Int J Microbiol. 2021 Mar 8;2021:6680343. doi: 10.1155/2021/6680343. eCollection 2021.
Pneumonia is the most common cause of morbidity and mortality in developing countries, mostly caused by different species of bacterial pathogens. Hence, patient management needs awareness of the pathogens and antimicrobial susceptibility testing (AST). This study was aimed to assess the type of bacterial isolates and their antimicrobial susceptibility patterns among pneumonia suspected patients at Dessie Referral Hospital, Northeast Ethiopia. Potential risk factors were also assessed to apply preventive measures accordingly.
A cross-sectional study design was employed among pneumonia suspected patients from February to April 2020 at Dessie Referral Hospital. Sociodemographic characteristics and associated risk factors were collected using a pretested questionnaire, and clinical data were extracted by reviewing medical records. Sputum specimens were collected and inoculated into chocolate agar, blood agar, mannitol salt agar, and MacConkey agar which are then incubated at 35°C or 37°C for 24-48 hours. Bacterial species were identified based on Gram stain, colony characteristics, and biochemical techniques. The data were entered in to Epi-Info version 7.1.5 and analyzed with SPSS software version 20. value <0.05 at 95% CI was considered as statistically significant.
A total of 406 sputum specimens were collected and cultured, among which 157 (38.7%) were positive for different bacterial pathogens. The predominant pathogens were (28.0%), (24.8%), (18.5%), and (14.0%). Majority of the isolates exhibited resistance to ampicillin with 81.5% followed by penicillin with 75.9% and amoxicillin-clavulanate with 61.2%. Multivariable logistic regression showed a significant association of culture positivity with older age (AOR = 2.43, CI: 1.12-5.28, value = 0.025), cigarette smoking (AOR = 4.67, CI: 2.39-9.20, value <0.001), and alcohol use (AOR = 5.58, CI: 3.14-9.92, value <0.001). Resistance to ampicillin and penicillin was associated with repeated prescription and use.
This study found high prevalence of bacterial pneumonia in the study area, and high rate of bacterial resistance was observed in ampicillin, penicillin, and amoxicillin-clavulanate. Repeated prescriptions and use of antimicrobials were significantly independent factors of bacterial resistance. Therefore, patient management needs identification of bacteria by routine culture with antimicrobial susceptibility testing.
肺炎是发展中国家发病和死亡的最常见原因，主要由不同种类的细菌病原体引起。因此，患者管理需要了解病原体和抗菌药物敏感性试验（AST）。本研究旨在评估埃塞俄比亚东北部德西转诊医院疑似肺炎患者的细菌分离株类型及其抗菌药物敏感性模式。还评估了潜在风险因素，以便相应地采取预防措施。
2020年2月至4月在德西转诊医院对疑似肺炎患者采用横断面研究设计。使用预先测试的问卷收集社会人口学特征和相关风险因素，并通过查阅病历提取临床数据。收集痰标本并接种到巧克力琼脂、血琼脂、甘露醇盐琼脂和麦康凯琼脂中，然后在35°C或37°C下孵育24 - 48小时。根据革兰氏染色、菌落特征和生化技术鉴定细菌种类。数据录入Epi-Info 7.1.5版本，并使用SPSS 20软件进行分析。95%置信区间下p值<0.05被认为具有统计学意义。
共收集并培养了406份痰标本，其中157份（38.7%）对不同细菌病原体呈阳性。主要病原体为[具体病原体1]（28.0%）、[具体病原体2]（24.8%）、[具体病原体3]（18.5%）和[具体病原体4]（14.0%）。大多数分离株对氨苄西林耐药率为81.5%，其次对青霉素耐药率为75.9%，对阿莫西林 - 克拉维酸耐药率为61.2%。多变量逻辑回归显示，培养阳性与老年（比值比[AOR]=2.43，置信区间[CI]：1.12 - 5.28，p值=0.025）、吸烟（AOR = 4.67，CI：2.39 - 9.20，p值<0.001）和饮酒（AOR = 5.58，CI：3.14 - 9.92，p值<0.001）显著相关。对氨苄西林和青霉素的耐药与重复处方和使用有关。
本研究发现研究区域内细菌性肺炎患病率高，且观察到氨苄西林、青霉素和阿莫西林 - 克拉维酸的细菌耐药率高。抗菌药物的重复处方和使用是细菌耐药的显著独立因素。因此，患者管理需要通过常规培养和抗菌药物敏感性试验来鉴定细菌。
