Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
Antimicrob Resist Infect Control. 2022 Jun 13;11(1):83. doi: 10.1186/s13756-022-01122-x.
Sepsis due to multidrug resistant (MDR) bacteria is a growing public health problem mainly in low-income countries.
A multicenter study was conducted between October 2019 and September 2020 at four hospitals located in central (Tikur Anbessa and Yekatit 12), southern (Hawassa) and northern (Dessie) parts of Ethiopia. A total of 1416 patients clinically investigated for sepsis were enrolled. The number of patients from Tikur Anbessa, Yekatit 12, Dessie and Hawassa hospital was 501, 298, 301 and 316, respectively. At each study site, blood culture was performed from all patients and positive cultures were characterized by their colony characteristics, gram stain and conventional biochemical tests. Each bacterial species was confirmed using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI TOF). Antimicrobial resistance pattern of bacteria was determined by disc diffusion. Logistic regression analysis was used to assess associations of dependent and independent variables. A p-value < 0.05 was considered as statistically significant. The data was analyzed using SPSS version 25.
Among 1416 blood cultures performed, 40.6% yielded growth. Among these, 27.2%, 0.3% and 13.1%, were positive for pathogenic bacteria, yeast cells and possible contaminants respectively. Klebsiella pneumoniae (26.1%), Klebsiella variicola (18.1%) and E. coli (12.4%) were the most frequent. Most K. variicola were detected at Dessie (61%) and Hawassa (36.4%). Almost all Pantoea dispersa (95.2%) were isolated at Dessie. Rare isolates (0.5% or 0.2% each) included Leclercia adecarboxylata, Raoultella ornithinolytica, Stenotrophomonas maltophilia, Achromobacter xylosoxidans, Burkholderia cepacia, Kosakonia cowanii and Lelliottia amnigena. Enterobacteriaceae most often showed resistance to ampicillin (96.2%), ceftriaxone (78.3%), cefotaxime (78%), cefuroxime (78%) and ceftazidime (76.4%). MDR frequency of Enterobacteriaceae at Hawassa, Tikur Anbessa, Yekatit 12 and Dessie hospital was 95.1%, 93.2%, 87.3% and 67.7%, respectively. Carbapenem resistance was detected in 17.1% of K. pneumoniae (n = 111), 27.7% of E. cloacae (n = 22) and 58.8% of Acinetobacter baumannii (n = 34).
Diverse and emerging gram-negative bacterial etiologies of sepsis were identified. High multidrug resistance frequency was detected. Both on sepsis etiology types and MDR frequencies, substantial variation between hospitals was determined. Strategies to control MDR should be adapted to specific hospitals. Standard bacteriological services capable of monitoring emerging drug-resistant sepsis etiologies are essential for effective antimicrobial stewardship.
由耐多药（MDR）细菌引起的败血症是一个日益严重的公共卫生问题，主要发生在低收入国家。
在 2019 年 10 月至 2020 年 9 月期间，在埃塞俄比亚中部（提克里安贝萨和耶卡蒂 12）、南部（霍瓦萨）和北部（德西）的四家医院进行了一项多中心研究。共纳入了 1416 名临床疑似败血症的患者。来自提克里安贝萨、耶卡蒂 12、德西和霍瓦萨医院的患者人数分别为 501、298、301 和 316。在每个研究地点，所有患者均进行了血培养，阳性培养物通过其菌落特征、革兰氏染色和常规生化试验进行特征描述。使用基质辅助激光解吸/电离飞行时间质谱（MALDI TOF）来鉴定每种细菌种类。通过圆盘扩散法确定细菌的耐药模式。使用逻辑回归分析评估依赖和独立变量之间的关联。p 值<0.05 被认为具有统计学意义。使用 SPSS 版本 25 对数据进行分析。
在进行的 1416 次血培养中，40.6%的培养物有生长。其中，致病性细菌、酵母细胞和可能的污染物的阳性率分别为 27.2%、0.3%和 13.1%。肺炎克雷伯菌（26.1%）、产酸克雷伯菌（18.1%）和大肠埃希菌（12.4%）是最常见的。大多数产酸克雷伯菌（61%）在德西发现，而霍瓦萨（36.4%）也有较多的产酸克雷伯菌。几乎所有的潘氏肠杆菌（95.2%）均在德西分离。罕见的分离株（每种分离株占比 0.5%或 0.2%）包括莱氏柠檬酸杆菌、鸟氨酸罗尔斯顿菌、嗜麦芽寡养单胞菌、木糖氧化无色杆菌、洋葱伯克霍尔德菌、考文垂克氏菌和阿氏肠杆菌。肠杆菌科最常对氨苄西林（96.2%）、头孢曲松（78.3%）、头孢噻肟（78%）、头孢呋辛（78%）和头孢他啶（76.4%）耐药。霍瓦萨、提克里安贝萨、耶卡蒂 12 和德西医院肠杆菌科的 MDR 频率分别为 95.1%、93.2%、87.3%和 67.7%。在 17.1%的肺炎克雷伯菌（n=111）、27.7%的阴沟肠杆菌（n=22）和 58.8%的鲍曼不动杆菌（n=34）中检测到碳青霉烯类耐药。
确定了不同的、不断出现的败血症革兰氏阴性细菌病因。检测到很高的多药耐药频率。医院之间在败血症病因类型和 MDR 频率方面存在显著差异。应根据具体医院制定控制 MDR 的策略。能够监测新兴耐药性败血症病因的标准细菌学服务对于有效的抗菌药物管理至关重要。
