Antimicrobial Susceptibility Pattern of Bacterial Pathogens Isolated from Patients with Lower Respiratory Tract Infection in Kebbi State, Nigeria

doi:10.21203/rs.3.rs-1508756/v1

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Antimicrobial Susceptibility Pattern of Bacterial Pathogens Isolated from Patients with Lower Respiratory Tract Infection in Kebbi State, Nigeria

https://doi.org/10.21203/rs.3.rs-1508756/v1

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Background

The rise in antibiotics resistance is a growing public health concern among agents of respiratory tract infection, which is responsible for morbidity, mortality and costs in Africa. This study was designed to survey for multidrug resistant bacterial pathogens in patients with lower respiratory tract infection (LRTI) attending some hospitals in Kebbi State, Nigeria.

Methods

Three hundred and fifty sputum samples were collected from consented patients with the symptoms of LRTI attending six different hospitals in Kebbi State. The samples were all screened for bacterial pathogens using standard microbiological techniques. The bacterial isolates were identified using conventional biochemical tests and then confirmed using commercial biochemical test kit (MICROBACT) according to manufacturerer’s instruction. Antimicrobial susceptibility test were determined using disc diffusion method.

Results

Staphylococcus aureus was the most predominant bacteria isolated in this location followed by Klebsiella pneumoniae with an estimated percentage occurrence of 31.1% and 22.2% respectively. Other bacteria isolated include Klebsiella oxytoca (13.9%), Escherichia coli (11.1%), Pseudomonas aeruginosa (5.6%), Aeromonas hydrophila (5.6%), Acinetobacter baumannii (4.6%), B. pseudomallei (2.8%) and Proteus spp (2.8%) in order of ranking. It was found out that, the young adults and the elderly were most at risk of a severe respiratory condition. The result also shows that LRTI were more common in males than in females. Most of the isolates were susceptible to piperacilin ((51%), trimethoprim sulphamethoxazole (61%), Azithromycin (70%), Ciprofloxacin (71%) and Gentamycin (74%), in order of ranking. High resistance were recorded in almost all the βeta-lactam antibiotics, erythromycin and vancomycin tested.

Conclusion

In conclusion, it was found out that, Staphylococcus aureus is the most predominant bacteria isolated, most of the isolates were resistance to β-lactam antibiotic tested. Azithromycin, Ciprofloxacin, Gentamycin and piperacillin remain the useful antibiotics in the treatment of LRTIs in this location.

Antibiotics

Susceptibility

Pathogens

Respiratory tract

Resistance

Antibiotic resistance is considered to be a worldwide problem, and unwise use of antibiotics has been recognized as a key contributor to the increasing rates of resistance (Ventola, 2015). Therefore, clinical practice typically uses empirical antibiotic selection to target the most likely pathogens based on antibiotic sensitivity data (Zhang et al., 2014). Most studies have described patterns in the resistance of bacterial pathogens among adults with respiratory tract infections, these patterns may occur differently in adults and children (Felmingham, 2004; Adam et al., 2013). According to an analysis of hospiatal acquired pneumonia (HAP) in Japan, methicillin resistant S. aureus accounts for 17.5%, P. aeruginosa 13.9%, and methicillin-sensitive S. aureus 6.5%. A similar analysis of nursing and healthcare-associated pneumonia (NHCAP) reported S. pneumoniae in 16.4% of cases, Klebsiella pneumoniae in 9.6%, and methicillin-resistant S. aureus in 9.6%. However, it should be noted that in about half of cases, the bacteria responsible for aspiration pneumonia could not be identified (Naoya and Yasuhiro, 2018). The choice of antimicrobial therapy for bacterial LRTIs is relatively straight forward when the etiologic agents and their antibiotic susceptibility patterns are known. However, the clinical presentation is usually not specific enough to make a firm etiologic diagnosis whether in the community or hospital setting (Shah et al., 2010). In almost all cases, eradication of causative agents requires initiation of antimicrobial therapy before obtaining culture report; however, during the last few years, the increase in antibiotic resistance has compromised the selection of empirical treatment (Jonaidi, 2009) and how to choose an effective antimicrobial agent is a new challenge to the clinicians, as the composition and the resistance to antimicrobial agents of infection pathogens was changing frequently. This trend is presumably due to the empirical administration of antibacterial therapy even before the availability of the culture results (Ahmed, 2013). Various other factors also contribute to the emergence of resistance such as irrational use of antibiotics, transmission of resistant bacteria from patient to patient and from healthcare practitioners to patients and vice versa (WHO, 2012; Mahmoud and Balkhy, 2012).

Nowadays, antibiotic resistance exerted by microorganisms against antibiotics is considered as a serious issue by global medicinal and research community (WHO, 2012; Mahmoud and Balkhy, 2012). Therefore, the clinicians and microbiologists worldwide are focusing on knowledge and strategies to limit the development of antimicrobial resistance. A study conducted at Kathmandu Model Hospital, Kathmandu, Nepal on Antibiotic Susceptibility Pattern of Gram-negative Isolates of Lower Respiratory Tract Infection revealed that among 6 multidrug resistance (MDR) isolates of E. coli, ESBL was detected in 4 (66.67%), among 15 MDR isolates of K. pneumoniae, ESBL was detected in 4 (26.66%) and of 9 MDR isolates of Acinetobacter calcoaceticus baumannii complex, ESBL was detected in 1(11.11%). All ESBL producing isolates are MDR (Rakshya et al., 2018). The resistance to cephalosporins, aminoglycosides and carbapenem was remarkable from January 2010 to December 2012 in the Microbiology Department of a Teaching Tertiary Care Hospital, Central India (Bajpai et al., 2013). Study of Gram negative Bacterial Isolates from Lower Respiratory Tract Infections (LRTI) and their antibiogram pattern in a Tertiary Care Hospital in South India showed that, most of the Gram negative bacterial isolates were resistance to commonly used cephalosporins. Klebsiella Spp showed resistance to most of the drugs like Amoxyclav (87.8%), cefuroxime (83.3%), ceftazidime (81.1%), ceftriaxone (70.5%). Pseudomonas aeruginosa showed relatively lesser resistance pattern. E. coli showed resistance to most of the cephalosporins, flouroquinolones and Amoxyclav (63.5%). Acinetobacter showed sensitivity only to higher level antibiotics like Imipenam (4.8%) and Piperacillin/Tazobactam (16.7%) (Arthi et al., 2016).

Antimicrobial susceptibility pattern of bacterial isolates from community acquired pneumonia patients in Jimma University Specialized Hospital, Jimma, Ethiopia revealed that, most S. pneumoniae isolates were resistant to oxacillin (55%). High resistance rates of S. aureus isolates were observed to tetracycline (100%), penicillin (81.3%), trimethoprim sulfamethoxazole (81.3%), erythromycin (75%), and doxycycline (50%). Gram‑negative bacteria isolates were resistant to tetracycline (66.7–100%), doxycycline (50–100%), trimethoprim-sulfamethoxazole (66.7–100%), and ampicillin (66.7–100%). Resistance to two or more drugs was also observed among 62.7% of bacterial isolates (Belayneh, et al., 2015). Current trend of Antibiotic Resistance in Lower Respiratory Tract Infections (LRTIs): An Experience in a Teaching Hospital in Bangladesh demonstrated that, Gram positive organisms showed maximum sensitivity to imipenem (94.6%), meropenem (97.3%) and cefotaxime (75%). The resistance pattern varied for different organisms. Staphylococcus aureus isolates were mostly resistant to amoxicillin and ceftazidime (89.2%), whereas, Streptococcus pneumoniae was resistant to ceftazidime, amoxicillin and cotrimoxazole (81.2%). In case of Gram negative isolates, Klebsiella sp. was mostly resistant to ceftriaxone, ceftazidime and amoxicillin (100%). Escherichia coli was resistant to amoxicillin, cotrimoxazole and vancomycin (100%) (Borkot et al., 2016). The antibiotic resistance associated with CA-LRTIs varies significantly depends on geographical locations and investigated populations (Ibrahim et al., 2014; Felmingham, 2004). Therefore, it is not adequate to simply copy the guidelines from other countries, which may be inappropriate and lead to serious problems in clinical practice. For example, the incidence of aminoglycosides and quinolones resistant-MRSA is relatively high in the USA (McDougal et al., 2010). Penicillin-resistant S. pneumoniae is also relatively high in USA (McDougal, 2008) and Southeast Asia (Felmingham, 2004).

In developing countries including Nigeria, treatment of LRTI is made usually empirically in which the etiologic agent is rarely identified. So, identifying the most common bacterial pathogens from patients with LRTI and drug resistance profile would be valuable to reduce morbidity and mortality as a result of the disease (Temesgen et al., 2019). Therefore, this study was conducted to determine the antimicrobial susceptibility profile of bacterial pathogens in patients with Lower Respiratory Tract infection attending some hospitals in Kebbi State, Nigeria.

Study Area/Site

This study was conducted in Kebbi State, Kebbi State is located on latitude 11.6781° N and longitude 4.0695° E, the state is bounded by Sokoto State to the north and east, Niger State to the south, and Benin Republic to the west. The major ethnic groups are Hausa and Fulani, other ethnic groups includes Dakarkari, Zabarmawa, Dukkawa and Kambari. Kebbi State have a total land area of 36,129 sq. km. Agriculture is the main occupation of the people especially in rural areas. Crops produced are mainly grains. Animal rearing and fishing are also common. The state has the total population of 3,256,541 people as projected from the 2006 census. The study site includes: Sir Yahaya Memorial Hospital Birnin Kebbi, Kebbi Medical Centre, Aisha Buhari General Hospital Jega and General Hospital Argungu.

Study Population

The study population included patients from all age group that presented the clinical evidence of lower respiratory tract infection such as fever, rigors, fatigue, anorexia, diaphoresis, dyspnea, productive cough and pleuritic chest pain (Ashby and Turkington, 2007) as diagnosed by the attending physician at the General out Patient Department (GOPD) of the selected hospitals in Kebbi State.

Study Design

This is a Cross-sectional and hospital based study.

Sampling Technique

Stratified sampling technique was employed for this study until the sample size was completed.

Inclusion Criteria

All consented patients with clinical sign and symptoms of LRTI as diagnosed by the attending physician and those who have not taken antibiotic at least two weeks prior to sample collection were included into this study.

Exclusion Criteria

Patients who did not give their consent (see appendix I) or those that took antibiotic about two weeks prior to sample collection were excluded from this study.

Sample Collection

Early morning sputum specimens were collected aseptically from patients attending the selected Hospitals in Kebbi State after obtaining an approval from the ethical review committee. All patients were instructed on how to collect the sputum samples aseptically, i.e. they were asked to cough deeply early in the morning into a well-labeled sterile, leak proof, wide mouthed container, with tight fitting cover, which was taken to the laboratory for analysis.

Culture of the sputum

The sputum samples were cultured on chocolate agar, sheep blood agar (5%), and MacConkey agar plates (oxoid). On the Chocolate agar, bacitracin and optochin disks were placed at secondary inoculation to screen S. pneumoniae. The chocolate agar plates were incubated in a incubator (5% CO₂) at 37 ºC for 24 hours while blood agar and MacConkey agar were incubated in an aerobic atmosphere at 37ºC for 24 hours (Borkot et al., 2016). Suspicious colonies was sub-cultured for purification and thereafter preserved on nutrient agar slants and stored in a refrigerator (4ºC) for subsequent analysis.

Identification of the isolated bacteria

The bacterial isolates were identified based on colonial morphology, gram staining characteristics and series of biochemical tests which includes: catalase test, coagulase test, indole test, citrate test, Urease test oxidase test, TSI, Mannitol fermentation, growth on EMB agar, The isolates were further confirmed using commercial biochemical test kit (MICROBACT) according to manufacturer’s instructions.

Antimicrobial Susceptibility Pattern of the Isolated Bacteria

Antimicrobial susceptibility test were determined using disc diffusion method, the disc diffusion method that was presented in this study, was a modification of the Kirby Bauer technique that has been carefully standardized by CLSI described below

Inoculums Preparation

The colonies were suspended in saline, and then the inoculums were adjusted to a turbidity equivalent to a 0.5 McFarland standard, (a chemical solution of 1% barium chloride (BaCl₂) and 1% sulfuric acid (H₂SO₄) Solution in appropriate proportion. 1% Barium Chloride (BaCl₂) solution was prepared by mixing 1gram of anhydrous barium chloride (BaCl₂) in 100 ml Distilled water and 1% Sulfuric Acid (H₂SO₄) solution was prepared by mixing 1 ml of concentrated H₂SO₄in 99 ml of Distilled water. 1% Barium chloride (BaCl₂) and 1% Sulfuric acid (H₂SO₄) were then mixed in an appropriate proportion). The prepared solution were mixed well to form a turbid suspension equivalent to 0.5 McFarland standard and the resulting mixture were kept in a screw cap tube covered with the Aluminium foil to prevent the evaporation of the solution. (CLSI, 2017).

Inoculation of Test Plates

After adjusting the turbidity of the inoculum suspension, a sterile cotton swab was dipped into the adjusted suspension. The swab was then rotated several times and pressed firmly on the inside wall of the tube above the fluid level. This removed the excess inoculum from the swab. The dried surface of a Mueller-Hinton agar plate was inoculated by swabbing the swab over the entire sterile agar surface. This procedure was repeated by streaking two more times, rotating the plate approximately 60° each time to ensure an even distribution of inoculums. The lid was then left slightly open for 3 to 5 minutes, but no more than 15 minutes, to allow for any excess surface moisture to be absorbed before applying the drug impregnated discs (Lalitha, 2006). The following antibiotics disc was used for this research: Azithromycin, erythromycin, Ciprofloxacin, Ceftriaxone, Ceftazidime, Cefixime, Cefuroxime, Amoxicilin, Gentamycin, Cotrimoxazol, Cefotaxime, Cloxacilin, Vancomycin and Piperacillin.

Application of Discs to Inoculated Agar Plates

The predetermined batteries of antimicrobial discs were dispensed onto the surface of the inoculated agar plate. Each disc was pressed down to ensure complete contact with the agar surface. The discs were distributed evenly so that they are no closer than 24 mm from center to center. The plates were inverted and placed in an incubator set to 36°C within 15 minutes after the discs were applied and incubated for 18 hours.

Plates and Interpreting Results

The diameters of the zones of complete inhibition (as judged by the unaided eye) were measured, including the diameter of the disc. Zones were measured to the nearest whole millimetre, using a ruler, which was held on the back of the inverted Petri-plate. The organisms were reported as susceptible, intermediate or resistant to the agents that were tested (CLSI, 2017).

Table 1

Distribution of bacterial pathogens of lower respiratory tract infection in Kebbi State
S/N	Bacterial pathogens isolated	Number of occurrence	% Occurrence
1	Staphylococcus aureus	34	31.1
2	Klebsiella pneumoniae	24	22.2
3	Klebsiella oxytoca	15	13.9
4	Escherichia coli	12	11.1
5	Aeromonas hydrophila	6	5.6
6	Acinetobacter baumannii	5	4.6
7	Pseudomonas aeruginosa	6	5.6
8	B. pseudomallei	3	2.8
9	Proteus spp	3	2.8
	TOTAL	108	100

Table 2

Incidence of lower respiratory tract infection in relation to gender
Gender	No. of samples examined (%)	No. of positive samples (%)
Male	216 (61.7)	58 (53.7)
Female	134 (38.3)	50 (46.3)
TOTAL	350 (100)	108 (100)

Table 3

Incidence of lower respiratory tract infection in relation to age
Age	No. of samples examined (%)	No. of positive samples (%)
0–19	39(11.1)	11 (10.2)
20–39	150(42.9)	47 (43.5)
40–59	116(33.1)	39 (36.1)
60–79	42(12.0)	11 (10.2)
80–100	3(9.0)	0 (0)
TOTAL	350 (100)	108 (100)

Table 4.1

Antimicrobial Susceptibility Pattern of the bacterial isolates to commonly used antibiotics
Isolates	NO.	Pattern	AML	OB	CXM	CAZ	CRO	CFM	CTX	PRL	SXT	AZM	E	VA	CN	CIP
S. aureus	34	S I R	N(%) 3(9) 0(0) 31(91)	N(%) 9(26) 1(3) 24(71)	N(%) 8(24) 1(3) 25(73)	N(%) 3(9) 2(6) 29(85)	N(%) 9(26) 5(15) 20(59)	N(%) 5(15) 0(0) 29(85)	N(%) 5(15) 2(6) 27(79)	N(%) 17(50) 8(24) 9(26)	N(%) 25(74) 2(6) 7(20)	N(%) 23(68) 3(9) 8(23)	N(%) 11(32) 2(6) 21(62)	N(%) 8(24) 7(21) 19(55)	N(%) 25(74) 1(3) 8(23)	N(%) 23(68) 4(12) 7(20)
K. pneumoniae	24	S I R	2(8) 1(4) 21(88)	1(4) 1(4) 22(92)	3(13) 3(13) 18(74)	5(21) 3(13) 16(66)	4(17) 2(8) 18(75)	2(8) 1(4) 20(83)	3(13) 3(13) 18(74)	14(58) 6(25) 4(17)	15(63) 0(0) 9(37)	15(63) 0(0) 9(37)	4(17) 2(8) 18(75)	4(17) 1(4) 19(79)	19(79) 1(4) 4(17)	19(79) 1(4) 4(17)
K. oxytoca	15	S I R	0(0) 0(0) 15(100)	0(0) 0(0) 15(100)	3(20) 3(20) 9(60)	2(13) 4(27) 9(60)	2(13) 3(20) 10(67)	4(27) 2(13) 9(60)	3(20) 3(20) 9(60)	9(60) 5(33) 1(7)	10(67) 1(7) 4(27)	11(73) 1(7) 3(20)	2(13) 1(7) 12(80)	3(20) 0(0) 12(80)	13(87) 0(0) 2(13)	14(93) 1(7) 0(0)
E. coli	12	S I R	0(0) 0(0) 12(100)	1(8) 0(0) 11(92)	7(58) 0(0) 5(42)	5(42) 0(0) 7(58)	6(50) 3(25) 3(25)	2(17) 2(17) 8(66)	4(33) 1(8) 7(59)	6(50) 1(8) 5(42)	7(59) 0(0) 5(41)	11(92) 0(0) 1(8)	3(25) 0(0) 9(75)	1(8) 0(0) 11(92)	9(75) 1(8) 2(17)	6(50) 3(25) 3(25)
Pseu. Aeruginosa	6	S I R	0(0) 0(0) 6(100)	0(0) 0(0) 6(100)	0(0) 0(0) 6(100)	0(0) 0(0) 6(100)	0(0) 1(20) 5(80)	0(0) 0(0) 6(100)	0(0) 0(0) 6(100)	5(100) 0(0) 1(0)	1(20) 0(0) 5(80)	5(80) 0(0) 1(20)	0(0) 1(20) 5(80)	0(0) 0(0) 6(100)	4(80) 0(0) 2(20)	5(100) 1(0) 0(0)
Key: S- Susceptible, I- Intermediate, R- Resistance, AML- Amoxicillin, OB- Cloxacillin, CXM- Cefixime, CAZ- Ceftazidine, CRO- Ceftriaxone,
CFM- Cefuroxime, CTX- Cefotaxime, PRL- Piperacillin, SXT- Trimethoprim Sulphametaxazole, AZM- Azithromycin, E- Erythromycin, VA- Vancomycin, CN- Gentamycin, CIP- Ciprofloxacin

Table 4.2

Antimicrobial Susceptibility Pattern of the bacterial isolates to commonly used antibiotics continues...
Isolates	NO.	Pattern	AML	OB	CXM	CAZ	CRO	CFM	CTX	PRL	SXT	AZM	E	VA	CN	CIP
Acinetobacter baumannii	5	S I R	1(20) 0(0) 4(80)	1(20) 0(0) 4(80)	1(20) 1(20) 3(60)	2(40) 0(0) 3(60)	2(40) 1(200 2(40)	2(40) 1(20) 2(40)	2(40) 0(0) 3(60)	2(40) 2(40) 1(20)	4(80) 0(0) 1(20)	3(60) 0(0) 2(40)	1(20) 0(0) 4(80)	1(20) 0(0) 4(80)	4(80) 0(0) 1(20)	5(100) 0(0) 0(0)
B. pseudomallei	3	S I R	0(0) 0(0) 3(100)	0(0) 0(0) 3(100)	0(0) 1(33) 2(67)	0(0) 0(0) 3(100)	0(0) 0(0) 3(100)	0(0) 1(33) 2(67)	0(0) 0(0) 3(100)	0(0) 1(33) 2(67)	0(0) 1(33) 2(67)	0(0) 0(0) 3(100)	0(0) 0(0) 3(100)	0(0) 0(0) 3(100)	1(33) 1(33) 1(33)	2(67) 0(0) 1(33)
Aeromonas hydrophila	6	S I R	0(0) 0(0) 6(100)	0(0) 0(0) 6(100)	0(0) 0(0) 6(100)	0(0) 0(0) 6(100)	0(0) 1(17) 5(83)	1(17) 1(17) 4(66)	0(0) 1(17) 5(83)	0(0) 2(33) 4(67)	1(17) 0(0) 5(83)	4(66) 0(0) 2(34)	0(0) 0(0) 6(100)	0(0) 0(0) 6(100)	2(34) 1(17) 3(49)	0(0) 2(33) 4(67)
Proteus Vulgaris	3	S I R	0(0) 0(0) 3(100)	0(0) 0(0) 3(100)	0(0) 1(33) 2(67)	0(0) 1(33) 2(67)	0(0) 1(33) 2(67)	0(0) 1(33) 2(67)	0(0) 0(0) 3(100)	2(67) 1(33) 0(0)	3(100) 0(0) 0(0)	3(100) 0(0) 0(0)	2(67) 0(0) 1(33)	0(0) 0(0) 3(100)	3(100) 0(0) 0(0)	3(100) 0(0) 0(0)
TOTAL	108	S I R	6(6) 1(1) 101(93)	12(11) 2(2) 94(87)	23(21) 10(9) 75(70)	17(16) 10(9) 81(75)	23(21) 17(16) 68(63)	16(15) 9(8) 82(75)	17(16) 10(9) 81(71)	55(51) 26(24) 27(25)	66(61) 4(4) 38(35)	75(70) 4(4) 29(26)	23(21) 6(6) 79(73)	17(16) 8(7) 83(77)	80(74) 5(5) 23(21)	77(71) 12(11) 19(18)
Key: S- Susceptible, I- Intermediate, R- Resistance, AML- Amoxicillin, OB- Cloxacillin, CXM- Cefixime, CAZ- Ceftazidine, CRO- Ceftriaxone,
CFM- Cefuroxime, CTX- Cefotaxime, PRL- Piperacillin, SXT- Trimethoprim Sulphametaxazole, AZM- Azithromycin, E- Erythromycin, VA- Vancomycin.

The rise in multidrug resistance is a growing public health concern among agents of respiratory tract which is responsible for morbidity, mortality and costs (Uskudar et al., 2021), this make management of respiratory tract infections a great challenge in Africa due to the socioeconomic burden and limited access to good healthcare facilities and indiscriminate use of antibiotics (Serges et al., 2019). The overall incidence of bacterial pathogens of LRTIs recorded in this study was 31%. This finding is slightly higher than those of earlier studies recorded at National Hospital Abuja (14.5%), Ilorin (15.53%), Benin (18.91%), Kano (21.5%) and Nepal (24.6%) (Abdullahi and Iregbu, 2018; Kalgo et al., 2016; Christopher et al., 2011; Taura et al., 2013; Rakshya et al., 2018). Higher prevalence were reported in Bangladesh (64%) and some European countries (59%) (Borkot et al., 2016; Leven et al., 2018), this variation of incidence may be due to differences in geographical location.

Table 1 shows that Staphylococcus aureus (31.1%) was the most predominant bacteria isolated in this location followed by Klebsieella pneumoniae (22.2%), Klebsiella oxytoca (13.9%), Escherichia coli (11.1%), Pseudomanas aeruginosa (5.6%), Aeromonas hydrophila (5.6%), Acinetobacter baumannii (4.6%), B. pseudomallei (2.8%) and Proteus spp (2.8%) in order of ranking. The distribution of aetiology of lower respiratory tract as recorded in this study is similar to the previous study at National Hospital Abuja (Abdullahi and Iregbu, 2018), study in Shanghai, China from 2013 to 2015 (Pengcheng et al., 2018), a multicenter Analysis from Turkey (Guclu et al., 2021) and Ethiopia (Dessie et al., 2021) except that, in addition, the current study isolated Aeromonas hydrophila and B. pseudomallei. Some studies from neighbouring countries such as Yaoundé, Cameroon (Tchatchouang et al., 2019) and other studies in some part of Europe (Leven et al., 2018) documented S. pneumoniae as the leading pathogen of LRTIs followed by H. influenzae which contradict the current findings where Staphylococcus aureus were the most prevalence bacteria isolated followed by Klebsiella spp, this is similar to the findings in Bangladesh as reported by Borkot et al., (2016) and some studies from southern Ethiopia (Gebre et al., 2021)

Table 2 indicated that, LRTIs were more common in males (53.7%) than that of females (46.3%). This finding is similar to the work conducted in Kano by Taura et al., (2013), India (Shah et al., 2010), Abeokuta, Ogun State, Nigeria (Akingbade et al. 2012) and Bangladesh (Borkot et al., 2016) but however, these results contradicts the data obtained by El- Mahmood et al., (2010), in which in a similar study, out of 232 total isolates, 114 (49.1%) were from males while 118 (50.9%) from females. This also contradicts previous findings in 11 European countries (Belgium, Spain, Poland, Slovakia, UK, Slovenia, Sweden, Italy, France, Germany, and Netherland) where 60% of the female were reported with LRTIs (Ieven et al., 2018). Male prevalence of LRTI may be due to their exposure to different group of population and also to some associated risk factors of respiratory tract infection such as smoking, alcohol consumption and COPD (Panda et al., 2012; Borkot et al., 2016).

Table 3 demonstrated that, most of pathogens were isolated among patients in age range 20–39 years with the percentage occurrence of 43.5%, closely followed by age range 40–59 years with 36.1%, the lowest rate was recorded in age range 0–19 and 60–79 years with 10.2% each. From our study, it was observed that, the young adults and the elderly were most at risk of a severe respiratory condition. This finding tally with the work of Taura et al., (2013) in Kano, Nigeria and some works conducted in Bangladesh (Borkot et al., 2016), India (Akansha et al., 2017) and northwest Ethiopia (Tomasz et al., 2013). In contrast to the current study as reported by Dessie et al., (2021) in Ethiopia, aging is a risk factor for bacterial pneumonia. In their study, the age group > 64 years was 2.4 times more likely to have bacterial pneumonia compared to the age group of 5–15 years (Almirall et al., 2017). Similar findings were reported from Spain (Prina et al., 2015; Rivero-Calle et al., 2016), Pakistan (Ahmad et al., 2017), Japan (Morimoto et al., 2015), and the USA (Quartin et al., 2013)

Table 4 revealed that, most of the isolates were susceptible to piperacilin ((51%), trimetprin sulphamethoxazole (61%), Azithromycin (70%), Ciprofloxacin (71%) and Gentamycin (74%), in order of ranking, these are supported by the findings of El-Mahmood et al., (2010), Taura et al., (2013) and a study in Kathmandu, Nepal (Rakshya et al., 2018). High resistance were recorded in almost all the βeta-lactam antibiotics tested such as Ceftriaxone (63%), Cefuroxime (70%), Cefotaxime (71%), Ceftazidine (75%), Oxacillin (87%) and Amoxicillin (93%). High resistance were also recorded among macrolide (Erythromycin) and Glycopeptide (Vancomycin). This findings correlate with the work carried out by Barkot et al., (2016) in Bangladesh.

Staphylococcus aureus displayed wide range of resistance among βeta-lactam antibiotics tested such as Amoxicillin, cloxacillin, cefuroxime, ceftazidine, cetriaxone, cefixime, cefotaxime except piperacillin in which 50% of the isolates were susceptible, 24% were intermediately resistance and 26% were resistance. Moderately resistance were found associated with erythromycin and Vancomycin among Staphylococcus aureus isolates in this study. Gentamycin and trimtophrim sulphamethoxazole remain the drug of choice in the treatment of LRTI caused by Staphylococcus aureus in this location followed by Azithromycin and ciprofloxacin. The resistance pattern of Staphylococcus aureus is Similar to the work of Garba et al., (2017) in Zaria among Staphylococcus aureus isolated from different clinical samples.

Klebsiella pneumoniae is the second most predominant bacteria isolated from patients with clinical evidence of LRTI in this location followed by Klebsiella oxytoca. They demonstrated an alarming resistance among βeta-lactam antibiotics such as cefuroxime, ceftazidine, ceftriaxone, cefixime, cefotaxime except piperacillin. While Ciprofloxacin and gentamycin demonstrated high activity among Klebsiella pneumoniae and Klebsiella oxytoca isolates followed by Azithromycin and trimethoprim sulphamethaxazole, this finding is similar to the work of Rakshya et al., (2018) in Nepal and Abayomi et al., (2020) in Ogbomoso, Nigeria.

The activity of βeta-lactam antibiotics on Eschericia coli was moderate except that high resistance were recorded on cefuroxime, this finding correlates with the work in Ogbomoso, Nigeria (Abayomi et al., 2020) Most of the Escherichia coli isolates were susceptible to gentamycin and trimethoprim sulphamethoxazole followed by Azithromycin and Ciprofloxacin.

Pseudomonas aeruginosa demonstrated 100% resistance to all βeta-lactam antibiotic tested except piperacillin and good activity were also documented on Ciprofloaxacin, Gentamycin and Azithromycin. The resistance to all antibiotics tested by Pseudomonas aeruginosa as presented in this study is of public health concern with associated treatment failure. P. aeruginosa is a common pathogen in the lungs of those with cystic fibrosis (CF) and is associated with frequent pulmonary exacerbations and high morbidity and mortality (Sriramulu, 2013). The lungs of patients with CF can harbor this organism for decades. With increasing levels of P. aeruginosa drug resistance, treatment of pulmonary exacerbations can be increasingly difficult over time (Atkin et al., 2018).

Burkholderia pseudomallei demonstrated 100% resistance to all the antibiotics tested except that, one of the isolate was susceptible to gentamycin and two isolates were susceptible to ciprofloxacin. Burkholderia pseudomallei is the causative agent for melioidosis, an often fatal disease with a predicted global burden of 165,000 cases per year and 89,000 deaths worldwide (Limmathurotsakul et al., 2016). Regions of melioidosis endemicity, including Southeast Asia and northern Australia, account for up to 40% (Limmathurotsakul et al., 2010) and 10% (Currie et al., 2010) case fatality rates, respectively. Transmission routes include percutaneous inoculation, inhalation, and ingestion of contaminated soil and water (Limmathurotsakul et al., 2013). B. pseudomallei is intrinsically resistant to many antibiotics, including penicillin, ampicillin, and first- and second-generation cephalosporins (Wiersinga et al., 2018).

Aeromona hydrophila also shows resistance to almost all the antibiotics tested except Gentamycin and Azithromycin, this is consisted with the findings in Taiwan (Chao et al., 2013). This study also found out that, approximately 67% of the patients with Aeromonas infection had various underlying diseases, such as diabetes mellitus and hypertension. Similar findings have been reported in a number of case reports, Nagata et al., (2011) described a case of A. hydrophila pneumonia in a 75-year-old woman with colon cancer who died of the disease, Ye et al., (2010) reported on a patient with severe pneumonia due to drug-resistant A. caviae, and Murata et al., (2001) reported on a case of fulminant A. hydrophila pneumonia in a patient with chronic renal failure and liver cirrhosis. The morbidity and mortality rates associated with Aeromonas pneumonia were relatively high (Chao et al., 2013). Therefore, physicians should be aware that immunocompromised patients of advanced age are at risk of developing Aeromonas pneumonia.

Staphylococcus aureus is the most predominant bacteria isolated in this location followed by Klebsiella pneumoniae with an estimated percentage occurrence of 31.1% and 22.2% respectively. Most of pathogens were isolated among patients in age range 20–39 years with the percentage occurrence of 43.5%, closely followed by age range 40–59 years with 36.1%. The result also shows that LRTI were more common in males than in females. Most of the isolates were susceptible to piperacillin ((51%), trimetprin sulphamethoxazole (61%), Azithromycin (70%), Ciprofloxacin (71%) and Gentamycin (74%), in order of ranking. High resistance were recorded in almost all the βeta-lactam antibiotics tested. Treatment of lower respiratory tract infection with β-lactam actibiotics in this centre should be discouraged, due to high level of resistance exhibited by the isolated bacteria.

This is to declare that, this research article is our original work and all other information obtained in the literature has been duly acknowledged.

Ethical Approval

Ethical approval was obtained from the Ministry of Health ethical review committee in Kebbi State. Informed consent both oral and written was obtained from all the participants while ascents were obtained from parents in case of children. All data were stored anonymously and was handled only by the investigator and authorized personnel.

Consent for Publication

Consent for publication was obtained from the ministry of health Kebbi State and also from all the participants as signed by during sample and data collection.

Availability of Data and Materials

The data used in this study can be found in the selected hospitals in Kebbi State, Nigeria. It was agreed and signed by the patients that, Information such as name, place of residence or any means of identification and other data will be kept confidential.

The data used for this research

Not applicable

Funding

This research work was sponsored by Tertiary Education Trust Funds through Federal University Birnin Kebbi, Nigeria.

Use of animal/ tissue data

Not applicable

Competing interest

The authors declared that, there is no competing interest

Author’s contribution

Kalgo, Z. M. collected the samples and carried out identification, Antimicrobial Susceptibility Test and drafted the original work.

Amin, B. M. responsible for design, tables arrangement and helped to draft the manuscript.

Mohammed, B. helped in design, coordination and performed the statistical analysis

Acknowledgements

This is to acknowledge the federal university Birnin Kebbi and Tertiary Education Trust Funds (TETFUND) for their financial support during the course of my PhD programme at the Department of Microbiology, Bayero University Kano. This in turn gave rise to this piece of research article.

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No competing interests reported.

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Antimicrobial Susceptibility Pattern of Bacterial Pathogens Isolated from Patients with Lower Respiratory Tract Infection in Kebbi State, Nigeria

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Abstract

Introduction

Materials And Methods

Study Area/Site

Study Population

Study Design

Sampling Technique

Inclusion Criteria

Exclusion Criteria

Sample Collection

Culture of the sputum

Identification of the isolated bacteria

Antimicrobial Susceptibility Pattern of the Isolated Bacteria

Inoculums Preparation

Inoculation of Test Plates

Application of Discs to Inoculated Agar Plates

Plates and Interpreting Results

Results

Discussion

Conclusion And Recommendation

Declarations

References

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