Three years Retrospective Analysis of Distribution and Antimicrobial Resistance Profiles of Isolates from Culture-positive Clinical Specimens at Felege Hiwot Comprehensive Specialized Hospital in northwestern Ethiopia

doi:10.21203/rs.3.rs-3975798/v1

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Three years Retrospective Analysis of Distribution and Antimicrobial Resistance Profiles of Isolates from Culture-positive Clinical Specimens at Felege Hiwot Comprehensive Specialized Hospital in northwestern Ethiopia

https://doi.org/10.21203/rs.3.rs-3975798/v1

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Background

The main concerns affecting human health are infectious diseases. Bacterial infections comprise a large portion of infectious disorders. Infections acquired in health institutions are also among their sources of infections. The location of culture-positive specimens and the thorough profiles of antibiotic resistance for common pathogens were the subsequent focal points of the current investigation.

Methodology:

The bacterial isolates and antibiotic resistance of the bacterial pathogens extracted from the patient's biological samples were evaluated in this retrospective study (2020–2022). Biological specimens utilized for microbiological culture included blood, urine, genital, respiratory, soft tissue and body fluids, stool, urine, and Cerebro-spinal fluid. The diagnosis of microbiology was carried out using traditional culture techniques. In accordance with Clinical and Laboratory Standards Institute guidelines, the Kirby-Bauer disk-diffusion method was employed for the antimicrobial susceptibility analysis. The data was extracted from WHONET and analyzed.

Result

In total, 2489 isolates were isolated from 2073 patient specimens in three consecutive years from different locations. According to this analysis, most of the isolates were from the neonatal intensive care unit 471 (18.9%) and pediatrics ward 397 (16%). Above half of isolates (63.2%) were from blood specimen. The predominant isolates were gram positive aerobic bacteria (1117, 44.9%). Secondly, predominant isolates were aerobic gram negative bacteria (1008, 40.5%). Among the ESKPAE pathogen frequencies, Klebsiella pneumonia, Staphylococcus aurous, Enterococcus species, Pseudomonas aeruginosa, and Acinetobacter baumannii (391, 15.7%), (356, 14.3%), (300, 8.5%), (140, 5.6%), and (89, 3.6%) are the predominant ones, respectively. Beside antimicrobial activities about 100 Entrobactercae family member bacteria resisted for carbapenem drug groups and 320 isolates of this family were expected to be extended beta lactamase producer. Farther more about 120 Methicillin-resistant Staphylococcus aureus isolates were also identified.

Conclusion

Among the isolates ESKAPE pathogens accounts the maximum proportion. The higher isolates were from neonatal intensive care unit. Significant amount of multi drug resistance, extreme drug resistance and pan drug resistance isolates found in the current study. The Felege Hiwot Comprehensive Specialized Hospital has to identify the source of infection for their further preventive measures.

Bacterial isolates

Antimicrobial resistance

ESKAPE pathogens

Background: Among human health problems infectious diseases are the major ones. According to a 2001 report, across the world, mortality due to infectious disease accounts for 56.2 million (26.1%) (1). Among all infectious diseases, bacterial infection accounts for a significant share (2). Based on the source of infection, the infection could be either community-acquired or health institution-acquired. Classically, health institution acquired infections are termed nosocomial infections. Although health institutions are sites for infectious disease identification and treatment, they could be also sources for infectious agents (3).

The public's health is significantly impacted by bacterial illnesses. Particularly in underdeveloped nations, infectious illnesses, primarily bacterial infections, are the main causes of child death (2). Additionally, bacterial bloodstream infections (BSIs) are a significant source of morbidity and mortality in clinical settings all over the world (4).

Any part of the body can develop disease, and it can be brought on by the organism itself or by the body's reaction to its existence. Humans can contract bacteria via the air, water, food, or living things (5). The main means of bacterial infection transmission are contact, aerosol, droplet, vectors, and moving and/ medical vehicles. Morbidity and mortality are significantly impacted by preventive strategies. These actions include safer sex practices, immunization of humans and animals, water purification, and personal hygiene initiatives. Since bacterial resistance to antibiotics is a developing issue, their judicious usage is required (5-7).

Due primarily to the growth of multidrug-resistant infections, antimicrobial resistance (AMR) has significantly reduced the arsenal of medical professionals fighting infectious diseases worldwide (5, 7).

Bacteria that are resistant to many commonly used antibiotics have emerged as a result of the overuse and misuse of antibiotics, as well as failures in infection prevention and control (IPC), a lack of policies, and inadequate education. The development of biofilms, a decline in antibiotic permeability, and the employment of active efflux pumps are some of the main processes of AMR (8, 9).

Between 2000 and 2015, there was a 65% increase in global antibiotic usage, which contrasts with the drop in infectious disease-related fatalities. Antibiotic-resistant bacterial strains have developed as a result of widespread antibiotic use, hindering infection control efforts and reducing the potency of currently available antibiotics. Researchers estimate that bacterial AMR will cause millions of deaths, underscoring the need of taking action. Setting up AMR surveillance systems is essential for gathering information on antimicrobial resistance in order to address this problem. These findings can be utilized to create empirical therapy and create regional and federal antibiotic treatment recommendations. The World Health Organization (WHO) has developed the 'One Health' concept, emphasizing the surveillance of AMR in humans, animals, and the environment through cooperative efforts amongst many scientific fields (8, 10).

It is normally advised that hospital settings summarize the results of the cumulative antimicrobial susceptibility test statistics for Gram-positive and Gram-negative bacteria, which is commonly referred to as an "antibiogram". There have been more than or equal to 20 isolates examined. Although the Clinical and Laboratory Standards Institute (CLSI) M39 document and other sources officially recommend at least 30 isolates, a maximum of 20 is still helpful, particularly for species of clinical value and in low-resource settings with lesser data volumes (11).

Policymakers must be very aware of problems in laboratory test quality and different types of bias due to patient presentation, sampling practices, and laboratory test practices. If the routine microbiology laboratory data is not sufficient, typically underestimates the incidence of microbial disease but overestimates the proportion of resistance (11).

The current study was amid to assess retrospectively the bacterial isolates and their antimicrobial activities at Felege Hiwot Comprehensive Specialized Hospital (FHCSH).

General Objective

The general objective for this analysis was, assessing bacterial isolates and resistance profile from different biological culture positive samples at FHCSH.

Specific objectives

Assessing the distribution of isolates from culture positive specimens

Profiling the comprehensive antimicrobial resistance

This retrospective study (2020–2022) assessed the bacterial isolate and antimicrobial resistance from the patient’s biological samples at FHCSH in Bahir Dar, Ethiopia. This hospital is among the largest specialized hospitals in Ethiopia, serving a population of over 7 million people. FHCSH has 12 wards with 500 beds and around 1420 healthcare staff. Blood, Urine, Genital, Respiratory, Soft tissue and body fluids, Stool, Urine, and CSF were biological specimens used for microbiological culture. The microbiological diagnosis was performed by classical culture methods. The antimicrobial susceptibility analysis used the Kirby–Bauer disk-diffusion method according to the CLSI standards. The data was extracted and analyzed from WHONET software at which FHCSH microbiology laboratory manages its isolates.

Data volume

Among the laboratory data managing tools WHONET is frequently used tool in microbiology laboratory. Some laboratories enter all bacteriological results into WHONET, whereas others only enter the results for positive samples. In this analysis, we only took the positive results. In total, 2489 isolates were isolated from 2073 patient specimens in three consecutive years. The (table 1) presents the number of bacterial isolate records over time at FHCSH micro lab.

The table includes the average number of isolate records per patient. This metric quantifies how often patients have multiple samples taken over time. In low-resource settings, this number is typically between 1.1 and 1.5 isolates per patient.

Patient and sample details

Patient demographics

In this analysis, the proportion of males and female were 53.4% and 46.6% respectively. The distribution of patients by sex and age group is displayed in the below (figures 1). For a variety of reasons, the number of isolates from female patients often surpasses that from male patients in many countries. Firstly, a significant fraction of laboratory samples are typically from urinary tract infections in women; secondly, women may seek medical attention more frequently than men; and thirdly, women typically live longer than men in many of these nations. The Median age groups for males and females were (1-4) and (5-14).

Location details

The location generally refers to the specific location where samples are collected. According to this analysis, most of the isolates are from the neonatal intensive care unit (NICU, 471) and pediatrics ward (PD, 397). Around 918 isolated locations were not fielded in the software (table 2).

Sample details

Specimen types are grouped into eight broad categories: Blood, Urine, Genital, Respiratory, Soft tissue and body fluids, Stool, Urine, and CSF. Above half of isolates (63.2%) were from blood specimen (figure 2).

Organism statistics

The FHCSH manages bacterial isolates by WHONET. The predominant isolates were gram positive aerobic bacteria (1117, 44.9%). Secondly, predominant isolates were aerobic gram negative bacteria (1008, 40.5%) (Table 3).

According to the frequent results and the average number of isolates per patient, except Coagulase negative Staphylococcus (CoNS) (598, 23.7%) which was predominant one, the most were ESKPAE pathogens. Among the ESKPAE pathogen frequencies, Klebsiella pneumonia, Staphylococcus aurous, Enterococcus species, Pseudomonas aeruginosa, and Acinetobacter baumannii (391, 15.7%), (356, 14.3%), (300, 8.5%), (140, 5.6%), and (89, 3.6%) are the predominant ones, respectively (Table 4).

Among the isolates, Listeria monocytogenes, Neisseria gonorrhoeae, Neisseria meningitides, Salmonella sp., and Pseudomonas aeruginosa are pathogens that alert the hospital according to their medical consequences. Such pathogens are typically of public health importance because of their potential for outbreaks and resistance profiles. They are often recommended by world health organization (WHO) to be included in nations’ disease control programs (Table 5).

Organism frequencies by specimen categories

CoNs (38%) were predominant isolates from the blood specimen. Escherichia coli from urine, yeasts in genital samples, Gram-positive cocci from respiratory specimens, Staphylococcus aureus from soft tissue and body fluids, and Salmonella sp. from stool specimens in FHCSH microbiology laboratory (Table 6).

Most of the isolates were from blood samples. More than half of the sample volume at the FHCSH microbiology laboratory was blood specimen (Figure 2). Five of the ESKPAE pathogens: Klebsiella pneumoiae, Staphylococus aureus, Entrococus species, Acinetobacter baumannii, and Pseudomonas aerogensa (20.60%, 13.60%, 15.70%, 4.20%, and 2.50%) were frequently isolated pathogens from blood specimen in the FHCSH, respectively (Figure 3).

Urine specimen volume is also the third most frequently requested specimen in the FHCSH microbiology laboratory. The most frequently isolated ESKPAE pathogens: Escherichia coli, Pseudomonas aerogensa, Klebsiella pneumoiae, Staphylococcus aureus, and Enterococcus species were isolated in a urine sample (Figure 4).

The second frequently requested specimen in FHCSH microbiology laboratory is soft tissue infection specimen. Staphylococcus aureus was predominant isolate from such sample (Figure 5).

Organism trends

It is valuable to study changes in organism isolation over time. Organism frequencies depend on several factors. The frequency of organisms seen in a microbiology laboratory may change over time for different reasons. Three-year total isolate frequency from 2020 to 2022 was 829, 930, and 705, respectively.

A simple way to look for long-term changes is with simple linear regression of organism counts over time, as shown in the table7.

Antimicrobial statistics

Isolate alerts - Important resistance

The high- and medium-priority "important resistance" alerts are important according to WHO recommendations. Based on these recommendations there were defined a "Global Priority List of Antimicrobial Resistant Bacteria". These are summarized in a separate section (Table 8).

Multidrug resistance ESKPAE Pathogens: (MDR/XDR/PDR)

MDR/XDR/PDR results are summarized in the table 9. Subsequently, the resistance profile for multiple drugs in all ESKPAE was high. 189 (53%), 153 (43%) and 7 (2%) of the Staphylococcus aureus were isolate with MDR, XDR and PDR, respectively.

Multidrug resistance: Resistance profiles

Reporting to the World Health Organization and the United Nations

According to the Sustainable Development Goals performance evaluation, there were isolates prioritized for measures to be taken to reduce the effects of antimicrobial resistance. Prioritizations are important for the research and development of new antibiotics based on their resistance profiles. In the current study, identified pathogens that met WHO requirement are numerated in Table 10.

The most frequent ESKAPE pathogens and their resistance profiles

In the FHCSH’s essential drug lists that are frequently prescribed antibiotics, cephalosporin drug families and fluoroquinolones are predominant. About 44.1% of Staphylococcus aureus strains were resistant to second-generation cephalosporins (J01DC), and 21.9% of Klebsiella pneumonia strains were resistant to ceftazidime (CAZ). Moreover, 37.3% of Escherichia coli strains were also resistant to fluoroquinolones (J01MA) (table 11).

The current study focused on the culture-positive clinical specimens in the FHCSH microbiology laboratory. According to the analysis, the sample volume was relatively good. In three consecutive years, about 2073 culture-positive patients visited the hospital. About 2489 isolates were identified. The reason why the isolates exceeded the number of patients is that repeated blood specimen collection from a single patient is mandatory to increase the probability of isolate detection and to ensure that the isolate is not contaminant (12, 13).

In this analysis, the proportion of males and females was 53.4% and 46.6%, respectively. In the current study, the number of male patients exceeded the number of female patients, which is unusual. In many countries, the number of isolates from female patients exceeds the number of isolates from male patients for a number of reasons: the first is that a large proportion of laboratory samples are often from urinary tract infections in women; secondly, women may seek medical assistance more frequently than men; and thirdly, in many countries, women have a longer lifespan than men (14–16).

Most of the culture-positive microbiological specimens were from impatient wards. The higher number of isolates was from the NICU ward. Secondly, a large number of isolates were found in the pediatric ward with the respective frequencies (18.9% and 16%). This finding is higher in the NICU, ward when compared with other studies (17). This could be in the neonatology ward of FHCSH; most of the cases that were admitted to the intensive care unit were due to infections during birth (17). As the median age of the population indicated [males and females were (1–4) and (5–14)], most of the specimens look like from neonates and children. In addition to this the infection prevention activity in these wards, compared with other wards, looks poor (18).

Eight major categories were used in FHCSH to classify specimen types that were delivered to the microbiology lab for microbial isolation: blood, urine, genital, respiratory, soft tissue and body fluids, stool, urine, and CSF. Sixty-three percent of the isolates (63.2%) came from blood samples. This finding is contradictory to a study conducted in Ethiopia (EPHI), whose predominant isolates were from urine specimens (19). In the current study, the predominant isolates from blood specimens were CoNs, which are indicative of blood specimen collection being exposed to skin contaminants (20). Although CoNs are used as indicator microbes for blood specimen contamination, they are medically important as they are cause of infective endocarditis and other organ infections unless the source is clearly identified (21).

Klebsiella pneumoiae is one of the five ESKPAE pathogens and leading isolate from the blood specimens in FHCSH. From blood specimens in the FHCSH, pathogens such as Staphylococcus aureus, Entrococus species, Acinetobacter baumannii, and Pseudomonas aerogensa were frequently isolated (20.60%, 13.60%, 15.70%, 4.20%, and 2.50%), respectively.

A class of bacteria that are the primary cause of hospital-acquired infections worldwide, including Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and (Enterobacter species, Enterobacterales, or Escherichia coli) are called ESKAPE pathogens (22–24). There are variants of ESKAPE where the last letter "E" stands for Enterobacteriaceae, or Enterobacterales, other than Klebsiella pneumoniae or Escherichia coli. These bacteria are significant from a clinical standpoint because they are widespread, frequently resistant to drugs, and challenging to cure (24, 25).

According to the above definitions from the current study, Klebsiella pneumonia, Staphylococcus aurous, Enterococcus species, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter baumannii are the most common pathogens among the ESKPAE pathogen frequencies, with respective frequencies of 391 (15.7%), 356 (14.3%), 300 (8.5%), 282 (11.3%) 140 (5.6%), and 89 (3.6%). Among the total culture-positive samples in FHCSH, ESKAPE isolates account for more than 67%. Although the finding is lower compared with the retrospective analysis conducted in an infectious diseases hospital from the southeast of Romania, whose ESKAPE pathogen isolation proportion is around 97% (26). But the isolation rate of this study is higher for ESKAPE pathogens compared to the systematic review of ESKAPE pathogen prevalence in Ethiopia done by Gebremeskel TK et al., 2020 (27). The FHCSH has to strictly identify the source of infection for better patient management with minimal nosocomial infections.

In the current study, the public health concerns of prioritized pathogens due to their potential to cause epidemics were also isolated. Listeria monocytogenes (expected to cause a food-borne epidemic), Neisseria gonorrhoeae (expected to be a superbug), Neisseria meningitides (expected to cause an epidemic), Salmonella species (expected to cause a food- and water-borne epidemic), and Pseudomonas aeruginosa (expected to be a superbug and to cause a nosocomial infection epidemic) were the isolates (28–31). Although their frequency was low, FHCSH’s public health emergency response team has to attentively follow these pathogens (32).

It was normally advised that hospital settings have to summarize the results of the cumulative antimicrobial susceptibility test statistics for Gram-positive and Gram-negative bacteria, which is commonly referred to as an "antibiogram". Because, among the major challenges in hospital settings, antimicrobial resistance is worsening, it is important to establish the local empirical therapy protocol for health institutions that have no settings for antimicrobial sensitivity testing (33). In the current study, isolates were significantly resistant to common antibiotics. As this study revealed Carbapenems non-susceptible Enterobacteriaceae account for about 4% of the total isolate. Additionally, Enterobacteriacea that are expected to be ESBL make up about 13% of the total isolate. According to the WHO’s prioritization for research and new drug development, there were a significant number of pathogens in the current study (32, 34). Thus, 20% of Pseudomonas aeruginosa, 25% of Escherichia coli, and 15% of Acinetobacter baumannii fall under the critical category of isolates.

Furthermore, the resistance profiles of ESKAPE pathogens were also very high in the current study. In a 2012 publication, the European Centre for Disease Prevention and Control (ECDC) proposed definitions for common bacterial pathogens resistant to multiple antimicrobials as MDR, XDR and PDR (35). Subsequently, from the total isolates of Staphylococcus aureus which is the second leading ESKAPE pathogen in the current: the MDR, XDR and PDR were 53%, 43% and 2% respectively. The MRSA accounts 30%. 26%of Klebsiella pneumonia isolates were identified as PDR.

The highest sample volume was from the NICU and pediatric ward. Concordantly, a large number of isolates were from underage inpatient wards. Blood culture was a frequently requested sample in FHCSH. The higher number of isolates was from blood specimens. It looks like bloodstream nosocomial infection was high at FHCSH. Among the isolates, the ESKPAE pathogen accounts for the highest proportion. The FHCSH microbiology laboratory has to identify the source of infection, and the WHONET tool also has to a platform where the source of infection is correctly fielded. As there are carbpeneme-resistant isolates, genomic cloning has to be performed by concerned public health-accountable institutes to prove the emerging resistance strains are happening.

Acknowledgment

Our heartfelt thanks go to the Felege Hiwot Comprehensive Specialized Hospital and the Medical Laboratory Staffs at the Microbiology Unit.

Author contribution

M.E: conceived the protocol, designed and coordinated microbiological experiments, carried out data collection, analysis, interpretation, and conclusion, and constructed the first manuscript draft.

A.A, B.L, A.AL, A.B, B.G, T.K, A.F, Y.S, S.D, T.E, B.M, B.S, Z.A, M.G, A.E, B.A and D.A: participated in critical revision of data analysis, data interpretation, and manuscript preparation

Funding

There was no specific fund for this work

Data availability

All data made or analyzed all through this study were encompassed in this manuscript

Ethical consideration

An ethical clearance letter was obtained from the research and ethical review committee of the college of health sciences, Debre Tabor University with reference number: CHS/RCC/232/16. In addition, a permission letter was obtained from Felege FHCSH to conduct this study.

Consent

Not applicable

Conflict of interest

The authors have no conflicts of interest for this work.

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Table 1

The number of isolates and patients by laboratory over time (2020–2022)
Laboratory	Number of isolates	Number of patients	Isolates per patient	Unknown	2020	2021	2022
Felege Hiwot comprehensive Specialized Hospital Micro lab	2,489	2,073	1.2	25	829	930	705

Table 2

The distribution of isolates and patients by location (the location codes are those used by the laboratory to identify the specimen collection site).
Location	Number of isolates	(%)	Number of patients	Isolates per patient
(Blank) Missing	918	36.9	776	1.2
NICU	471	18.9	421	1.1
PD	397	16	353	1.1
MMW	133	5.4	107	1.2
OPD	95	3.8	91	1
FMW	76	3.1	70	1.1
AICU	56	2.2	42	1.3
Ortho	171	6.9	105	1.1
Emergency	173	7.00	108	1.2
Note NICU: neonatal intensive care, PD: pediatric ward, OPD: outpatient department, MMW: men medical ward, FMW: female medical ward, AICU: adult intensive care unit,

Table 3

Distribution of results by organism type
Organism type	Number of isolates	(%)	Number of patients	Isolates per patient
(Blank) Missing	354	14.2	325	1.1
Aerobic Gram-positive bacteria	1117	44.9	964	1.1
Aerobic Gram-negative bacteria	1008	40.5	872	1.2
Anaerobes	3	0.1	3	1
Other bacteria	1		1	1
Fungi	16	0.6	16	1

Table 4

The distribution of the most common organism results
Organism	Number of isolates	(%)
Staphylococcus, coagulase negative	598	23.7
Klebsiella pneumonia	391	15.7
Staphylococcus aureus	356	14.3
Escherichia coli	282	11.3
Enterococcus sp.	300	8.5
Acinetobacter baumannii	89	3.6
Pseudomonas aeruginosa	140	5.6
Proteus mirabilis	100	4.0
Others	233	9.3

Table 5

Public health alerts - important species
.Organisms	Number of isolates	Priority
Listeria monocytogenes	2	High priority
Neisseria gonorrhoeae	3	High priority
Neisseria meningitides	1	High priority
Salmonella species.	1	Medium priority
Pseudomonas aeruginosa	44	Medium priority

Table 6

The most common pathogens specimen category
Specimen category	Most common organism	(%)
Blood	Staphylococcus, coagulase negative	(38%)
Genital	Yeast	(54%)
Respiratory	Gram positive cocci	(33%)
Soft tissue and body fluids	Staphylococcus aureus ss. aureus	(33%)
Stool	Salmonella specimen	(25%)
Urine	Escherichia coli	(38%)

Table 7

Organisms with statistically significant increases in organism frequency over time using simple linear regression by patient p < 0.05 - The slope indicates that estimated change in the number of patients by quarter.
Organism	Q1-20	Q2-20	Q3-20	Q4-20	Q1-21	Q2-21	Q3-21	Q4-21	Q1-22	Q2-22	Q3-22	Q4-22	Slope
Acinetobacter baumannii	2	1	4	3	2	4	3	8	8	26	18	10	0.8
Escherichia coli	3	3	18	15	15	15	42	30	36	36	45	21	1.1
Enterococcus sp.	5		5	10		10	12	33	33	27	21	36	1.1
Klebsiella. Pneumonia	12	15	38	27	20	43	39	36	46	46	46	69	2.1
Staphylococcus, coagulase negative	12	13	12	18	20	26	32	29	36	46	51	43	4.2

Table 8

Global Priority Lists of Antimicrobial Resistant Bacteria
Organisms	Alert	Number of isolates	Priority
Enterobacteriaceae	Carbapenems = Non-susceptible	100	High priority
Neisseria meningitides	Cephalosporin III = Non-susceptible	1	High priority
Staphylococcus aureus	Linezolid = Non-susceptible	1	High priority
Enterobacteriaceae	Possible ESBL-producing Enterobacteriaceae	320	Medium priority
Staphylococcus aureus	Methicillin-resistant Staphylococcus aureus	120	Medium priority

Table 9

MDR, XDR, and PDR summary at FHCSH 2020–2022
Organism	Number of isolates	MDR	Possible XDR	Possible PDR
Staphylococcus aureus	356	189 (53%)	153 (43%)	7 (2%)
Acinetobacter baumannii	89	16 (18%)	9 (10%)	7 (8%)
Escherichia coli	282	107 (38%)	76 (27%)	62 (22%)
Klebsiella pneumonia	391	156 (40%)	129 (33%)	101 (26%)
Pseudomonas aeruginosa	140	66 (47%)	38 (27%)	6 (4%)

Table 10

WHO Global priority list of antibiotic-resistant bacteria
Priority	Organism	Antibiotic results	Number (%)
Critical	Acinetobacter spp.	Carbapenem-resistant	13/89 (15%)
	Pseudomonas aeruginosa	Carbapenem-resistant	30/140 (20%)
	Escherichia coli	Cefotaxime-resistant	-
	Escherichia coli	Ceftriaxone-resistant	71/282 (25%)
	Escherichia coli	Meropenem-resistant	42/282 (15%)
High	Enterococcus faecium	Vancomycin-resistant	-
	Staphylococcus aureus	Methicillin-resistant (MRSA)	120/356 (30%)
	Staphylococcus aureus	Vancomycin-resistant	-
	Staphylococcus aureus	Vancomycin-intermediate	-
	Helicobacter pylori	Clarithromycin-resistant	-
	Campylobacter spp.	Fluoroquinolone-resistant	-
	Salmonella spp.	Fluoroquinolone-resistant (Ciprofloxacin)	-
	Neisseria gonorrhoeae	Third generation cephalosporin-resistant	3/20 (6.7%)
	Neisseria gonorrhoeae	Fluoroquinolone-resistant	1/20 (5%)
Medium	Streptococcus pneumonia	Penicillin non-susceptible	-
	Haemophilus influenza	Ampicillin-resistant	-
	Shigella spp.	Fluoroquinolone-resistant	1/10 (10%)

Table 11

The number of isolates and antimicrobial resistant statistics for some FHCSH’s essential drug lists
Pathogen	Antibiotic	Number tested	%Resistant	%Intermediate	%Susceptible
Klebsiella pneumoniae	CAZ	323	21.9	7.4	70.7
Klebsiella pneumoniae	CIP	323	12.3	18.5	69.2
Klebsiella pneumoniae	IPM	323	12.8	2.6	84.6
Klebsiella pneumoniae	AUG	323	41.2	2.4	56.3
Klebsiella pneumoniae	GEM	323	9.8	1.8	88.4
Klebsiella pneumoniae	SX	323	32.3	18.5	49.2
Klebsiella pneumoniae	MEM	323	12.2		94.8
Staphylococcus aureus	FOX	356	37.2		63.8
Staphylococcus aureus	J01DC	356	44.1	1.5	29.4
Escherichia coli	CIP	282	17.2	3.4	79.3
Escherichia coli	J01DH	282	14.8		85.2
Escherichia coli	J01MA	282	37.3		17.2
Escherichia coli	MEM	282	15		85
Note: CAZ- Ceftazidime, CIP- Ciprofloxacin, IPM- Imipenem, AUG- Augmentin (amoxicillin and clavulanic acid), GEM-Gentamycin, SX- Trimethoprim and Sulfamethoxazole, MEM- Meropenem, FOX- Cefoxitin, J01DC- Second generation Cephalosporins, J01DH- Carbapenems, J01MA- Fluoroquinolones

No competing interests reported.

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Three years Retrospective Analysis of Distribution and Antimicrobial Resistance Profiles of Isolates from Culture-positive Clinical Specimens at Felege Hiwot Comprehensive Specialized Hospital in northwestern Ethiopia

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Abstract

Background

Methodology:

Result

Conclusion

Figures

Introduction

Methodology

Result

Data volume

Patient and sample details

Patient demographics

Location details

Sample details

Organism statistics

Organism frequencies by specimen categories

Organism trends

Antimicrobial statistics

Isolate alerts - Important resistance

Multidrug resistance ESKPAE Pathogens: (MDR/XDR/PDR)

Multidrug resistance: Resistance profiles

Reporting to the World Health Organization and the United Nations

Discussion

Conclusion

Declarations

References

Tables

Additional Declarations

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