Distribution of bacterial etiologic agents and antimicrobial susceptibility patterns in sterile body fluids collected at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

Abstract

Sterile body fluid infection requires rapid and accurate diagnosis and treatment, as its morbidity and mortality are high. Continuous laboratory surveillance is necessary to guide clinicians in providing effective, preventive, and evidence-based antimicrobial therapies. To determine the prevalence of bacterial growth, characterize bacterial isolates, and assess antimicrobial susceptibility patterns in sterile body fluids collected at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. A hospital-based cross-sectional study was conducted from April 11 to July 11, 2023, among 205 consecutively enrolled patients. Data were collected through interviews using a pre-tested questionnaire. The sterile body fluids were processed according to standard procedures. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method, as outlined in the CLSI guidelines. Multivariable logistic regression was used to evaluate the associations between outcomes and predictor variables. A P value < 0.05 was considered to indicate statistical significance. Approximately one-fifth (19.5%, n = 40) of the processed samples were culture-positive. Most of the pathogens detected were gram-negative bacteria (GNB), 72.5%, while gram-positive bacteria accounted for 27.5%. Gram-negative isolates were 25 (86.2%) sensitive to amikacin and meropenem, 22 (76%), while gram-positive isolates were sensitive to ciprofloxacin, 8 (72.7%). Among the GNB, 51.7% were extended-spectrum beta-lactamase producers, while 48.3% were carbapenemase producers. Multidrug resistance (MDR) was detected in 67.5% of the isolates. Among these MDR isolates, 23 (79.3%) were GNB, while 4 (36.3%) were gram-positive. Culture positivity was associated with rural (vs. urban) residence (AOR: 3.86, 95% CI: 1.58–9.42, P = 0.003), inpatient (vs. outpatient) status (AOR: 2.65, 95% CI: 1.17–5.99, P = 0.019), presence (vs. absence) of comorbidities (AOR: 5.46, 95% CI: 2.22–13.40, P = 0.001), turbid (vs. clear) appearance (AOR: 3.37, 95% CI: 1.17–9.70, P = 0.024) and use (vs. no use) of indwelling devices (AOR: 0.125, 95% CI: 0.033–0.471, P = 0.002). Significant drug resistance to commonly prescribed beta-lactam antibiotics and high MDR were observed, necessitating the use of prudent antibiotics in hospital and community settings.