Multi-Drug Resistance Profile, Prevalence of Extended-Spectrum Beta-Lactamase and Carbapenemase-Producing Gram Negative Bacilli Among Admitted Patients After Surgery with Suspected of Surgical Site Nosocomial Infection North East Ethiopia

Figures & data

Table 1 Socio-Demographic Characteristics of the Study Participants Debre Birhan Comprehensive Specialized Hospital, Ethiopia, from April 2021 to February 2022

Variables		Frequency	Percent (%)
Age in years
	5–16	22	5.7
	17–30	195	50.8
	31–45	144	37.5
	>45	23	6
Sex	Male	180	46.9
	Female	204	53.1
Residence
	Urban	290	75.5
	Rural	94	24.5
Occupation
	Daily labour	121	31.5
	Government employed	126	32.8
	Student	34	8.8
	Merchant	55	14.3
	House wife	48	12.5
Educational level
	Illiterate	105	27.34
	Only read and write	23	6
	Primary school	85	22
	Secondary school	90	23.4
	College and above	71	18.5
Marital status
	Single	49	12.76
	Married	288	75
	Divorced	18	4.7
	Widowed	29	7.55
Monthly family income (ETB)
	≤500	93	24.2
	501–1000	76	19.8
	1001–1500	59	15.4
	1501–2000	55	14.3
	>2000	101	26.3

Table 2 Distribution of Bacterial with Clinical and Procedural Condition of Study the Study Participants Debre Birhan Comprehensive Specialized Hospital, Ethiopia, from April 2021 to February 2022

Variable	Category	Frequency	Percent	Significant Bacterial Growth
				Yes N (%)	No N (%)
Ward	Surgical	257	66.9%	245(95.3%)	12(4.7%)
	Pediatrics	22	5.7%	14(63.6%)	8(36.4%)
	Gyni/Obs	105	27.4%	84(80%)	21(20%)
Location of wound	Hand	65	16.9%	57(87.7%)	8(22.3%)
	Abdomen	191	49.7%	181(94.8%)	10(5.2%)
	Leg	91	23.7%	80(87.9%)	11(12.1%)
	Head	25	6.5%	17(68%)	8(32%)
	Others	14	3.6%	8(57.1%)	6(42.9%0
Type of surgery	Elective	165	43.0%	150(90.9%)	15(9.9%)
	Emergency	114	29.7%	101(88.6%)	13(11.4%)
	CS	105	23.3%	92(87.6%)	13(12.4%)
Type of wound	Clean	48	12.5%	25(52.1%)	23(47.9%)
	Contaminate	129	33.6%	120(93%)	9(7%)
	Clean contaminate	120	31.3%	115(95.8%)	5(4.2%)
	Dirty	87	22.6%	83(95.4%)	4(4.6%0
Duration of surgery	<120 minutes	256	66.7%	225(87.9%)	31(12.1%)
	>120 minutes	128	33.3%	118(92.2%)	10(7.8%)
Medical stay in hospitals	<2 weeks	208	54.2%	178(85.6%)	30(14.4%)
	>2 weeks	176	45.8%	165(93.8%)	11(6.2%)
HIV status	Positive	45	11.7%	40(88.9%)	5(11.1%)
	Negative	339	88.3%	303(89.4%)	36(10.6%)
Diabetics	Yes	78	20.3%	65(83.3%)	13(16.7%)
	No	306	79.7%	278(90.8%)	28(9.2%)
Discharge develops	Yes	114	29.7%	105(92.1%)	9(7.9%)
	No	270	70.3%	238(88.1%)	32(11.9%)
Antimicrobial prophylaxis	Yes	345	89.8%	325(94.2%)	20(5.8%)
	No	39	10.2%	18(46.2%)	21(54.8%)
Cigarette smoking	Yes	75	19.5%	60(80%)	15(20%)
	No	309	80.5%	283(91.2%)	23(8.8%)
Chat chewing habit	Yes	96	25%	78(81.3%)	18(18.7%)
	No	288	75%	265(92%)	23(8%)
Alcohol drinking habit	Yes	86	22.4%	68(79.1%)	18(20.9%)
	No	298	77.6%	275(92.3%)	23(7.7%)

Figure 1 Frequency of bacteria isolated from surgical site infection in Dessie Comprehensive Specialized and Borumeda General Hospital, from April 2021- February 2022.

Table 3 Antimicrobial Susceptibility Pattern of Gram-Positive Bacterial (n = 140) Isolates Among Surgery Patients with Suspected of Surgical Site Nosocomial Infection at Dessie and Borumeda Comprehensive Specialized Hospital, from April 2021 to February 2022

Bacterial Isolates		Number of Resistance Pathogens to Antimicrobial Agents No (%)
		E N (%)	P N (%)	C N (%)	CXT N (%)	CL N (%)	CIP N (%)	SXT N (%)	FOX N (%)	TE N (%)
S. aureus (125)	S	55(66)	50(40)	30(24)	65(52)	50(40)	80(64)	40(32)	23(18.4)	20(16)
	R	70(30)	75(60)	95(76)	60(48)	75(60)	45(36)	85(68)	102(81.6)	105(84)
CONS (15)	S	4(26.7)	3(20)	5(33.3)	NT	10(66.7)	NT	4(26.7)	NT)	2(12.3)
	R	11(73.3)	12(80)	10(66.7)	NT	5(33.3)	NT	11(73.3)	NT	13(86.7)
Total (140)	S	59(42.14)	53(37.85)	35(25.0)	65(52)	60(42.85)	80(64)	44(34.13)	23(18.4)	22(15.71)
	R	81(57.86)	87(62.15)	105(75)	60(48)	80(57.15)	45(36)	96(65.87)	102(81.6)	118(84.29)

Abbreviations: CL, Clindamycin; E, Erythromycin; C, Chloramphenicol; CIP, Ciprofloxacin; TE, Tetracycline; SXT, Trimethoprim-Sulfamethoxazole; CTX, cefotaxime; FOX, Cefoxitin; P, penicillin; R, Resistant; OX, oxacillin; FOX, Cefoxitin S, Sensitive; NT, Not tested.

Table 4 Antimicrobial Susceptibility Pattern of Gram-Negative Bacterial (n = 203) Isolates Among Surgery Patients with Suspected of Surgical Site Nosocomial Infection at Dessie and Borumeda Comprehensive Specialized Hospital, from April 2021 to February 2022

Gram negative Bacterial Isolates	Antimicrobials Tested
		C N (%)	TE N (%)	CIP N (%)	CXT N (%)	SXT N (%)	GN N (%)	AMP N (%)	AMC N (%)	FOX N (%)	CAZ N (%)	AMK N (%)	MEM N (%)	IMP N (%)
E. coli (80)	S	32(60)	4(5)	41(51.5)	28(35)	15(18.7)	50(62.5)	1(12.5)	11(13.7)	41(51.5)	38(47.5)	44(55)	46(57.5)	NT
	R	48(60)	76(95)	39(48.5)	52(65)	65(81.3)	30(37.5)	67(87.5)	69(86.3)	39(48.5)	42(52.5)	36(45)	38(42.5)	NT
P. aeruginosa (31)	S	NT	NT	20(64.5)	17(54.8)	NT	19(61.3)	NT	NT	16(51.6)	15(48.4)	13(41.9)	18(58.1)	15(48.4)
	R	NT	NT	11(35.5)	14(45.2)	NT	12(38.7)	NT	NT	15(48.4)	16(51.6)	18(58.1)	13(41.9)	16(51.6)
K. pneumoniae (30)	S	12(40)	3(10)	17(56.7)	14(46.3)	7(23.3)	18(60)	5(16.7)	6(20)	11(43.3)	14(46.7)	16(53.3)	17(56.7)	NT
	R	18(60)	27(90)	13(43.3)	16(53.3)	23(76.7)	12(40)	25(83.3)	24(80)	17(56.7)	16(53.3)	14(46.7)	13(43.3)	NT
Citrobacter species (25)	S	6(23.4)	2(8)	14(56)	11(44)	8(32)	5(55.6)	2(8)	NT	12(48)	12(48)	13(52)	13(52)	NT
	R	19(76.6)	23(92)	11(44)	14(56)	17(68)	4(44.4)	23(92)	NT	13(52)	13(52)	12(48)	12(48)	NT
P. mirabilis (25)	S	7(28)	NT	15(60)	14(55.6)	6(24)	15(60)	5(20)	8(32)	9(36)	NT	13(52)	12(48)	NT
	R	18(72)	NT	10(40)	11(44.4)	19(76)	10(40)	20(80)	17(68)	16(64)	NT	12(48)	13(52)	NT
P. vulgaris (9)	S	4(44.4)	NT	6(66.7)	5(55.6)	2(22.2)	4(44.4)	1(11.1)	1(11.1)	4(44.4)	4(44.4)	5(55.6)	5(55.6)	NT
	R	5(55.6)	NT	3(33.3)	4(44.4)	7(77.8)	5(55.6)	8(88.9)	8(88.9)	5(55.6)	5(55.6)	4(44.4)	4(44.4)	NT
Acinetobacter species (3)	S	NT	NT	2(66.7)	NT	NT	1(33.3)	NT	NT	NT	1(33.3)	1(33.3)	1(33.3)	0(0)
	R	NT	NT	1(33.3)	NT	NT	2(66.7)	NT	NT	NT	2(66.7)	2(66.7)	2(66.7)	3(100)
Total (203)	S	61(36.1)	9(6.7)	115(56.7)	91(45.5)	38(22.5)	128(63.1)	26(15.4)	21(18.1)	95(47.5)	(40.2)	105(51.7)	109(53.7)	15(44.1)
	R	108(63.9)	126(93.3)	88(43.3)	111(54.5)	131(77.5)	75(36.9)	143(84.6)	118(81.9)	105(52.5)	79(59.8)	98(48.3)	94(46.3)	19(55.9)

Abbreviations: NT, Note tested; AMP, Ampicillin; GN, Gentamicin; AMK, Amikacin; CIP, Ciprofloxacin (5μg); SXT, trimethoprim-sulfamethoxazole; MEM, Meropenem; IMP, Imipenem; AMC, Amoxicillin-clavulanic acid; CTX, cefotaxime; CAZ, Ceftazidime; FOX, Cefoxitin; TE, Tetracycline (30 μg); C, Chloramphenicol; R, Resistant; S, Sensitive.

Table 5 Magnitude of Multi-Drug Resistance Profile of Bacterial Isolates (n = 175) Among Surgery Patients with Suspected of Surgical Site Nosocomial Infection at Dessie and Borumeda Comprehensive Specialized Hospital, from April 2021 to February 2022

Organism Isolated	Antimicrobial Resistance Pattern						MDR N (%)
	Ro; N (%)	R1 N (%)	R2 N (%)	R3 N (%)	R4 N (%)	≥R5 N (%)
Gram positive	7(5)	22(15.7)	20(14.3)	27(19.3)	34(24.3)	30(21.4)	91(65)
S. aureus	6(4.8)	19(15.2)	15(12)	24(19.2)	32(25.6)	29(23.2)	85(68)
CONS	1(6.7)	3(20)	5(33.3)	3(20)	2(13.3)	1(6.7)	6(40)
Gram negative	8(3.9)	16(7.9)	22(10.8)	53(26.1)	65(32.0)	42(20.7)	160(78.8)
E. coli	3(3.8)	4(5)	6(7.5)	20(25)	25(31.3)	22(27.5)	67(83.8)
P. aeruginosa	1(3.2)	4(12.9)	5(16.1)	9(29)	8(25.8)	4(13)	21(67.7)
K. pneumoniae	2(6.7)	2(6.7)	2(6.7)	7(23.3)	11(36.7)	6(20)	24(80)
Citrobacter species	1(4)	3(12)	2(8)	6(24)	8(32)	5(20)	19(76)
P. mirabilis	1(4)	2(8)	3(12)	7(28)	8(32)	4(16)	19(76)
P. vulugaris	0(0)	1(50)	2(50)	3(0)	3(0)	0(0)	6(66.7)
Acinetobacter species	0(0)	0(0)	2(100)	1(0)	0(0)	0(0)	1(33.3)
Overall Total	15(4.4)	38(11.1)	42(12.2)	80(23.3)	99(28.9)	72(21)	251(73.2)

Abbreviations: MDR, multi-drug resistant; R0, No antibiotic resistance; R1, resistance to one; R2, resistance to two; R3, resistance to three; R4, resistance to four; R4, resistance to four antibiotics; R5, resistance to five and more than five antibiotics.

Table 6 Prevalence of ESBL, Carbapenem and AmpC Production Among Gram-Negative Isolates Among Surgery Patients with Suspected of Surgical Site Nosocomial Infection at Dessie and Borumeda Comprehensive Specialized Hospital, from April 2021 to February 2022

Isolates(number)	Total (N)	ESBL n (%)		AmpC beta-lactamase n (%)		Carbapenemase n (%)
		Positive	Negative	Positive	Negative	Positive	Negative
E. coli	80	44(54.5%)	36(45.5%)	25(31.3%)	55(68.7%)	9(11.2%)	68(88.8%)
P. aeruginosa	31	15(48.4%)	16(51.6%)	13(38.7%)	18(73.5%)	6(19.4%)	24(80.6%)
K. pneumoniae	30	16(53.3%)	14(46.7%)	10(33.3%)	20(66.7%)	4(13.3%)	27(86.7%)
Citrobacter species	25	14(56%)	11(44%)	7(28%)	18(72%)	3(12%)	22(88%)
P. mirabilis	25	13(52%)	12(48%)	8(32%)	17(68%)	3(12%)	22(88%)
P. vulgaris	9	5(55.6%)	4(44.4%)	3(33.3%)	6(66.7%)	1(11.1%)	5(55.6%)
Acinetobacter species	3	1(33.3) %	2(66.7%)	1(33.3%)	2(66.7%)	1(33.3%)	1(66.7%)
Total	203	108(53.2%)	95(46.8%)	67(33%)	136(67%)	27(13.3%)	176(86.7%)