Gondar University Teaching Research Articles

Treatment outcome of tuberculosis patients at Gondar University Teaching Hospital, Northwest Ethiopia. A five - year retrospective study

BackgroundIn Gondar University Teaching Hospital standardized tuberculosis prevention and control programme, incorporating Directly Observed Treatment, Short Course (DOTS) started in 2000. According to the proposal of World Health Organization (WHO), treatment outcome is an important indicator of tuberculosis control programs. This study investigated the outcome of tuberculosis treatment at Gondar University Teaching Hospital in Northwest Ethiopia.MethodsWe analyzed the records of 4000 tuberculosis patients registered at Gondar University Teaching Hospital from September 2003 to May 2008. Treatment outcome and tuberculosis type were categorized according to the national tuberculosis control program guideline. Multivariate analysis using logistic regression model was used to analyse the association between treatment outcome and potential predictor variables.ResultsFrom the total of 4000 patients, tuberculosis type was categorized as extrapulmonary in 1133 (28.3%), smear negative pulmonary tuberculosis in 2196 (54.9%) and smear positive pulmonary tuberculosis in 671 (16.8%) cases. Of all patients, treatment outcome was classified as successfully treated in 1181(29.5%), defaulted in 730 (18.3%), died in 403 (10.1%), treatment failed in six (0.2%) and transferred out in 1680 (42.0%) patients. Males had the trend to be more likely to experience death or default than females, and the elderly were more likely to die than younger. The proportion of default rate was increased across the years from 97(9.2%) to 228(42.9%). Being female, age group 15-24 years, smear positive pulmonary tuberculosis and being urban resident were associated with higher treatment success rate.ConclusionThe treatment success rate of tuberculosis patients was unsatisfactorily low (29.5%). A high proportion of patients died (10.1%) or defaulted (18.3%), which is a serious public health concern that needs to be addressed urgently.

Serodiversity and Antimicrobial Resistance Pattern of <i>Shigella</i> Isolates at Gondar University Teaching Hospital, Northwest Ethiopia

The aims of this study were to determine the distribution of serogroups and serotypes as well as the antimicrobial resistance pattern of Shigella isolates from Gondar patients with acute diarrhea. A cross-sectional study was conducted from August 2006 to February 2008. Stool specimens were received from study subjects and cultured. Isolates were confirmed by biochemical and serological tests. The isolates were tested for antimicrobial susceptibility by the disc diffusion method. Of the 1,200 stool specimens, 90 (7.5%) yielded Shigella isolates with the serogroups of Shigella flexneri (72.2%), S. dysenteriae (10.0%), S. boydii (8.9%), and S. sonnei (8.9%). S. flexneri was the predominant serogroup. S. dysenteriae type 1 was absent, and S. sonnei was present. Eighty-five (94.5%) of the isolates showed resistance to one or more drugs, and 79% of those were multi-resistant. S. flexneri showed the highest resistance (91.2%). S. flexneri serotype 1, resistant to ciprofloxacin and norfloxacin, was observed. All isolates were sensitive to nalidixic acid and ceftriaxone. Only 5 (5.6%) of the isolates were sensitive to all antibiotics tested. Based on these findings, we recommend ciprofloxacin as the drug of choice for treatment of shigellosis in Gondar, with frequent monitoring of drug susceptibility testing.

Antimicrobial Resistance Pattern of Salmonella Isolates from Gondar University Hospital, Northwest Ethiopia

Salmonellosis is a major health problem, especially in developing countries. Moreover, Salmonella species are becoming resistant to the commonly used antimicrobials in most parts of the world. Nevertheless, studies on Salmonella are limited in Ethiopia. The aim of this paper is, therefore to determine the antibiotic resistance pattern of Salmonella species isolated from clinical specimens in the Gondar University Teaching Hospital from September 2001 to August 2005. Data were obtained from the laboratory records on bacterial culture, isolation and antimicrobial sensitivity testing, which were done following the standard and conventional bacteriological methods. From a total of 3363 miscellaneous specimens cultured, 59 yielded Salmonella species. The isolates were from stool (N = 28, 47.5%), blood (N = 25, 42.3%), pus (N = 4, 6.8 %) and urine (N = 2, 3.4 %). Resistance to one or more antibiotics was observed in 94.9% of the isolates, with multiple drug resistance in 84.7%. 91.5%, 78%, 78%, 64.4%, 44.1% and 10.2% of the Salmonella species, were resistant to ampicillin, chloramphenicol, tetracycline, cotrimoxazole, gentamicin and ciprofloxacin, respectively. Resistance to all the six antibiotics was observed in 3.4% of the isolates. The results demonstrated widespread emergence of ampicillin, tetracycline and chloramphenicol resistant Salmonella isolates. Multiple patterns of antibiogram and predominance of certain multi-resistant isolates were observed. Comparison with reports from elsewhere in Ethiopia indicated resistance to the commonly available broad spectrum antibiotics is a nation-wide problem. Rational drug use for the currently available potent antibiotics such as the fluoroquinolones should be enforced. Keywords: salmonellosis, multi-drug resistance, pan-resistance, Salmonella, antibiogramEthiopian Pharmaceutical Journal Vol. 25 (2) 2007: pp. 85-90

Visceral Lieshmaniasis and HIV co-infection in patients admitted to Gondar University Hospital, Northwest Ethiopia

Worldwide after malaria and sleeping sickness leishmaniases are the third most important vector borne diseases. Visceral leishmaniasis (kala-azar) is a disseminated protozoan infection caused by L. donovani L. infantum or L. arachibaldi and transmitted by the female phlebotomine sand fly bite. Coinciding with HIV infection the number of visceral leishmaniasis cases in Ethiopia has increased in the last decade. The objective was to assess the clinical and laboratory manifestations and factors associated with mortality and morbidity of visceral leishmaniasis with or without HIV co-infection. A hospital-based case series study of visceral leishmaniasis assessing clinical manifestations laboratory data treatment outcomes and HIV sero-status was conducted in Gondar University Teaching Hospital over a period of five years and seven months (from January 1999 to July 2004). A total of 221 kala-azar patients participated in the study. Out of 212 visceral leishmaniasis cases tested for HIV 87(41.0%) were HIV co-infected. Age > 20 years was independently associated with HIV co-infection. Out of 213 kala-azar patients treated with sodium stibogluconate (SSG) 52 died resulting in a case fatality rate of 24.4%. The case fatality rates among HIV positive and HIV negative kala-azar cases were 39.3% and 13.0% respectively. Using logistic regression HIV infection body mass index (BMI) of 15 and below bleeding tendency and age > 20 years were identified as independent variables predicting death. HIV co-infection and the case fatality rates are very high among patients with Visceral leishmaniasis. We recommend further study and improved care for HIV co-infected visceral leishmaniasis cases. (authors)

Bacterial isolates from cerebrospinal fluids and their antibiotic susceptibility patterns in Gondar University Teaching Hospital, Northwest Ethiopia

Abstract Background: Bacterial meningitis remains a common disease worldwide. Its most frequent causes are Nessieria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae. Information on the relative frequency of the isolation and antibiotic susceptibility patterns of these pathogens is scarce in Ethiopia. Objectives: To identify bacterial pathogens that cause meningitis and to assess the antibiotic susceptibility patterns of the isolates from the cerebrospinal fluids (CSF) of acute bacterial meningitis cases/specimens. Methods: A retrospective analysis of 390 cerebrospinal fluid specimens submitted for culture and antibiotic susceptibility patterns to the bacteriology laboratory of Gondar University Teaching Hospital was conducted between September 2002 and August 2003. Results: Bacterial pathogens were isolated from 22 patients showing an isolation rate of 5.6%. The most commonly isolated bacteria were Neisseria meningitidis 10(45.5%) and Streptococcus pneumoniae 7(31.8%). Among gram positive organisms S. pneumoniae showed a high level of drug resistance against chloramphenicol 4(57%), tetracycline 3 (43%), co-trimoxazole 3(43%), ampicillin 3(43%), and gentamicin 1(14%). Among gram negative bacteria, N. meningitidis was found to be resistant to co-trimoxazole 5(50%), chloramphenicol 3(30%), gentamicin 3(30%) and ampicillin 2(20%). The single isolate from Proteus species was found to be resistant to co-trimoxazole and tetracycline. E. coli was found to be resistant to all antibiotics except for gentamicin and ciprofloxacin. Multiple drug resistance was observed in 50% of the isolates. No organism was found to be resistant to ciprofloxacin. Conclusions: The isolation rate of bacterial pathogens from cerebrospinal fluids was found to be low. However, the frequency of single as well as multiple drug resistance was very high among the bacterial isolates. Ciprofloxacin may be used for the empirical treatment of bacterial meningitis when culture and sensitivity report is not available for adult patients. [Ethiop.J.Health Dev. 2005; 19(2):160-164]