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Diarrhea is a serious health problem in children, with the highest mortality rate in sub-Saharan Africa. Diarrheagenic Escherichia coli (DEC) is among the major bacterial causes of diarrhea in children under age five. The present study aims to determine molecular epidemiology and antimicrobial resistance profiles of DEC and identify contributing factors for acquisition among children under age five in Central Ethiopia. A health facility-centered cross-sectional study was conducted in Addis Ababa and Debre Berhan, Ethiopia, from December 2020 to August 2021. A total of 476 specimens, 391 from diarrheic and 85 from non-diarrheic children under age five were collected. Bacterial isolation and identification, antimicrobial susceptibility, and pathotype determination using polymerase chain reaction (PCR) were done. Of the 476 specimens analyzed, 89.9% (428/476) were positive for E. coli, of which 183 were positive for one or more genes coding DEC pathotypes. The overall prevalence of the DEC pathotype was 38.2% (183/476). The predominant DEC pathotype was enteroaggregative E. coli (EAEC) (41.5%, 76/183), followed by enterotoxigenic E. coli (21.3%, 39/183), enteropathogenic E. coli (15.3%, 28/183), enteroinvasive E. coli (12.6%, 23/183), hybrid strains (7.1%, 13/183), Shiga toxin-producing E. coli (1.6%, 3/183), and diffusely-adherent E. coli (0.6%, 1/183). DEC was detected in 40.7% (159/391) of diarrheic and 28.2% (24/85) in non-diarrheic children (p = 0.020). The majority of the DEC pathotypes were resistant to ampicillin (95.1%, 174/183) and tetracycline (91.3%, 167/183). A higher rate of resistance to trimethoprim-sulfamethoxazole (58%, 44/76), ciprofloxacin (22%, 17/76), ceftazidime and cefotaxime (20%, 15/76) was seen among EAEC pathotypes. Multidrug resistance (MDR) was detected in 43.2% (79/183) of the pathotypes, whereas extended spectrum ß-lactamase and carbapenemase producers were 16.4% (30/183) and 2.2% (4/183), respectively. All six common DEC pathotypes that have the potential to cause severe diarrheal outbreaks were found in children in the study area; the dominant one being EAEC with a high rate of MDR.

Persistence of high-risk Human papillomaviruses (HR-HPV) infection increases the risk of precancerous lesions development. The aim of this study was to assess the persistence and clearance rate of HPV infection. A prospective cohort study was conducted between January and December 2023 among patients attending gynecology unit of FHCSH in Bahir Dar, northwest Ethiopia. Out of 297 study participants, 95 women with HPV infected and cytological abnormalities were followed; of these 93.7% were HPV positive at the baseline study. Of which, 46.1% did not receive treatment, the rest 53.9% were treated. Among the women without treatment, HPV persistence and clearance rates were 65.9% and 34.1% respectively while persistence rate of 46.3% and clearance rate of 53.7% were observed in 12-month follow up period. Among women who received treatment, HPV persistence rate of 45.8% and clearance rate of 54.2% were recorded in six while persistence rate of 33.3% and clearance rate of 66.7% were observed in 12- month follow up period. The findings of our study indicated that the high persistence rate and low clearance rate of HPV infection. Detection of persistent HPV infection without treatment or after treatment should be considered as the main risk factor for the development or recurrence of cervical neoplasia.

The World Health Organization [WHO] recommends a genotype-specific human papillomavirus [HPV] vaccination as a primary prevention strategy to control the burden of cervical cancer globally. In Ethiopia, where the non-vaccine-targeted HPV genotypes have not been adequately studied, a vaccination initiative was launched in 2018 targeting HPV-6,-11, -16, and -18 for girls aged 14–18 years. The co-existence of both vaccine-targeted and non-targeted genotypes is a serious concern, as it can accelerate cancer progression. Therefore, this study was conducted to determine the prevalence of non-vaccine-targeted HPV genotypes and assess the level of multiple infections with other genotypes in eastern Ethiopia. A health facility-based cross-sectional study including 110 women with positive HPV DNA results was conducted from April to August 2021. A structured questionnaire to collect demographic and clinical data was used. Cervical swabs were collected using L-shaped FLOQSwabs. Women's cytological profile was determined based on Pap smear test results. An automated nucleic acid extraction system using STARMag 96 ProPrep Universal Extraction Kit was utilized following the manufacturer's protocol. An amplification assay in real-time was employed to amplify and identify the HPV Late 1 [L1] gene, which is utilized for genotyping purposes. Following this, the collected data was entered into Epi data version 3.1 software, and the analysis was performed using STATA version 14. A total of 110 women [age range 30–60 years, mean age = 36.5 years and SD ± 6.9] had positive HPV DNA results and were included in the study. Among these, 108 women had valid co-testing [Pap test and HPV DNA test] results for further analysis, and the results of the remaining 2 women were rejected. Overall, the prevalence of non-vaccine-targeted HPV was 56 (51.8%, 95%CI [0.42, 0.61]), of which 28 women (25.4%, 95%CI [0.18, 0.34]) had a single non-vaccine HPV genotype infection. The remaining 29 women (26.4%, 95% CI: 0.190–0.355) experienced multiple infections. The non-vaccine-targeted genotypes of HPV-35 accounted for 11 cases (10%, 95%CI [0.06, 0.17]), HPV-68 was detected in 9 women (8.2%, 95%CI [0.04, 0.15]), HPV-56 and HPV-66 were both found in 8 cases each (7.3%, 95%CI [0.04, 0.14]) of the total. In addition, out of these 108 women, 93 (86.1%, 95%CI [0.78, 0.91]) had low-grade squamous intraepithelial lesions, 13 (12%, 95%CI [0.07, 0.20]) no intraepithelial lesion or malignancy, and two (1.9%, 95%CI [0.01, 0.07]) high-grade squamous intraepithelial lesions. Furthermore, there was no statistical difference [ p  = 0.755] between vaccine-targeted and non-vaccine-targeted genotypes as the primary cause of cervical lesions. In conclusion, the findings of the present study highlight the existence of a notable prevalence of multiple infections caused by non-vaccine-targeted HPV genotypes. Therefore, it is recommended that both the Federal and regional health bureaus to evaluate the range of hr HPV genotypes protected by the current HPV vaccine and explore the option of transitioning from the quadrivalent HPV vaccine to a novavalent vaccine that includes seven high-risk HPV genotypes.

Cervical cancer is a significant public health concern in Ethiopia. It is mainly caused by persistent infection with the human papillomaviruses. The aim of this study was to assess the relationship between carcinogenic risk of probable, possible and low risk HPV infection and those of cervical intraepithelial neoplasia (CIN) and cervical cancer. A cross sectional study nested from prospective cohort study was conducted in Bahir Dar, northwest Ethiopia. Statistical analyses were performed using SPSSversion 26.0. HPV-16 was associated with a relatively higher risk of CIN II + , (AOR = 15.42; 95% CI 6.81–34.91). In addition, HPV-52, -18, -53 and -58, were significantly associated with an increased risk of CIN II + , (AOR = 7.38 (1.73–31.54), 5.42 (1.61–18.31), 4.08 (1.53–10.87), and 3.17 (1.00–10.03)), respectively. The current study shows high rate of HPV with predominance of HPV-16, -53, -58, -18, -35, and -52. The quadrivalent and nonavalent vaccine had only covered 27.1% and 45% of the circulating HPV genotypes. Ethiopia may need to consider introduction of nonavalent vaccine into the national public health strategy. Polyvalent vaccine which includes the genotypes not covered by existing approved vaccines should be considered.

Background Globally, extended-spectrum beta-lactamase-producing and carbapenem-resistant Enterobacterales are major causes of hospital-acquired infections and there are increasing concerns about their role in community-acquired infections. Objective We aimed to investigate the prevalence of extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) and Carbapenemase-producing-Carbapenemresistant- Enterobacterales (CP-CRE) and associated factors in community settings in Gulele sub city, Addis Ababa, Ethiopia. Methods A cross-sectional study was conducted among 261 healthy individuals. Stool samples were collected and processed using standard microbiological methods. Antimicrobial susceptibility and phenotypic ESBL and carbapenemase tests were performed. Antibiotic resistance genes were detected by Polymerase Chain Reaction (PCR). Results The colonization rate of ESBL-PE and CP-CRE were 31.4% (82/261, 95% CI: 25.91–37.48) and 0.8% (2/261, 95% CI: 0.13–3.1), respectively by phenotypic method. Molecular detection of genes for ESBL-PE was 27.9% (73/261, 95% CI:22.7–33.9), and for CP-CRE was 0.8% (2/261, 95% CI: 0.13–3.1). The most prevalent genes were bla TEM [76.7% (56/73)] and bla CTX-M [45.2% (33/73)]. Previous antibiotic use (AOR:2.04, 95%CI: 1.35–4.41, P:0.041) and age between 42 and 53 years old (AOR:3.00, 95%CI:1.12–7.48, P:0.019) were significantly associated with ESBL-PE colonization. Conclusion Intestinal colonization by ESBL-PE harboring the associated antibiotic resistance genes was substantially high but with low CP-CRE. Continued surveillance of community-level carriage of antimicrobial resistance Enterobacterales is warranted.

Effective infection control requires identifying and eliminating carbapenemase-producing (CP) Gram-negative bacteria (GNB) in high-risk groups like intensive care unit (ICU) patients and from contaminated environmental surfaces. This study aimed to describe the diversity of carbapenemase-encoding genes among critical GNB isolates from ICU patients with infection and/or gastrointestinal (GI) colonization, as well as from ICU environmental surfaces in the Amhara National Regional state, Ethiopia.A total of 169 carbapenem-resistant isolates were identified, including 26 from infections, 82 from GI colonization, and 61 from environmental samples. These comprised Klebsiellapneumoniae (n = 107), Escherichia coli (n = 16), Pseudomonas aeruginosa (n = 9), and Acinetobacter species (n = 37), of which 147 were analyzed.Singleplex and multiplex PCR were performed to detect predominant carbapenemase-encoding genes, including KPC ( bla KPC ), MBLs ( bla IMP , bla VIM , and bla NDM ), and OXA ( bla OXA-48 , bla OXA-23 , and bla OXA-58 ). PCR analysis revealed that at least one carbapenemase-encoding gene was detected in 133 (78.7%) of the 169 carbapenem-resistant isolates from patients and environmental surfaces. They were detected in 22/133(16.5%), 70/133(52.6%), and 41/133(30.8%) isolates obtained from infection, GI colonization, and environmental samples, respectively. The most prevalent carbapenemase-encoding gene, bla NDM , was found in 101 (75.9%) of the 133 CP isolates. Other detected carbapenemase-encoding genes included bla OXA-23 in 5 (3.8%) isolates, bla VIM in 4 (3.0%), bla OXA-48 in 1 (0.8%), and bla OXA-58 in 1 (0.8%). K. pneumoniae and Acinetobacter spp. harbored all the gene types detected in this study. Co-harboring of two or more carbapenemase-encoding genes, in combination with bla NDM , was observed in 21 of 133 (15.8%) isolates, including 7 K. pneumoniae and 14 Acinetobacter spp. isolates. However, bla KPC and bla IMP were not identified in any of the tested isolates. This study highlights the presence of carbapenemase-encoding genes among critical GNB across all sample source types in the study area. Moreover, the detection of isolates harboring multiple carbapenemase-encoding genes underscores the need for enhanced infection control measures in ICU settings.

Extended-spectrum beta-lactamases (ESBLs) producing Gram-negative bacteria are public health threats. This study aims to characterize ESBL-producing Gram-negative bacteria (GNB) isolated from surgical site infection patients. A multicenter cross-sectional study was conducted at four hospitals located in central (Addis Ababa), southern (Hawassa), northern (Debre Tabor), and Southwestern (Jimma) parts of Ethiopia. A wound culture was performed among 752 surgical site infection (SSI) patients where 286 GNB were confirmed using MALDI-TOF; of which 135 were subjected to whole genome sequencing using the Illumina (HiSeq 2500) system. The overall genotypic frequencies of ESBL-producing GNB were 57.8%. The detection of ESBL-producing GNB at Hawassa, Debre Tabor, Jimma, and Addis Ababa was 21.5%, 19.3%, 29.6%, and 29.6%, respectively. The detection frequency of bla CTX−M , bla TEM , and bla SHV genes was 51.8%, 40%, and 8.1%, respectively. The most frequently detected ESBL gene was bla CTX−M−15 (56.4%). Both bla TEM−1B (41%) and bla SHV−187 (5.1%) were the most frequently detected variants of bla TEM and bla SHV , respectively. The molecular epidemiology of ESBL-producing GNB among surgical site infection patients in Ethiopia showed many variants of ESBL genes. Good antimicrobial stewardship and standard bacteriological laboratory services are necessary for the effective treatment of ESBL-producing GNB.

Background Globally, surgical site infections (SSI) are the most commonly reported healthcare-associated infections. Methods A multicentre study was conducted among patients who underwent surgical procedures at four hospitals located in Northern (Debre Tabor), Southern (Hawassa), Southwest (Jimma), and Central (Tikur Anbessa) parts of Ethiopia. A total of 752 patients clinically studied for surgical site infection were enrolled. The number of patients from Debre Tabor, Hawassa, Jimma, and Tikur Anbessa, hospitals was 172, 184, 193, and 203, respectively. At each study site, SSI discharge culture was performed from all patients, and positive cultures were characterized by colony characteristics, Gram stain, and conventional biochemical tests. Each bacterial species was confirmed using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI TOF). An antimicrobial susceptibility test (AST) was done on Mueller–Hinton agar using the disk diffusion method. Logistic regression analysis was used to assess associations of dependent and independent variables. A p-value < 0.05 was considered statistically significant. Data were analysed using STATA 16 software. Results Among 752 wound discharge cultures performed, 65.5% yielded growth. Among these, 57.9% and 42.1% were Gram-negative and Gram-positive isolates, respectively. In this study, a total of 494 bacteria were isolated; Staphylococcus aureus (31%), Escherichia coli (20.7%), and Klebsiella pneumoniae (9.8%) were the most common. Rare isolates (0.8% each) included Raoultella ornithinolytica, Stenotrophomonas maltophilia , Alcalignes faecalis, Pantoea ecurina, Bacillus flexus, and Paenibacillus tylopili . Enterobacteriaceae showed high levels of resistance to most of the tested antibiotics but lower levels of ertapenem (32.9%), amikacin (24.3%), imipenem (20.3%), and meropenem (17.6%) resistance. Multidrug-resistant (MDR) frequency of Enterobacteriaceae at Debre Tabor, Hawassa, Jimma, and Tikur Anbessa hospitals was 84.5%, 96.5%, 97.3%, and 94%, respectively. Ages ≥ 61 years (AOR = 2.83, 95% CI: 1.02–7.99; P 0.046), prolonged duration of hospital stay (AOR = 4.15, 95% CI: 2.87–6.01; P 0.000), history of previous antibiotics use (AOR = 2.83, 95% CI: 1.06–2.80; P 0.028), history of smoking (AOR = 2.35, 95% CI: 1.44–3.83; P 0.001), emergency surgery (AOR = 2.65, 95% CI: 1.92–3.66; P 0.000), and duration of operation (AOR = 0.27, 95% CI: 0.181–0.392; P 0.000) were significant risk factors. Conclusion The most prevalent isolates from Gram-positive and Gram-negative bacteria across all hospitals were S. aureus and E. coli, respectively . Many newly emerging Gram-negative and Gram-positive bacteria were identified. Variation between hospitals was found for both SSI etiology type and MDR frequencies. Hence, to prevent the emergence and spread of MDR bacteria, standard bacteriological tests and their AST are indispensable for effective antimicrobial stewardship.

A comprehensive understanding of the dynamics of Streptococcus pneumoniae colonization in conjunction with respiratory virus infections is essential for enhancing our knowledge of the pathogenesis and advancing the development of effective preventive strategies. Therefore, a case–control study was carried out in Addis Ababa, Ethiopia to investigate the colonization rate of S. pneumoniae and its coinfection dynamics with respiratory viruses among children under the age of 5 years. Samples from the nasopharyngeal and/or oropharyngeal, along with socio-demographic and clinical information, were collected from 420 children under 5 years old (210 cases with lower respiratory tract infections and 210 controls with conditions other than respiratory infections.). A one-step Multiplex real-time PCR using the Allplex Respiratory Panel Assays 1–4 was performed to identify respiratory viruses and bacteria. Data analysis was conducted using STATA software version 17. The overall colonization rate of S. pneumoniae in children aged less than 5 years was 51.2% (215/420). The colonization rates in cases and controls were 54.8% (115/210) and 47.6% (100/210), respectively ( p  = 0.14). Colonization rates were observed to commence at an early age in children, with a colonization rate of 48.9% and 52.7% among infants younger than 6 months controls and cases, respectively. The prevalence of AdV (OR, 3.11; 95% CI [1.31–8.19]), RSV B (OR, 2.53; 95% CI [1.01–6.78]) and HRV (OR, 1.7; 95% CI [1.04–2.78]) tends to be higher in children who tested positive for S. pneumoniae compared to those who tested negative for S. pneumoniae . Further longitudinal research is needed to understand and determine interaction mechanisms between pneumococci and viral pathogens and the clinical implications of this coinfection dynamics.

Background Bacterial meningitis remains a significant global health concern, particularly in resource-limited settings where patients often present late and have co-existing conditions. This study aimed to identify the common bacterial pathogens causing meningitis, assess their antibiotic resistance profiles, and evaluate treatment outcomes in suspected meningitis patients. Methods We conducted a prospective cross-sectional study involving 195 patients suspected of meningitis at the University of Gondar Comprehensive Specialized Hospital. Cerebrospinal fluid samples were collected and analyzed using both culture and PCR for bacterial etiology. Antimicrobial susceptibility was determined via the disc diffusion method. Treatment outcomes were evaluated using the Glasgow Outcome Scale. We used descriptive statistics, bivariate analysis, and multivariable analysis to identify factors associated with unfavorable patient outcomes, with statistical significance set at a p-value < 0.05 at a 95% confidence level. Results The prevalence of bacterial meningitis, confirmed by either culture or PCR, was 28.2% (55/195). Among the 55 detected bacterial etiologies, E. coli was the most common (45.5%, n  = 25), followed by H. influenzae (16.4%, n  = 9), S. pneumoniae (10.9%, n  = 6), N. meningitidis (7.3%, n  = 4), S. aureus (5.5%, n  = 3), S. agalactiae (5.5%, n  = 3), K. pneumoniae (1.7%, n  = 1), L. monocytogenes (1.7%, n  = 1), and mixed infections of E. coli and K. pneumoniae (5.5%, n  = 3). Notably, only 7.2% (14/195) of bacteria were recovered by culture, with S. pneumoniae and K. pneumoniae (4 each) being the most frequently cultured etiologies, followed by E. coli and S. aureus (2 each). Among K. pneumoniae isolates, 75% (3/4) were resistant to trimethoprim-sulfamethoxazole, and 50% (2/4) to meropenem, cefotaxime, and ciprofloxacin. One of four (25%) S. pneumoniae isolates showed resistance to erythromycin, trimethoprim-sulfamethoxazole, ciprofloxacin, and rifampin. Overall, 13.8% (27/195) of study participants experienced unfavorable outcomes. Factors independently associated with unfavorable outcomes included a low Glasgow Coma Scale (AOR = 0.668, 95% CI = 0.529–0.845), comorbidity (AOR = 9.221, 95% CI = 1.580–53.815), and delayed presentation (AOR = 1.684, 95% CI = 1.206–2.352). Conclusions PCR significantly outperformed culture in detecting bacterial pathogens. E. coli was the most common causative agent of bacterial meningitis, and we observed high rates of antibiotic resistance among Gram-negative bacteria. While most patients had favorable outcomes, low Glasgow Coma Scale scores, comorbidities, and delayed presentation to healthcare facilities were independently associated with unfavorable outcomes.