Bacterial Profile, Antimicrobial Susceptibility, and Treatment Outcomes of Bacterial Conjunctivitis among Patients Treated At The Ophthalmologic Clinic of Jimma Medical Center, Ethiopia

Abstract

Background: Bacterial conjunctivitis is a common ocular infection in Ethiopia with high ocular morbidity and complications. Antimicrobial resistance to agents commonly used for infectious conjunctivitis makes it crucial to consider changing resistance trends when prescribing; however, data in this area are limited in Ethiopia. Objective: To assess bacterial profile, antimicrobial susceptibility, and treatment outcomes of bacterial conjunctivitis among patients treated at the Ophthalmologic Clinic of Jimma Medical Center, Ethiopia, 2022. Methods: Hospital-based longitudinal study was conducted at the Ophthalmologic Clinic of Jimma Medical Center, from January-June 2022. Conjunctival swabs were collected from 190 patients clinically diagnosed with bacterial conjunctivitis. All Ocular specimens were collected using an aseptic technique for gram stain and culture. Bacteria were identified by a series of biochemical tests using the standard microbiological method. Antimicrobial susceptibility testing was done using the disk diffusion method. Sociodemographic, Clinical characteristics, treatment, clinical response, and complications were recorded prospectively from the first visit (diagnosis) to 30-day. Data were entered into EPI data 3.1 and exported to SPSS version 21 for data analysis. Bivariate and multivariable logistic regressions were done to identify factors associated with poor treatment outcomes. P-value <0.05 was taken as statistically significant. Results: Among 190 patients included in this study, 97 (51.1%) were males, and more than half 107(56.3) were under 18 years. The bacterial growth rate from bacterial conjunctivitis was 160 (84.2%) (95%CI: 78.4, 89.5). The most frequently isolated bacteria were gram-positive 124 (77.5%); predominantly Coagulase-negative staphylococcus 57 (35.6%) and Staphylococcus aureus 35 (21.9%) with a higher resistance rate against penicillin, ampicillin, and tetracycline. Common gram negative isolates were Pseudomonas aeroginosa 13 (8.1%) and Klebsiella pneumonia 7 (4.4%) with a higher resistance rate to penicillin and ampicillin. Multidrug-resistant bacteria were detected among 124 (77.5%) of the 160 bacterial isolates. A total of 84 (44.2%) patients had poor treatment outcomes (persistent or worsened symptoms from baseline). Factors associated with poor treatment outcomes were comorbid chronic diseases [AOR=11, 95%CI (2.8-43)], traditional eye medicine use [AOR=3.7, 95%CI (1.3-10)], infection with Coagulase-negative staphylococcus [AOR = 4.2, 95%CI (1.4-12)], treatment with Zoxan D [AOR =10, 95%CI (3-13)], Topical steroids use [AOR =14, 95%CI [4-48)], fortified antibiotics[AOR=10, 95%CI (3-35)], and non-adherence to a treatment regimen [AOR= 3.3, 95%CI (1.1-9.5)]. Blepharoconjuntivitis 17 (8.9%) was the most common type of complication experienced by the study participants. Conclusions: Coagulase-negative staphylococcus and Staphylococcus aureus were the most predominant bacterial isolates with high resistance to frequently used antibiotics for ocular infections such as ciprofloxacin, gentamycin, and tetracycline. Almost half of the patients had poor treatment outcomes. Therefore, empirical treatment of bacterial conjunctivitis in the study area should be supported by antimicrobial susceptibility tests.