Wondwossen Amogne

Urinary tract infections (UTIs), often associated with the lower urinary tract, are a major public health problem. Traditionally, urine has been believed to be sterile in healthy individuals, but increasing evidence shows that the urinary tract may contain a variety of viruses even in healthy populations. Bacteria remain the major etiologic agents of UTIs, but growing evidence points to viruses as emerging causes. This narrative review focuses on six viruses: adenoviruses, cytomegalovirus (CMV), BK virus (human polyomavirus), severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2), Zika virus, and West Nile virus. West Nile virus has been detected in urine without clear evidence of causing UTIs; however, the other five viruses reviewed in this narrative discussed have been associated with UTIs and may lead to various complications. Management of viral UTIs is mainly supportive, with reduced immunosuppression, symptom alleviation, prevention of complications, and monitoring of response to therapy. Key interventions include managing secondary bacterial infections, ensuring adequate hydration, using analgesics for pain and discomfort, and closely monitoring for treatment failure or recurrence. Effective prevention and control of viral infections also rely on broader public health strategies, including vaccination, sanitation, surveillance, early diagnosis, and appropriate treatment. Additional approaches may include prophylaxis, preemptive therapy, virus-specific treatments, and donor–recipient serostatus matching. Regular monitoring and careful adjustment of immunosuppressive therapy are also important, as no effective vaccine is available except for Ad4/Ad7 and SARS-CoV-2, and definitive preventive strategies are currently unavailable. Future research should focus on developing safe and effective antivirals and vaccines to prevent and treat viral UTIs and their complications.

Background: Clinical data may not accurately diagnose pulmonary tuberculosis (PTB), mainly due to manifestation overlap with other diseases, causing delays and misdiagnoses. Many gaps in the interpretation of clinical and radiographic findings were addressed and updated in our study. Methods: An institutional-based study was carried out between 02/01/2018 and 26/06/2020 to clinically assess TB outpatients in high-burden zones. Those patients were identified through smear microscopy, GeneXpert Ultra, and chest X-rays and TB positives were interviewed. Of total, 329 patients were enrolled from Bench-Skeko, 23 from Skeka, and 29 from Keffa. Both descriptive and inferential statistics were performed using Stata 14/16. Results: A total of 410 TB confirmed cases, with 328 (80%) being PTB, 79 (19.3%) EPTB, and 3 (0.73%) involving both forms were involved in this study. The mean age was 27.65 ± 11.44 years, with 55% male. Most patients were recently identified (99.3%). GeneXpert was used in 62.4%, AFB in 8.78%, and lesion biopsy or FNAC for EPTB in 16.83%, and 98% was on the intensive therapy for susceptible TB. A febrile episode was diagnosed in 93% (5.4% >40°C, 87% < 39°C), night sweat in 93.17%, appetite loss in 89%, fatigue in 90%, and weight loss in 88%. Respiratory symptoms were very common, with cough reported in 94.2%: productive in 91%, and prolonged (>3 wks) in 77%. Abnormalities in chest X ray were reported in 16.3%, with pleural effusion in 11.2%, cavitary formations in 13%, and lymph node enlarged in 14%. Blood pressure abnormalities were relatively low, with 76.3% having normal. Only few findings were reported as statistically significant predictors of active PTB. Chest abnormalities (OR=6.87), prolonged cough (OR=6.4), mucoid (OR=14.6), and mucopurulent sputum (OR=56.4) increased PTB odds, while lymphadenopathy was less commonly reported (OR=0.16). Appetite loss (OR=3.26), pleural effusion (OR=2.41), and fibrosis (OR=2.31) showed weak associations. Conclusions: A high prevalence of the TB tetrad: prolonged cough, night sweat, fever and appetite loss were observed. PTB odds were higher with chest abnormalities, effusion, fibrosis, infiltration, and expansion, highlighting the diagnostic value of radiology.

Urinary tract infections (UTIs) are major public health issues that are mostly caused by bacterial pathogens and less frequently by viral agents, especially in immunocompromised people, where they are more frequently linked to lower UTIs. Despite the long held belief that urine is sterile in healthy people, the urinary system is known to retain a range of viruses even in healthy populations. While bacterial pathogens continue to be the main cause of UTIs, mounting research indicates that viral infections are becoming more important. Six viruses were the subject of this narrative review: adenoviruses, CMV, West Nile virus, BK virus (human polyomavirus), Zika virus, and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). With the exception of West Nile virus, this has been found in urine but does not seem to cause.

The threat of healthcare-associated infections is significantly heightened when caused by drug-resistant pathogens. This study evaluates water management practices and prevalence of antibiotic-resistant Pseudomonas aeruginosa in water systems of two tertiary hospitals of Ethiopia. We employed a mixed-methods approach, combining the qualitative data thematic analysis with quantitative microbiological results from 120 potable water samples. P. aeruginosa isolates were identified and subjected to antimicrobial susceptibility testing. Data collection was conducted between December 2023 and January 2024. The findings indicate that neither hospital had a dedicated water management programme for preventive maintenance. Microbial analysis revealed a 16% prevalence of P. aeruginosa in the water samples, with 26.3% of isolates demonstrating resistant to at least one antibiotic class. Notably, two isolates from the maternity ward of Hospital A exhibited multidrug resistance (MDR) to ciprofloxacin, amikacin, and imipenem. Overall, the structural and operational standard of the water management programmes in both hospitals were found to be non-conformant to international standards. A higher rate of Pseudomonas positivity, including resistant and MDR strains, indicates persistent hospital water contamination and a tangible risk for HAIs. These results underscore the critical need for the formation of multidisciplinary water safety team to optimize water quality management in these hospitals.

Objectives: Legionella pneumophila is a waterborne bacterium known to cause Legionnaires’ disease, a severe form of pneumonia particularly affecting older and immune compromised individuals. This study evaluates the level of risk awareness, clinical practices, and barriers to optimal management of nosocomial Legionnaires’ disease in Ethiopia’s two largest hospitals. Methods: We employed a cross-sectional survey design, utilizing a self-administered questionnaire to collect data from 374 practicing physicians at two specialized hospitals in Addis Ababa. Results: A total of 324 questionnaires were returned, yielding a response rate of 86.6%. Eighty percent ( n = 270) reported some level of awareness of Legionnaires’ disease as a clinical condition. However, 43% of the physicians were unaware of the association between hospital water systems and the risk of nosocomial Legionnaires’ disease. Fifty-seven percent of the respondents indicated the absence of technical guidelines to inform the diagnosis and management of nosocomial Legionnaires’ disease. Most physicians relied on clinical assessment (57%, n = 51) for diagnosing the disease, citing diagnostic barriers (68%, n = 140) and perceived low reliability of existing laboratory tests as key challenges. Notably, physicians with limited knowledge about Legionnaires’ disease were associated with a 79% reduction in accurate diagnosis of cases. Additionally, poor hospital water quality (43%) and inadequate infection prevention and control measures were identified as significant contributors to the persistence of waterborne hospital-acquired pneumonia. Conclusions: This study highlights physicians’ limited awareness of the risks posed by hospital water systems in the transmission of Legionnaires’ disease. Additionally, the diagnosis of Legionnaires’ disease is impeded by the lack of clinical guidelines and specific diagnostic testing capabilities. These findings underscore the urgent need to revise hospital-acquired pneumonia protocols, strengthen infection prevention and control guidelines, and enhance hospital water management practices.

In addition to anemia, urinary tract infection (UTI) is a common pregnancy issue that affects the health of the mother and her fetus. The aim of this study was to estimate the prevalence of UTIs and determine risk factors, the bacterial profile and antibacterial susceptibility in pregnant women in central Ethiopia. Serially diluted urine samples were inoculated onto plate count agar for CFU determination. Standard conventional microbiological testing techniques were used to identify bacterial uropathogens at the species level. The Kirby-Bauer disc diffusion method was used to evaluate antibacterial susceptibility. A binary logistic regression model was employed to investigate factors linked to the prevalence of UTIs. Out of the 873 pregnant women recruited, 180 (20.6%) had culture-confirmed UTIs, the majority of whom (n = 165, 91.7%) were asymptomatic. A body mass index ≤24.9 (adjusted OR = 0.61, 95% CI = 0.39–0.98, P < 0.05) was found to be protective against UTIs. The most often identified bacterial uropathogen was Escherichia coli (n = 85, 45%), followed by Klebsiella pneumoniae (n = 23, 12.0%), Staphylococcus aureus (n = 17, 9.0%) and Enterococcus faecalis (n = 14, 7%). A large proportion of the E. coli isolates were resistant to amoxicillin (n = 74, 87.1%). More than half of the S. aureus isolates (n = 10, 58.8%) were methicillin-resistant. The high prevalence of UTIs and antibacterial resistance and the detection of rarely encountered UTI-causing bacterial uropathogens are concerning factors. These findings highlight the need for routine UTI screening and drug susceptibility testing before treatment to minimize complications during the perinatal period.

Background: Patients with end stage renal disease (ESRD) are at a higher risk of developing tuberculosis (TB) due to the immunosuppressed state along with concomitant comorbidities and socioeconomic and demographic factors. Data on the prevalence of tuberculosis in ESRD are scarce despite the high burden of the disease in developing nations. Methods: A multicenter, cross-sectional study was conducted at eight dialysis centers in Addis Ababa on the prevalence of TB among CKD patients on maintenance hemodialysis from August 2022 to October 2022 G.C. The study enrolled 263 participants selected by systematic random sampling. Data were collected by reviewing the patient’s electronic medical records. The Collected data were analyzed using SPSS version 26.0. Results: Our study found a 27% prevalence of TB in patients with ESRD receiving maintenance hemodialysis (MHD). Pulmonary tuberculosis was the most prevalent form, and lymphadenitis was the most common extra-pulmonary tuberculosis (EPTB). Only 5.6% of the study participants had microbiologic evidence of TB. Chemistry and cytological studies from pleural fluid and imaging evidences were commonly used diagnostic modalities. The presence of HIV infection, longer duration of dialysis (> 1 year), and contact history with a known TB patient were all significantly associated with higher prevalence of TB among the study participants. Conclusion: Although there is a strong association between TB and CKD, there are no local data from Ethiopia. Our study identified a higher prevalence of TB among CKD patients on MHD. Thus, maintaining a high index of suspicion and early diagnosis and treatment of TB among ESRD patients on MHD and use of TB preventive therapy (TPT) is important in decreasing morbidity and mortality.

Background: Prophylactic antibiotics reduce surgery-associated infections and healthcare costs. While quantitative methods have been widely used to evaluate antibiotic use practices in surgical wards, they fall short of fully capturing the intricacies of antibiotic decision-making in these settings. Qualitative methods can bridge this gap by delving into the often-overlooked healthcare customs that shape antibiotic prescribing practices.Aim: This study aimed to explore the etiquette of the antibiotic decision-making process of surgical prophylaxis antibiotic use at Tikur Anbessa Specialized Hospital (TASH).Methods: The observational study was carried out at TASH, a teaching and referral hospital in Addis Ababa, Ethiopia, from 26 August 2021 to 1 January 2022. Overall, 21 business ward rounds, 30 medical record reviews, and 11 face-to-face interviews were performed sequentially to triangulate and cross-validate the qualitative observation. The data were collected until saturation. The data were cleaned, coded, summarized, and analyzed using the thematic analysis approach.Result: Surgical antibiotic prophylaxis (SAP) discussions were infrequent during surgical ward rounds in TASH, leading to practices that deviated from established recommendations. Clear documentation differentiating SAP from other antibiotic uses was also lacking, which contributed to unjustified extended SAP use in the postoperative period. Missed SAP documentation was common for emergency surgeries, as well as initial dose timing and pre-operative metronidazole administration. Importantly, there was no standardized facility guideline or clinical protocol for SAP use. Furthermore, SAP prescriptions were often signed by junior residents and medical interns, and administration was typically handled by anesthesiologists/anesthetists at the operating theater and by nurses in the wards. This suggests a delegation of SAP decision-making from surgeons to senior residents, then to junior residents, and finally to medical interns. Moreover, there was no adequate representation from pharmacy, nursing, and other staff during ward rounds.Conclusion: Deeply ingrained customs hinder evidence-based SAP decisions, leading to suboptimal practices and increased surgical site infection risks. Engaging SAP care services and implementing antimicrobial stewardship practices could optimize SAP usage and mitigate SSI risks.

Objectives: HIV-induced chronic inflammation, immune activation and combination antiretroviral therapy (cART) are linked with adverse metabolic changes known to cause cardiovascular adversities. This study evaluates the prevalence of lipodystrophy, and metabolic syndrome (MetS), and analyses risk factors in HIV-infected Ethiopians taking cART.Methods: A multicentre cross-sectional study was conducted at tertiary-level hospitals. Eligible participants attending the HIV clinics were enrolled. Sociodemographic, anthropometric, clinical, HIV treatment variables, lipid profile, fasting blood glucose level, risk factors and components of MetS, also lipodystrophy, were studied. Data were analysed by SPSS statistical package V.25 with descriptive and analytical statistics. For multivariable analysis of risk factors, a logistic regression model was used. Results were presented in frequency and percentages, mean±SD, or median+IQR. Statistical significance was taken as p45 years (aHR 1.8, 95% CI 1.2 to 2.4), female sex (aHR 1.8, 95% CI 1.1 to 2.8), body mass index (BMI)>25 kg/m²(aHR 2.7, 95% CI 1.8 to 4.1), efavirenz-based cART (aHR 2.8, 95% CI 1.6 to 4.8) and lopinavir/ritonavir-based cART (aHR 3.7, 95% CI 1.0 to 13.3). The prevalence of lipodystrophy was 23.6%. Prior exposure to a stavudine-containing regimen was independently associated with lipodystrophy (aHR 3.1, 95% CI 1.6 to 6.1).Conclusion: Our study revealed 38% of the participants had MetS indicating considerable cardiovascular disease (CVD) risks. Independent risk factors for MetS were BMI≥25 kg/m², efavirenz and lopinavir/ritonavir-based cART, female sex and age ≥45 years. In addition to prevention, CVD risk stratification and management will reduce morbidity and mortality in people with HIV infection.