MAGNITUDE, DRUG SUSCEPTIBILITY PATTERN AND ASSOCIATED FACTORS OF BACTERIAL ISOLATES AMONG ACUTE TONSILLITIS PATIENTS VISITING PUBLIC HOSPITAL, HARAR EASTERN ETHIOPIA

Abstract

Background: Acute tonsillitis is a common infectious disease contributing to significant social-economic impact worldwide. Tonsillitis is usually viral; it is most commonly caused by the rhinovirus, followed by the corona virus, and the adenovirus. Less commonly it is caused by the influenza virus, the parainfluenza virus, enteroviruses, or herpes viruses. In tonsillitis associated with infectious mononucleosis, the most common infective agent is the Epstein-Barr virus (Georgalas C., et al, 20015).Bacterial agents such as group A Beta hemolytic streptococci, staphylococcus aureus, hemophilus influenza, streptococcus pneumonia, corynebacterium diptheriae and neisseria gonorrhea can cause tonsillitis. Past decade has seen the rise of resistance amongst the bacteria that causes tonsillitis to the commonly used antibiotics like amoxicillin, amoxicillin/clavulanic acid and erythromycin, as well as rise in the number of unusual offenders. Determination of the causative agent and prescribing an antibiotic as per the sensitivity pattern is of utmost importance. Data on bacteriology of tonsillitis in Ethiopia is scarce. Objective: To determine the bacterial profile, drug resistance pattern and associated factors among Acute Tonsillitis Patients Visiting Hiwot Fana Specialized University Hospital and Jugal Hospital, eastern Ethiopia Method: A health facility based cross-sectional study was conducted among acute tonsillitis patients. Socio-demographic and clinical data were collected from the study participants using a structured questionnaire. Throat swabs samples were collected and processed to identify bacteria using the conventional culture and biochemical tests as per the standard procedures. The Kirby Bauer disk diffusion method was implemented for the antimicrobial susceptibility testing. Data was entered to Epi-data version 3.1 then exported and analyzed by SPSS version 20. P-value ≤ 0.05 was considered for statistical significance. Result: Out of 357 throat swab sample, 76(21.3%, 95% CI) samples were culture positive for potential pathogens. Predominant isolates were Streptococcus pyogens 81.6%, followed by Staphylococcus aureus 11.8%, Klebsiella pneumonia 4%, Pseudomonas aeruginosa 2.6% and E.Coli 1.3% (it is occurred specially in children because of feco oral contamination). The presence of an inflamed tonsils (AOR 2.3, 95% CI (1.5-4.4); p < 0.002) and a Scarlatiniform rash (AOR 2.9, 95% CI (1.6-5.5) ; p < 0.000) were significantly associated with the presence of acute tonsillitis caused by bacterial infection. For antimicrobial susceptibility testing the Amoxicillin first line drug was used. Streptococcus pyogens isolates were resistant to Penicillin (82.3%), Cefuroxine (39%), Cefotaxime (35.5%) and Chloramphenicol (40.3%). Staphylococcus aureus showed 100% resistant to Penicillin, while 22.2% resistant to Amoxicillin and Cefotaxime. Klebsiella pneumoniae were also found to be 100% resistant to Penicillin, and 66.7% resistant to Chloramphenicol and Amoxycillin, Pseudomonas species were 100% resistant to Amoxicillin, Cefuroxine, Cefotaxime and Penicillin. Conclusion: Bacterial acute tonsillitis was found to be prevalent in our study setting with young individuals (1-10 years) being most commonly affected. Most of the bacterial isolates were resistant to penicillin, Chloramphenicol, Cefotaxime, and Cefuroxine. This finding indicated that there were significant proportions of Group A Streptococcus and most of the isolates were resistant to penicillin, Chloramphenicol, Cefotaxime and Cefuroxine. Clinicians should consider all sorts of throat infections seriously, in order to combat the squeal and also this work can serve as a baseline study for further complementary investigations to get fairly clear picture of bacteria isolates from acute tonsillitis patients (Group A Streptococcus epidemiology) in Harari.