PATHOGENIC BACTERIAL PROFILE, ANTIMICROBIAL SUSCEPTIBILITY PATTERNS, AND ASSOCIATED FACTORS OF LOWER RESPIRATORY TRACT INFECTIONS AMONG XPERT MTB/RIF-NEGATIVE PRESUMPTIVE TUBERCULOSIS ADULT PATIENTS AT HIWOT FANA COMPREHENSIVE SPECIALIZED UNIVERSITY HOSPITAL, HARAR, EASTERN ETHIOPIA

Abstract

Bacterial lower respiratory tract infection pathogens pose a serious health problem in developing countries including Ethiopia. In, Ethiopia, the trend to manage Xpert-negative presumptive pulmonary TB cases is empirical. Objective: This study aimed to determine the prevalence of pathogenic bacteria, antimicrobial susceptibility patterns, and associated factors of lower respiratory infection among Xpert-negative presumptive tuberculosis adult patients at Hiwot Fana Comprehensive Specialized Hospital, Harar, eastern Ethiopia. Method: A hospital-based cross-sectional study was undertaken from January to April 2024. Convenient sampling technique was used to enroll 371 study participants. Socio- demographic and other relevant data were collected by using a pretested structured questionnaire. The collected sputum were inoculated onto blood agar, chocolate agar and MacConkey. Biochemical tests and Gram staining were used to identify pathogenic bacteria down to species level. Antimicrobial susceptibility test was performed by Kirby- Bauer disc diffusion method. Data were entered into Epi data version 4.6 and analyzed by using Statistical Package for Social Science version 20. Bivariate and multivariable logistic regression analysis were used to assess the association between outcome and predictor variables. p -value ≤ 0.05 at 95 % CI was considered statistically significant. Results: The overall prevalence of pathogenic bacteria of lower respiratory infections was 34.0 % (126/37195% CI; 29.2, 38.8). S. aureus (19.0 %) was the dominant isolates followed by K. pneumonia (14.3%). S. aureus isolates were highly sensitive to cefoxitin, ciprofloxacin, and gentamycin and most of them were resistant to penicillin and tetracycline. Overall, the proportion of multi-drug resistance and its type methicillin- resistance S. aureus was 39.7% and 16.7% respectively. Educational status (AOR=4.008; 95% CI=1.619, 9.920; p =0.003), history of prior antibiotic usage (AOR=1.866; 95% CI=1.132, 3.077; p =0.014) and crowded living condition (AOR=5.106; 95% CI=3.028, 8.611; p <0.001) were factors associated with bacterial lower respiratory tract infections. Conclusion: This study found that Xpert-negative presumptive tuberculosis adult patients were predominantly infected with other pathogenic bacteria than M. tuberculosis. Therefore, the routine sputum culture and antibiotic susceptibility testing should be suggested to ensure favorable treatment outcomes. Promoting education, refraining from exploiting antibiotics and managing crowded living condition would mitigate lower respiratory tract infection