dc.description.abstract |
Wastes generated from hotspot environments contain many antibiotics and pathogens that
play a substantial role in disseminating antibiotic-resistant bacteria into the environment.
The antibiotic resistance profile of bacteria from hotspot environments is overlooked in
developing countries, particularly Ethiopia. There is also a growing interest in discovering
novel classes of antibiotics from microorganisms that have different mechanisms of action
worldwide to overcome antibiotic resistance. Although public awareness of antibiotic
resistance and use has been determined in different countries, information on the
awareness of antibiotic resistance and use in the Amhara National Regional State is scarce.
This study was conducted to identify bacteria in hotspot environments and determine their
resistance profiles; isolate antibiotic-producing bacteria and evaluate their antagonistic
activities against multidrug-resistant bacteria as well as to assess the knowledge, attitude,
and practice of healthcare professionals, patients, and animal farm owners/workers toward
antibiotic resistance and uses. A cross-sectional study was conducted to isolate bacteria in
hotspot environments and determine their resistance profiles, isolate antibiotic-producing
bacteria and evaluate their antagonistic activities against multidrug resistant bacteria
isolated from hotspot environments. A survey was also conducted to assess the
knowledge, attitude, and practice of healthcare professionals, patients, and animal farm
owners/workers toward antibiotic resistance and uses from November 2019 to June 2021.
A total of 126 waste and wastewater samples were aseptically collected, transported, and
processed for bacteriological isolation, identification, and susceptibility testing following
standard procedures. Antibiotic-producing bacteria were also isolated from waste and soil
samples and tested against multidrug-resistant bacteria using the single line streak and
agar well diffusion method. The minimum inhibitory and bactericidal concentrations of
the extracts were determined using two-fold serial dilution and streak plate methods.
Standard questionnaires were distributed to total of 460 participants to collect data on their
knowledge, attitude, and practice on antibiotic resistance and use. Results revealed that a
total of 411 bacterial isolates were recovered, with 122 (29.7%) bacterial isolates being
isolated from medical wastewater. The highest prevalence of resistance was observed in
isolates from beef waste and wastewater against tetracycline 12 (85.7%). Most bacterial
isolates 96 (23.4%) were resistant to two antibiotics, and 35 (8.5%) and 20 (4.9%) isolates
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showed possible extensive and pan-drug resistance. Among the isolated bacteria, 381
(92.7%) were resistant to at least one antibiotic, and the highest number of antibiotic
resistances 71 (98.6%) was observed in Staphylococcus aureus. Two hundred and sixteen
(52.6%) of the bacterial isolates showed multidrug resistance, and the highest multidrug
resistance prevalence was observed in Pseudomonas spp. 47 (65.3%) isolates. The
isolation source multi-antibiotic resistance index was greater than 0.2 in all hotspot
environments, and the highest multi-antibiotic resistance index (0.47) was recorded from
medical wastewater. The results showed that there was a statistically significant difference
among hotspot environments for resistance to all antibiotics except ampicillin (p<0.05).
The results also showed that antibiotic-producing bacterial isolates Ampb17 and Ampb33
obtained from soil and poultry waste showed the highest antagonistic activity against
Salmonella spp., with a mean inhibition zone of 20.3±0.3 mm. The crude extract from
isolate Ampb30 isolated from dairy waste showed the highest antagonistic activity against
Salmonella spp., with a mean inhibition zone of 27.7±0.3 mm. One-way analysis of
variance confirmed that most of the crude extracts against tested multidrug-resistant
bacteria were statistically significant at a p < 0.05. Crude extracts of Ampb29, Ampb32,
Ampb30, and Ampb33 showed minimum inhibitory concentrations of 0.13 mg/ml, and
extracts from Ampb29, Ampb32, Ampb30, and Ampb5 showed a minimum bactericidal
concentration of 0.25 mg/ml. Moreover, using the mean score as the cut-off point, most
health care professionals 76 (55.9%) had good knowledge of antibiotic resistance and use.
One hundred five (45.3%) patients and 48 (52.5%) animal farm owners/ workers had
positive attitudes of antibiotic resistance and use. About 20 (88.2%) of healthcare
professionals, 133 (57.3%) of patients, and 70 (76.9%) of animal farm owners/ workers
indicated that poor patient adherence, poor handwashing practices, and poor awareness of
antimicrobial resistance were significant factors for increasing antibiotic resistance,
respectively. Moreover, 124 (91.2%) of healthcare professionals, 139 (59.9%) of patients,
and 71 (78%) of animal farm owners/workers reported that establishing rapid and
effective diagnostic techniques, implementing hygiene, infection prevention, and control
practices, and increasing the use of complementary treatments were the most important
interventions to reduce antibiotic resistance. It was concluded that wastes generated from
hotspot environments and released into the environment contain large numbers of
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antibiotic-resistant, multidrug-resistant, possible extensively, and/or pan-drug-resistant
bacteria. The results also revealed that antibiotic-producing bacteria from waste and soil
are potential sources of antibacterial compounds. Moreover, the finding revealed that there
are crucial gaps in the attitudes and practices of healthcare professionals, knowledge,
attitudes, and practices of patients, and practice of animal farm owners/workers on
antibiotic resistance and use. Proper waste management strategies, raising awareness, and
implementing interventions are essential to reducing antibiotic resistance. |
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