Bacterial Pathogens, Antimicrobial susceptibility Pattern and predictors of Lower Respiratory Tract Infection among Children admitted in health care settings in South Ethiopia
Authors: Dejene Selemawit , Teklu Takele , Shiferaw Shimelis , Bisetegn Fithamlak Solomon 
Published: November 2023

Abstract
Background
Lower respiratory tract infection is the most widespread health problem that requires frequent hospitalization. It is the leading cause of childhood death, accounting for 16% of all deaths worldwide. An increase in antibiotic resistant strains of bacterial pathogens among children, mainly in hospitals and in the community, aggravates this problem.
Objective
To assess the prevalence of bacterial pathogens of lower respiratory tract infections, antibiotic susceptibility patterns and associated factors among children attending Wolaita Sodo University Comprehensive Specialized Hospital, Southern Ethiopia, from October 30, 2022 to April 1, 2023.
Methods
A hospital-based cross-sectional study was conducted on 329 children who visited the outpatient department of Wolaita Sodo University Comprehensive Specialized Hospital. The socio-demographic data was collected using pre-structured questionnaires. Bronchoalveolar lavage samples were collected aseptically and inoculated onto macconkey agar, chocolate agar, and blood agar, then incubated for 24 hours at 37℃. Biochemical testing was performed on colonies from pure cultures for the final identification of the isolates. Antimicrobial susceptibility testing was done using the Kirby-Bauer disk diffusion method. Data was entered into EpiData version 3.1 and exported to SPSS version 23 for analysis. Variables with a P-value of 0.25 in bivariate analysis were taken into multivariable logistic regression analysis to control potential confounding factors. Finally, the p-value < 0.05 was used as a significant association with lower respiratory tract infection.
Result
Out of the 329 bronchoalveolar lavage samples, 38.9% were found to be positive for LRTI with different bacterial isolates. The most predominant bacteria were K. pneumonia, 29.7%, followed by S.aureus, 27.3%, and E. coli, 26.6%. E. coli showed higher resistance 31(91.2%) to amoxicillin/clavulanic acid, and meropenem each 29(85.3%). S. aureus were pan resistant to penicillin and augmentin. Among the isolates of S. aureus, 15(43%) were extrapolated as methicillin-resistant S. aureus). Isolates of CoNS were 100% resistant to penicillin, and tetracycline. All isolates of S. pneumonia were resistant to penicillin and 5(83.7%) isolates were resistant to tetracycline and 4(66.7%) were resistant to vancomycin. Being under five [AOR = 0.32: 95% CI, 0.151, 0.68], having no formal education [AOR = 6: 95% CI, 2.178, 16.548] non-exclusive breast feeding [AOR = 0.43 95% CI, 0.206, 0.894], lack of iron folate intake [AOR = 0.3495% CI, 0.178, 0.642], and cooking area without window [AOR = 2.42 95% CI, 1.091, 5.354], were predictors for lower respiratory tract infections.
Conclusion
The overall prevalence of LRTI was relatively higher. K. pneumonia and S. aureus were the predominant bacteria. Hence, regular monitoring of LRTI etiologies and antimicrobial drug resistance testing is essential to maximize the shelf life of effective drugs. Age < 5 years old, lack of formal education, non-exclusive breastfeeding, iron folate intake, and a cooking area without windows were significantly associated with LRTI. It is advisable to continuously monitor trends in antimicrobial resistance pattern.