Bacteria aetiology, antimicrobial susceptibility and outcome of children aged 2 months to 15 years with sepsis admitted at Muhimbili National Hospital, Dar Es Salaam

Abstract

Sepsis is defined as a systemic inflammatory host response syndrome (SIRS) to infection, commonly bacterial. The global prevalence of sepsis is 8.2% with a mortality rate of 25%, whilst in Tanzania the prevalence is 6.6%. Treatment of sepsis involves early initiation of antibiotics based on local sensitivity patterns. However, there is an increase in antimicrobial resistance to commonly used antibiotics, hence the need to learn the local susceptibility patterns so as to promote rational use of antibiotics. Objective To determine the bacteria aetiology, antimicrobial susceptibility and outcome of children aged 2 months to 15 years with sepsis admitted at Muhimbili National Hospital (MNH), Dar es Salaam. Methodology A hospital based cross sectional study was conducted at MNH, among 245 participants who were consecutively recruited. A standardized structured questionnaire was used to collect information, Blood cultures and complete blood counts were done. Antimicrobial susceptibility was done using disc diffusion method (Kirby-bauer) and sensitivity was based on clinical and laboratory standard institute system. Data were analyzed using SPSS version 20. Continuous variables were analyzed using mean, median, range and interquartile range while categorical variables using frequencies and proportions. Measure of association was done using Student’s T test, for continuous variables whilst Chi square and Fisher’s exact test was used for categorical variables. A P value of 0.05 or less was considered to be statistically significant. Result There was predominance of male study participant’s 161/345 (67.5%) the median age was 2 years with interquatile range (IQR) 10 month – 4 years. Culture positive bacteria sepsis was 29.8%, common bacteria isolates were S.aureus (39.7%) Coagulase Negative Staphylococcus (CoNS) (35.6%) E coli (12.3%) Klebsiella spp (6.8%) and Pseudomonas aeruginosa (5.5%). All bacteria showed higher resistance to ampicillin (80%- 100%) followed by ceftriaxone (40 - vi 70%). All Pseudomonas aeruginosa were 100% resistant to ampicillin gentamycin and cefriaxone and were sensitive to amikacin. There was less than 40% resistance to amoxiclav, meropenem, ciprofloxacin, amikacin, and clindamycin. The overall mortality rate from sepsis was 9.4%. Among children discharged 59.3% had prolonged hospital stay of more than 7 days. Age group 1 to 5years, prior use of antibiotics, tachycardia, and leukocytosis were significantly associated with high mortality. Conclusion Bacterial sepsis is prevalent at Muhimbili National Hospital contributing to a high mortality of 9.4% and a prolonged hospital stay of more than 7 days in 59.3% of the children. In this study population gram positive bacteria were found to be predominant. Both groups of bacteria had a high resistance to first and second line antimicrobials including: ampicillin, gentamycin, and ceftriaxone. Recommendations Blood culture should be done once sepsis is suspected, and antimicrobial with good sensitivity pattern should be reserved for severe infection not responding to conventional antibiotics, children at risk of dying should be cared at intensive care unit.