Bacteremia, Associated Factors and Antibiotic Susceptibility Patterns among Febrile Pediatric Patients with Sickle Cell Disease in Mwanza, Tanzania

Abstract

Background: More than 300,000 infants are born annually with Sickle Cell Disease (SCD) and sub-Saharan Africa accounts for 75% of the global burden. The patients with SCD are prone to bacterial infections due to compromised immunity resulting in significant morbidity and mortality. Routine use of penicillin prophylaxis for SCD patients under the age of five and routine use of conjugate vaccines against invasive Streptococcus pneumoniae have been widely deployed. There are however reports of increasing rates of penicillin resistance globally. Objectives: The study determined the prevalence of bacteremia, antibiotic susceptibility patterns (AST) and associated factors among febrile SCD patients in Mwanza, Tanzania. Methodology: This was a hospital-based cross-sectional study conducted among febrile pediatric patients with SCD between January and June 2021. Three health facilities in Mwanza, Nyamagana District Hospital (NDH), Sekou-Toure Regional Referral Hospital (SRRH) and Bugando Medical Centre (BMC) were conveniently selected. Blood culture samples from assented children and/or consented parents/guardians of the febrile SCD patients were collected aseptically by a trained research assistant. Independently associated factors for bacteremia among febrile SCD patients were determined by univariate and multivariate logistic regression analysis using odds ratios, 95% confidence intervals and p-value cut-off of less than 0.05. Results: A total of 321 febrile pediatric SCD patients were included in the study. The median age (IQR) of the study participants was 5 (0.7-17) years. Females accounted for more than half 175/321 (54.5%) of the study participants. A total of 32/321 (10.0%) bacteria species strains were isolated from the blood culture specimens. The gram-positive micro-organisms constituted 22/32 (68.8%) with a predominance of S. aureus (81.8%). The gram-negative bacteria were predominated by K. pneumoniae (50%). The S. aureus strains isolated from the blood culture specimens were more resistant to erythromycin, penicillin and co-trimoxazole with resistance rates ranging from 55.6 -77.8% whereas gram-negative bacteria showed high resistance rate (80 to 100%) to ceftriaxone, amoxicillin-clavulanic and cefepime. Conclusion: Our findings have shown that a large proportion of children with SCD still acquire bacterial infection with S. aureus constituting to the majority of the bacteremic episodes. High rate of resistance has been observed towards penicillin (a prophylactic antibiotic) along with other commonly used antibiotics. However, ciprofloxacin, gentamicin and clindamycin are still sensitive and can therefore be used as alternative antibiotics. Nevertheless, the high resistance rates towards the commonly used antibiotic calls for need to introduce routine culture and AST at health facilities that lack the services