Bacterial aetiology and factors associated with poor treatment outcome among children with bloodstream infection at Muhimbili national hospital

Abstract

Background Bloodstream infections (BSI) are a significant cause of morbidity and mortality of children, especially in resource-limited settings. The objective of this study was to assess proportion of BSI, bacterial aetiology, antimicrobial susceptibility patterns, and factors associated with poor treatment outcomes in children with BSI at Muhimbili National Hospital. Materials and methods: This was a cross-sectional study design conducted at the Muhimbili National Hospital between June and October 2020. A total of 650 Blood culture samples from children of age 0–15 years were studied. Microbiological data of bacterial, social-demographics and clinical data were captured summarized in descriptive tables and analyzed by using Stata software. A statistical tool STATA version 12 was used during analysis and a p-value of <= 0.05, at 95% CI was considered significant. Results: Out of 650 blood culture samples, 289 (44.5 %) were culture positive. The proportion of bacteria pathogens was 21.5% (140/650) of the total blood culture samples. The proportion of BSI based on age (years) group was <1, 1–24, 25-48, 49-72, 73-96, 97-120 and >120 were 33.2%, 15.6%, 14.5%, 21%, 10.5%, 13.6% and 11.8%, respectively. Gram-negative bacteria (GNB) were mostly isolated (102/140, 72.9%), and the common isolated bacteria was Klebsiella spp. (35.0%). Other isolated bacteria were Staphylococcus aureus (22.1%), Escherichia coli (15.7%), Acinetobacter baumannii (8.6%), Pseudomonas aeruginosa (7.1%), Streptococcus spp (5.0%) and other Gram-negative bacteria 9 (5.9%). The overall resistance of bacteria to ampicillin and Gentamycin were 72.1% and 56.4% respectively. Gram-negative bacteria were resistant to ampicillin (79.4%), Gentamycin (60.8%), Ceftriaxone (73.5%), ciprofloxacin (55.9%), ceftazidime (80.2%) and was less when tested to amoxicillin-clavulanic acid (33.3%) and Meropenem (19.6%). The analysis shows that, in-hospital mortality rate following BSI was 10.3%, and was associated with Gram-negative bacteria infection. The length of stay in the hospital was associated with MDR, admission in the oncology ward, initially prescription of antibiotics. Conclusions: The proportion of BSI from blood culture samples obtained from hospitalized children was 21.5%. Majority of isolated bacteria showed high resistance to the commonly use antimicrobial agents in children (especially in neonates and under five children) for first-line and second-line. Therefore, more studies are required to be done so as to extract more information and hence to come out with a valuable decision on treatment and management of children with BSI.