A prospective observational study of bacteraemia in adults admitted to an urban Mozambican hospital

Abstract

Background Bacteraemia is a common cause of fever among patients presenting to hospitals in sub-Saharan Africa. The worldwide rise of antibiotic resistance makes empirical therapy increasingly difficult, especially in resource-limited settings. Objectives To describe the incidence of bacteraemia in febrile adults presenting to Maputo Central Hospital (MCH), an urban referral hospital in the capital of Mozambique, and characterise the causative organisms and antibiotic susceptibilities. We aimed to describe the antibiotic prescribing habits of local doctors, to identify areas for quality improvement. Methods Inclusion criteria were: (i) ≥18 years of age; (ii) axillary temperature ≥38°C or ≤35°C; (iii) admission to MCH medical wards in the past 24 hours; and (iv) no receipt of antibiotics as an inpatient. Blood cultures were drawn from enrolled patients and incubated using the BacT/Alert automated system (bioMérieux, France). Antibiotic susceptibilities were tested using the Kirby-Bauer disc diffusion method. Results Of the 841 patients enrolled, 63 (7.5%) had a bloodstream infection. The most common isolates were Staphylococcus aureus, Escherichia coli, and non-typhoidal Salmonella. Antibiotic resistance was common, with 20/59 (33.9%) of all bacterial isolates showing resistance to ceftriaxone, the broadest-spectrum antibiotic commonly available at MCH. Receipt of insufficiently broad empirical antibiotics was associated with poor in-hospital outcomes (odds ratio 8.05; 95% confidence interval 1.62 – 39.91; p=0.04). Conclusion This study highlights several opportunities for quality improvement, including educating doctors to have a higher index of suspicion for bacteraemia, improving local antibiotic guidelines, improving communication between laboratory and doctors, and increasing the supply of some key antibiotics.

A Systematic Review and Meta-analysis of the Prevalence of Community-Onset Bloodstream Infections among Hospitalized Patients in Africa and Asia

“…Eight studies reported malaria and BSI coinfection (31,32,43,45,(61)(62)(63)65 (62,65). Twelve (27.3%) studies with 8,109 participants tested patients for HIV using either serological or nucleic acid amplification methods and described BSI coinfection (32,33,35,36,40,41,48,61,62,65,67,69). Among the 2,513 HIV-infected participants, 676 (26.9%) had BSI; 566 (10.1%) of 5,596 HIV-uninfected participants had BSI (OR, 3.2 [95% CI, 2.8 to 3.7]).…”

“…The proportions of typhoidal Salmonella isolates susceptible to ampicillin, chloramphenicol, and trimethoprim-sulfamethoxazole for the earlier period versus the contemporary period were 99 (100%) of 99 isolates versus 22 (48.9%) of 45 isolates, 125 (99.2%) of 126 isolates versus 23 (51.1%) of 45 isolates, and 52 (81.3%) of 64 isolates versus 23 (51.1%) of 45 isolates, respectively. There were 11 studies with antimicrobial susceptibility results for S. pneumoniae (32,37,40,41,43,44,61,67,68,71,73). The proportions of isolates susceptible to erythromycin, penicillin, and trimethoprim-sulfamethoxazole for the earlier period versus the contemporary period were 190 (99.0%) of 192 isolates versus 24 (96.0%) of 25 isolates, 220 (86.6%) of 254 isolates versus 24 (85.7%) of 28 isolates, and 38 (16.3%) of 233 isolates versus 11 (39.3%) of 28 isolates, respectively.…”

“…Among E. coli isolates with ampicillin susceptibility testing, 4 (6.0%) of 67 were susceptible in the earlier period versus 6 (23.1%) of 26 in the contemporary period. Among E. coli isolates with ciprofloxacin susceptibility testing, 22 (91.7%) of 24 were susceptible in the earlier period (36) versus 20 (76.9%) of 26 in the contemporary period (38,67,71). Eight studies tested S. aureus isolates for methicillin resistance (33, 36-38, 43, 67, 68, 71).…”

Fatal multi-drug-resistant Acinetobacter baumannii pneumonia in Maputo, Mozambique: A case report

“…A recent report analysed 65 strains from 5 different countries and found a high prevalence of MDR strains 7 . International clone II/ST2 isolates belong to one of the major clonal lineages associated with the spread of MDR A. baumannii worldwide, but in Africa they have only been reported in Algeria and Kenya 8,9 . Two recent studies 10,11 (one of them conducted at the Maputo Central Hospital) reported non-MDR A. baumannii in Mozambique, whereas, to our knowledge, this is the first report of a MDR A. baumannii strain in this country. The patient had several known risk factors for acquiring A. baumannii infection such as severe immunosuppression and having been hospitalised for two weeks.…”

The Medical Education Partnership Initiative (MEPI), a collaborative paradigm for institutional and human resources capacity building between high- and low- and middle-income countries: the Mozambique experience

“…Thus we emphasize building partnerships both with our international collaborators (in our case UCSD as well as several universities in Africa, Europe, and Brazil) and with local stakeholders. By doing this, we are able to leverage resources to achieve MEPI goals and develop funding streams that will last well after the term of the MEPI [11,19,24]. For example, at the inception of the program we defined increasing the number of postgraduate trainees as a major MEPI goal.…”