Blood Culture Testing Outcomes among Non-Malarial Febrile Children at Antimicrobial Resistance Surveillance Sites in Uganda, 2017–2018

Abstract

Blood culture (BC) processes are critical to the utility of diagnostic testing, bloodstream infection (BSI) management, and antimicrobial resistance (AMR) surveillance. While Uganda has established BC guidelines, often laboratory practice does not meet the desired standards. This compromises pathogen recovery, reliability of antimicrobial susceptibility testing, and diagnostic test utility. This study assessed laboratory BC process outcomes among non-malarial febrile children below five years of age at five AMR surveillance sites in Uganda between 2017 and 2018. Secondary BC testing data was reviewed against established standards. Overall, 959 BC specimens were processed. Of these, 91% were from female patients, neonates, infants, and young children (1–48 months). A total of 37 AMR priority pathogens were identified; Staphylococcus aureus was predominant (54%), followed by Escherichia coli (19%). The diagnostic yield was low (4.9%). Only 6.3% of isolates were identified. AST was performed on 70% (18/26) of identified AMR priority isolates, and only 40% of these tests adhered to recommended standards. Interventions are needed to improve laboratory BC practices for effective patient management through targeted antimicrobial therapy and AMR surveillance in Uganda. Further research on process documentation, diagnostic yield, and a review of patient outcomes for all hospitalized febrile patients is needed.

The need to improve antimicrobial susceptibility testing capacity in Ugandan health facilities: insights from a surveillance primer

“…This study found a high prevalence of E. coli, P. aeruginosa , and S. aureus . These findings are similar to those of many short-term researcher-driven studies earlier done at MH, which stated a high prevalence of the same species [ 9 – 15 ]. These species continue to cause the commonest community- and hospital-acquired bacterial infections [ 9 – 15 ].…”

“…These findings are similar to those of many short-term researcher-driven studies earlier done at MH, which stated a high prevalence of the same species [ 9 – 15 ]. These species continue to cause the commonest community- and hospital-acquired bacterial infections [ 9 – 15 ]. But, these species could be used as surveillance markers for AMR in this setting as has been shown [ 16 ].…”

“…Broadly, our ASPs of the different bacterial species were similar to ASPs reported for the same species in many studies earlier done at MH [ 9 – 15 ]. Lab-based surveillance of AMR hinges on the availability of reliable ASP data [ 6 ].…”

“…Lab-based surveillance of AMR hinges on the availability of reliable ASP data [ 6 ]. Microbiology labs create such data and can drive the surveillance [ 9 , 17 ]. This finding hence shows the potential of MHL to steer LBS of AMR efforts in Uganda.…”

“…The AMR NAP outlines surveillance as one of its strategic aims [ 7 ]. Despite this, regular LBS is not systematically implemented in Uganda [ 8 , 9 ]. The country collects and uses data from short-term researcher-driven studies for surveillance [ 8 , 9 ].…”