Multi-drug resistance and high mortality associated with community-acquired bloodstream infections in children in conflict-affected northwest Nigeria

Abstract

Pediatric community-acquired bloodstream infections (CA-BSIs) in sub Saharan African humanitarian contexts are rarely documented. Effective treatment of these infections is additionally complicated by increasing rates of antimicrobial resistance. We describe the findings from epidemiological and microbiological surveillance implemented in pediatric patients with suspected CA-BSIs presenting for care at a secondary hospital in the conflict affected area of Zamfara state, Nigeria. Any child (> 2 months of age) presenting to Anka General Hospital from November 2018 to August 2020 with clinical severe sepsis at admission had clinical and epidemiological information and a blood culture collected at admission. Bacterial isolates were tested for antibiotic susceptibility. We calculated frequencies of epidemiological, microbiological and clinical parameters. We explored risk factors for death amongst severe sepsis cases using univariable and multivariable Poisson regression, adjusting for time between admission and hospital exit. We included 234 severe sepsis patients with 195 blood culture results. There were 39 positive blood cultures. Of the bacterial isolates, 14 were Gram positive and 18 were Gram negative; 5 were resistant to empiric antibiotics: methicillin-resistant Staphylococcus aureus (MRSA; n = 2) and Extended Spectrum Beta-Lactamase positive enterobacterales (n = 3). We identified no significant association between sex, age-group, ward, CA-BSI, appropriate intravenous antibiotic, malaria positivity at admission, suspected focus of sepsis, clinical severity and death in the multivariable regression. There is an urgent need for access to good clinical microbiological services, including point of care methods, and awareness and practice around rational antibiotic in healthcare staff in humanitarian settings to reduce morbidity and mortality from sepsis in children.

Antimicrobial Resistance and Associated Risk Factors of Gram-Negative Bacterial Bloodstream Infections in Tikur Anbessa Specialized Hospital, Addis Ababa

“…This result demonstrates that hospital pediatric patients are more affected by drug-resistant bacterial bloodstream infections. 75 Usage of Indwelling medical devices has exposure to multidrug resistance bloodstream infection. History of incubation has exposure to MDR bacterial infection.…”

Epidemiology and clinical presentation of community-acquired Staphylococcus aureus bacteraemia in children under 5 years of age admitted to the Manhiça District Hospital, Mozambique, 2001–2019

“…In 2019, S. aureus was amongst the top three pathogens responsible for global deaths associated with antimicrobial resistance (AMR), with methicillin-resistant S. aureus (MRSA) causing more than 100,000 annual deaths [ 3 ]. While SAB epidemiology is well described in high-income countries [ 2 , 4 ], data from low-income countries, particularly in sub-Saharan Africa, remain scarce [ 5 , 6 ]. This study aims to describe the burden, epidemiological trends and clinical presentation of community-acquired SAB among children aged < 5 years in southern Mozambique, between 2001 and 2019.…”

Assessment of blood cultures and antibiotic susceptibility testing for bacterial sepsis diagnosis and utilization of results by clinicians in Benin: A qualitative study

“…One of the laboratories included in our study reported yeast as the most commonly isolated microorganism from blood cultures. Indeed, yeasts are among the microorganisms isolated from bloodstream infections, but they are a relatively rare finding ( 4 , 14 , 23 , 24 ). It can therefore be assumed that, given the very low number of positive blood cultures in the laboratory in question, contamination and misidentification distorted the results.…”