Multi-drug resistant bacteria predict mortality in bloodstream infection in a tertiary setting in Tanzania

Abstract

BackgroundBloodstream infections (BSI) are serious and life-threatening, associated with high mortality and morbidity. In resource-limited settings, there is a paucity of data on predictors of outcome in patients with BSI. This study aimed at examining the predictors of mortality in patients with BSI as well as bacteria causing BSI. Methods and materialsThis was a cross-sectional study conducted at Muhimbili National Hospital between April and May 2018. Blood culture results from all inpatients at the clinical microbiology laboratory were recorded and clinical information was retrieved retrospectively from the files. Bacteria from positive blood culture were identified and antimicrobial susceptibility was performed. ResultsThe overall prevalence of BSI was, 46/402 (11.4% 95% CI 8.6-15), with a case fatality rate of 37%. There was a significantly high rate of BSI in patients who had died (19.5%) compared to those who survived (9.2%) p = 0.008. Gram-negative bacteria (74%) were the common cause of BSI, with a predominance of Enterobacteriaceae ( 22), followed by Pseudomonas aeruginosa (11). The majority of bacteria (70.5%) isolated from patients with BSI were Multi-drug resistant (MDR). Forty-six percent of Pseudomonas aeruginosa were resistant to meropenem while 68% (15/22) of Enterobacteriaceae were extended-spectrum β lactamase producers. Carbapenemase production was detected in 27% (3/11) of Pseudomonas aeruginosa and one Proteus mirabilis. Forty percent of Staphylococcus aureus were methicillin-resistant Staphylococcus aureus. Positive blood culture (aOR 2.24, 95%CI 1.12-4.47, p 0.02) and admission to the intensive care unit (aOR 3.88, 95%CI 1.60-9.41, p = 0.003) were independent factors for mortality in suspected BSI. Isolation of MDR bacteria was an independent predictor for mortality in confirmed BSI (aOR 15.62, 95%CI 1.24-161.38, p = 0.02).

Antimicrobial Resistance in Enterobacterales and Its Contribution to Sepsis in Sub-saharan Africa

“…A study in pediatric patients at a hospital in Senegal showed that AMR carriage is associated with delayed time to appropriate antibiotics and a substantial increase in mortality from 15.4 to 54.8% in patients with ESBL-producing Enterobacterales BSI compared to susceptible strains ( 77 ). This was confirmed by another study from Tanzania which found AMR to be an independent risk factor for mortality in both children and adults with BSI, with mortality rates increasing from 13.7 to 48.4% when organisms were multidrug resistant compared to those that were susceptible ( 78 ). Similarly, a study of adult patients in Ethiopia showed significant increase in mortality with BSI if the isolate was resistant to third generation cephalosporins, with all patients with resistant infection in that study having died ( 79 ).…”

The Governance and Implementation of the National Action Plan on Antimicrobial Resistance in Tanzania: A Qualitative Study

“…However, lack of information regarding how much is allocated to AMR-specific research is an indication of a lack of clear strategies to achieve the identified AMR objectives and goals. Moreover, in reviewing AMR articles (published from 2018–2020) none has indicated receiving financial assistance from the government of Tanzania [ 6 , 12 , 13 , 22 ].…”

“…The development of the NAP was coordinated by the Ministry of Health, Community Development, Gender, Elderly and Children (herein after referred to as Ministry of Health, MoH) in collaboration with the Ministry of Livestock and Fisheries and the World Health Organization (WHO). Despite the fact that the NAP has been in place for more than three years, AMR is still a challenge for human, animal and environmental health in Tanzania [ 6 , 12 , 13 ].…”

Multidrug-Resistant, Including Extended-Spectrum Beta Lactamase-Producing and Quinolone-Resistant, Escherichia coli Isolated from Poultry and Domestic Pigs in Dar es Salaam, Tanzania

“…AMR in humans has been associated with high morbidity and mortality rates, especially in low-income countries, due to an inability to detect resistance and limited treatment options [ 10 , 11 , 12 ]. In Tanzania, infections with AMR and multidrug-resistant (MDR) bacteria, especially extended-spectrum beta lactamase (ESBL) and carbapenemase producers, have been associated with increased morbidity and mortality [ 13 , 14 , 15 ]. Some of the studies conducted in the country have associated AMR with inappropriate prescriptions and self-medication [ 16 , 17 ], and often antibiotics are dispensed without a prescription [ 18 ].…”