Bacterial Bloodstream Infections and their Antimicrobial Susceptibility Patterns in Children and Adults in Ethiopia: a 6-Year Retrospective Study.

Abstract

In sub-Saharan Africa, bacterial bloodstream infection is the most common cause of morbidity and mortality. Regular antimicrobial surveillance is required to understand resistance development and to inform clinicians and policymakers on best empiric antibiotic choice, such type of data are scarce in the study area. This study aimed to determine bacterial profiles and their antibiotic susceptibility patterns from patients with suspected septicemia at the University of Gondar comprehensive specialized hospital, northwest Ethiopia, over a six-year period. We carried out a six-year (January 2, 2012, to January 1, 2018) retrospective analysis of blood cultures from patients with suspected septicemia. Laboratory report data were used to determine patient demographic, bacterial profiles, and antimicrobial resistance patterns. A total of 2,404 blood cultures were processed during the study period. Data were analyzed using SPSS version 20 software and the results were summarized using tables and graphs. Of the 2,404 blood cultures, 489 (20.7%, [95% CI, 19.2 - 22.3%]) bacteria isolates were obtained. The most common isolates were Staphylococcus aureus (215; 43.2%), followed by Klebsiella spp (67; 13.5%), coagulase-negative staphylococcus (62; 12.4%), Escherichia coli (38; 7.6%), viridans streptococci (25; 5%), Citrobacter spp (17; 3.4%), Enterobacter spp (15; 3%), and Streptococcus pneumoniae (12; 2.4%). Methicillin-resistant S. aureus isolation rate was 21/44 (47.7%). Gram-positive and negative bacteria showed high resistance to older antimicrobials, namely ampicillin, erythromycin, tetracycline, gentamicin, and trimethoprim-sulphamethoxazole. Gram-negative bacteria had a high level of resistance to 3rd generation cephalosporins, but both Gram-positive and negative bacteria were susceptible to ciprofloxacin. S. aureus, CoNS, S. pneumoniae, Klebsiella spp and E. coli remain the most important bacteria responsible for bloodstream infection in this study. Those pathogens showed a high rate of resistance to old antibiotics. Among the tested antimicrobials, ciprofloxacin was found to be the most effective drug to inhibit the in-vitro growth of both Gram-positive and negative bacteria. Therefore, there is a need for continuous screening of AMR from blood cultures to control the spread of drug resistant isolates in the study area.