Identification of selected primary bloodstream infection pathogens in patients attending Kisii level five and Homa Bay county hospitals

Ronald Kirera,Margaret Koech,Elizabeth Odundo,Christine Hulseberg,Janet Ndonye,Cliff Odhiambo Philip,Joseph Nganga,Alexander F Flynn,Erick Kipkirui,Abigael Ombogo,Mary Kirui,Daniel Kariuki,Judd Walson,Nancy Kipkemoi

doi:10.12688/f1000research.26300.1

Abstract

Background: Bloodstream infection (BSI) contributes to a substantial proportion of mortality in sub-Saharan Africa and is marked by the presence of bacterial and/or fungal microorganisms in the blood. Because BSI can be life threatening, it requires a timely, reliable and accurate diagnosis. This study retrospectively analyzed data of identified BSI pathogens and compared the performance of the different diagnostic technologies used in terms of accuracy, sensitivity, turnaround time (TAT) and cost. Methods: Currently, culture followed by analytical profile index biochemical strips (API), (BioMerieux) are used as the conventional standard diagnostics in Kenyan public hospitals and labs. We compared the results of this standard to that of the BioFire FilmArray (FA) (BioFire Diagnostics) and MicroScan WalkAway-40 plus System (MS) (Beckman Coulter) used in diagnosis of BSI. The FA technology was able to identify 150/152 bacterial and yeast isolates with an overall accuracy of 99.04% (95% CI: 96.59-99.88%), sensitivity of 98.68% (95% CI: 95.33-99.84%), mean TAT of 8 hours 40 minutes per eight samples and running cost per sample of USD 140.11. The MS identified 150/152 isolates with an overall accuracy of 98.56% (95% CI: 95.86-99.70%), sensitivity of 98.68% (95% CI: 95.30-99.84%), mean TAT per sample was 42 hours and running cost per sample of USD 28.05. API detected 150/152 isolates, with an overall accuracy of 99.04% (95% CI: 96.59-99.88%), sensitivity of 98.68% (95% CI: 95.33-99.84%) and the mean TAT per sample was 53 and 103 hours for bacterial and yeast samples, respectively, with a running cost per sample of USD 28.05.Conclusions: The findings in this paper suggest that the FA and MS platforms should be able to perform adequately in Kenya referral hospitals and medical clinics as a rapid diagnostic tool.

Highlights

Bacteremia accounts for a large number of hospital admissions and results in high morbidity and mortality1
The findings in this paper suggest that the FA and MicroScan WalkAway plus (MS) platforms should be able to perform adequately in Kenya referral hospitals and medical clinics as a rapid diagnostic tool
These positive factors outweigh the use of API strips for microbial identification, which is considered the conventional standard in Kenya for diagnosis of bloodstream infections (BSI)

Summary

Introduction

Bacteremia accounts for a large number of hospital admissions and results in high morbidity and mortality. In subSaharan Africa, there is limited information on bloodstream infections (BSI), which can be partly attributed to the paucity of studies conducted in developing countries lacking high throughput BSI diagnostic technology. Blood culture and analytical profile index (API, BioMerieux) strip analysis has been the conventional standard for bacteremia diagnosis in many hospitals throughout the world, including Kenya. Blood culture and analytical profile index (API, BioMerieux) strip analysis has been the conventional standard for bacteremia diagnosis in many hospitals throughout the world, including Kenya6,7 Using this technique has been a challenge because it is a labor intensive process that requires experienced laboratory technologists and has a reportedly lower level of accuracy than other techniques such as conventional cultures. API detected 150/152 isolates, with an overall accuracy of 99.04%

Methods

Results

Discussion

Conclusion