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

Joel Manyahi,Edna Mgimba,Mtebe Majigo,Upendo Kibwana,Anne Wertheimer

doi:10.1371/journal.pone.0220424

Abstract

Bloodstream 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. This 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. The 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). The prevalence of BSI was 11.4%, with the majority of bacteria in BSI were MDR. Positive blood culture, admission to the ICU and MDR were predictors for mortality.

Highlights

Bloodstream infection (BSI) is life-threatening associated with increased mortality, and morbidity and health care costs [1]
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

Summary

Introduction

Bloodstream infection (BSI) is life-threatening associated with increased mortality, and morbidity and health care costs [1]. MDR bacteria causing BSI are associated with poor patient outcome compared to susceptible bacteria [2, 3]. Treatment of BSI in the resource-limited setting is largely empirical using broad-spectrum antibiotics. Prompt reporting of results coupled with identifying critical values and antibiogram pattern provided by laboratories facilitate the successful management of patients with BSI. Factors predicting mortality in BSI have been investigated [2, 8] but few data exist in Tanzania. Bloodstream 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.

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Conclusion