Prevalence of bacterial bloodstream infections and antibiotic susceptibility patterns in a Regional Referral Hospital, Ghana-2017

Abstract

Introduction : bacterial Bloodstream Infections (BSIs) and associated antibiotic resistance are life threatening emergencies. They cause significant morbidity and mortality, especially amongst infants and the elderly. Delays in diagnosis, culture and antibiotic sensitivity often leads to poor management and prognosis. Patterns of circulating bacteria and their antibiotic susceptibilities continue to vary with facility settings and time, hence continuous surveillance is necessary. We determined the predominant bacteria, distribution, and antibiotic susceptibilities to provide empirical data for timely and effective management of BSIs in Brong Ahafo Regional Hospital, Sunyani (BARHS). Methods : we conducted a descriptive cross sectional studies. We reviewed and abstracted laboratory blood culture records of patients suspected of BSI at BARHS for the period January to December, 2016. Data collected included: sex, age, results of blood culture, type of organism and antibiogram results. Descriptive analysis was done and Results: presented as frequencies, ranges, percentages and rates. Results : of 485 blood culture records obtained on patients suspected of BSI, majority 248 (51.1%) were females; median age was 2years(range; 1day-93years). The prevalence of culture positive cases (confirmed BSI) was 148(30.5%). Amongst the confirmed BSI patients, the age-group positivity rates were; 65 years (elderly), 4/16 (25.0%); and, no age, 24/57 (42.1%). Proportion of positive cases was highest amongst females, 77/148 (52.0%). Gram-positive bacteria (GPB) were predominant, 106 (71.6%) and the most frequent bacteria species isolates were Streptococcus sp, Coagulase negative staphylococci (CNS), and Salmonella sp, 85 (57.4%), 19(12.8%) and 13 (8.8%) respectively. Three of the isolates were Candida sp. (Fungi). Across both GPB and Gram-negative bacteria, the most effective antibiotics were; Lincomycin, Levofloxacin, Amikacin, Ceftriaxone, and Ciprofloxacin with susceptibilities between 71 to 100%, whilst the least effective were Penicillin, Cefuroxime and Ampicillin, with susceptibilities of 4.5, 19.0 and 29.2% respectively. Streptococcus and Salmonella sp. were particularly susceptible to Lincomycin, Ciprofloxacin, and Ceftriaxone (80-100%). Conclusion : prevalence of BSIs is high in BARHS. Gram-positive bacteria were the predominant group isolated, and Streptococcus sp. was the most frequent bacteria implicated. Infant females are mostly affected. Overall, the most effective antibiotics were Lincomycin, Amikacin and Ciprofloxacin, We recommended, Lincomycin, Ciprofloxacin and Ceftriaxone as particularly useful for treating Streptococcal and Samonella BSIs in BARHS.