Transitioning to Automated Microbiologic Era: Blood Culture Isolates in Children and Adults in Federal Teaching Hospital in Gombe, North East Nigeria 2016-2020

Abstract

Introduction: Automated blood culture systems for incubation and growth monitoring have become the standard in high-income countries (HICs), but are still relatively expensive and not universally available for implementation in most low- and middle-income countries (LMIC). We aimed to report blood culture isolates using Automated technique in children and adults admitted into the Federal Teaching Hospital Gombe from 2016 to 2020. Materials and Methods: Blood Culture Isolates in children (0 - 18 years) and adults (>19 yrs) by Bactec 9050 Automated culture system from 2016-2020 were retrieved from the medical and laboratory register. Information analyzed included, age, sex, month, and year and culture growth and reported antibiotic sensitivity. A Bactec Blood culture tests is $20 in this facility. In Nigeria, the minimum monthly wage is $70 (Official currency exchange rate is N423/US Dollar). Results: Of the 1713 blood cultures performed, children 0 - 18 years were 1322 (77.2%) and adult (19 years above) (22.8%). Overall positivity was 733 (42.2%) with males 385 (52.5%). Of the 1322 Blood cultures (BC) in children 615 (46.5%) were positive for isolates and adults 118 (30.2)%. Blood culture positivity decreased with increasing age with newborns 251 (34.5%) and adults > 65 years 18 (2.5%). Staphylococcus aureus constituted 61.3% of all isolates and was the leading isolates in all age groups; Alkaligenes (9.1%); Citrobacter 8.1%, Klebsiella 6.7%; Pseudomonas 6.1%; E. coli 2.7%; Enterococcus 2%; Proteus 1%. Of the Antimicrobial resistance priority isolates E. coli susceptibility ranged from 71% to Gentamycin and 100% to Cefixime; Klebsiella from 25% sensitivity to Amikacin to 78% each to chloramphenicol and ciprofloxacin; Salmonella was 100% sensitive to chloramphenicol, ciprofloxacin and cefuroxime. Klebsiella was 100% sensitive to Cefoxitin; Proteus sensitivity ranged from 35% to ampicillin and 100% to ciprofloxacin and cefuroxime. Staph aureus sensitivity was 35% to cefoxitin, 70% to amoxicillin/clavulanate and 70% to cefuroxime. Conclusion: Blood culture yield by Automated method was high. Staph aureus was the predominant pathogen and bacterial yield reduced with increasing age. Antibiotic sensitivity was variably reduced against gram negative bacteria.