Antimicrobial Resistance and Associated Risk Factors of Gram-Negative Bacterial Bloodstream Infections in Tikur Anbessa Specialized Hospital, Addis Ababa

Abstract

Background

Bloodstream infections (BSIs) are significant causes of morbidity and mortality in Ethiopia and worldwide. Alarming is the rapid global spread of antimicrobial resistance (AMR) in bacteria.

Objective

To determine the microbial profile, antimicrobial susceptibility pattern, and associated risk factors for bloodstream infections in Tikur Anbessa Specialized Hospital (TASH) Addis Ababa Ethiopia.

Methods

A cross-sectional study was conducted between September 2018 and March 2019. Blood collected twice from each septicemia suspected patient were processed following standard bacteriological procedures. AST was performed by using the disk diffusion test according to CLSI 2017 and 2018 guidelines. Data captured in Epidata were cleaned and analyzed by SPSS version 21 software.

Results

The prevalence of BSI was 28.06% and a higher proportion of pathogene detected were gram-negative bacteria (GNB) (54.5%) and gram-positive bacteria (GPB) (45.43%). The most abundant bacterial species were Klebsiella pneumoniae 17.6%, CoNS 15.2%, and Acinetobacter spp 11.0%. Culture positivity was associated with age below 6 years, neonates AOR p=<0.001, infants AOR p=<0.001, Pre-school P=0.002, ICU admission COR p=<0.001, length of admission >5 days COR P=0.016, temperature greater than 38°C, AOR p=0.013, instrument usage during medical care AOR, p=<0.001, chronic illness AOR p=0.027, and neonatal incubation AOR p=0.013. GNB average drug resistance rate was 57.9% of the commonly used antibiotics and the most efficient and inefficient drugs were amikacin (10.8%) and ampicillin (94.6%). The gram-negative isolates showed a 95.3% rate of multi-drug resistance; and MDR, XDR, and PDR were observed at 55.8%, 32.2%, and 7.3%, of isolates respectively. This finding shows children especially neonates were highly affected by drug resistant BSI.

Conclusion

Pediatric patients and ICU patients are more affected by BSI, and drug-resistant bacteria are a major problem. Therefore, appropriate intervention approaches need to be implemented.

Keywords:

• bloodstream infections
• bacterial isolates
• antimicrobial resistance

Abbreviation

AMR, Antimicrobial resistance; AST, Antimicrobial susceptibility tests; BSI, Blood Stream Infection; CVC, Central Vein Catheter; GII, Gastrointestinal Tract Infection; GNB, Gram-negative bacteria; GPB, Gram-positive bacteria; HABS, Hospitals acquire bloodstream infection; HAI, Hospital Acquire Infection; HCAI, Health Care Acquire Infection; ICU, Intensive Care Unit; IP, Infection Prevention; NICU, Neonatal Intensive Care Unit; LRI, lower respiratory infections; MDR, Multi-drug resistance; PDR, Pan drug-resistant; SWI, Surgical Wound Infections; TASH, Tikur Anbessa Specialized Hospital; UTI, Urinary Tract Infections; XDR, Extensively drug-resistant.

Acknowledgments

The authors would like to acknowledge Addis Ababa University College of Health Sciences Tikur Anbessa Specialized hospital for sponsorship and facilitation to do research in the microbiology laboratory. Addis Ababa university college of natural and computational science microbial cellular molecular biology infection biology stream for teaching coaching and mentorship.

Disclosure

The authors declare no conflicts of interest in relation to this work.

Additional information

Funding

Addis Ababa University vice president for research and technology transfer office thematic research program funding (VPRTTPY-0402018).