Antimicrobial resistance patterns of isolates from bloodstream infections at Jinja Regional Referral Hospital in Uganda
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Abstract
Background: Bloodstream infections (BSIs) are common acute syndromes of variable origin with high chances for extreme health effects including death. Empirical therapy is usually employed to manage the BSIs despite the high resistance to the antibacterial agents used including cefriaxone and/or metronindazole. This study determined the aetiologic agents responsible for bloodstream infections, their antimicrobial susceptibility patterns, and infection sources in Eastern-central Uganda. Patients and methods: This retrospective cross-sectional study involved analysis of data from all non-duplicate blood culture reports from 2019 to 2021. These were earlier generated using single set blood culture, conventional microbiology techniques and disc diffusion-based antimicrobial susceptibility testing (AST) guided by the Clinical and Laboratory Standards Institute (CLSI) guidelines. World Health Organization Network (WHONET) 2022 desktop software and Microsoft Excel were utilised for data analysis. Results: The 1364 reports showed a diagnostic yield of 6.8% (93/1364) and a 1.5%(21/1364) contamination rate. Overall, 37% and 13% of infections were hospital-acquired and community-acquired respectively. Most etiologic agents were Gram-positive bacteria dominated by Staphylococcus aureus 39/114 (34.2%). Polymicrobial growth existed in 4/1364(0.3%) cases. Staphylococcus aureus was mainly resistant to penicillin G (100%) and most susceptible to gentamicin (%S=74.1, 95% C.I:53.4-88.1). Escherichia coli and unspecified Coliforms together showed high resistance to ampicillin (87.5%) and third-generation cephalosporins (100%). The least resistance was to chloramphenicol and carbapenems. Conclusion: Staphylococcus aureus highly sensitive to gentamicin was the commonest cause of BSIs in this setting. Therefore, empirical management of suspected BSI cases in the region should include gentamicin. Use of Microbiology services including culture and sensitivity to guide targeted antimicrobial use and monitor resistance trends is required to strengthen antimicrobial stewardship.
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Abstract
Background: Bloodstream infections (BSIs) are common acute syndromes of variable origin with high chances for extreme health effects including death. Empirical therapy is usually employed to manage the BSIs despite the high resistance to the antibacterial agents used including cefriaxone and/or metronindazole. This study determined the aetiologic agents responsible for bloodstream infections, their antimicrobial susceptibility patterns, and infection sources in Eastern-central Uganda.
Patients and methods: This retrospective cross-sectional study involved analysis of data from all non-duplicate blood culture reports from 2019 to 2021. These were earlier generated using single set blood culture, conventional microbiology techniques and disc diffusion-based antimicrobial susceptibility testing (AST) guided by the Clinical and Laboratory Standards Institute (CLSI) guidelines. World Health Organization Network (WHONET) 2022 desktop software and Microsoft Excel were utilised for data analysis.
Results
The 1364 reports showed a diagnostic yield of 6.8% (93/1364) and a 1.5%(21/1364) contamination rate. Overall, 37% and 13% of infections were hospital-acquired and community-acquired respectively. Most etiologic agents were Gram-positive bacteria dominated by Staphylococcus aureus 39/114 (34.2%). Polymicrobial growth existed in 4/1364(0.3%) cases. Staphylococcus aureus was mainly resistant to penicillin G (100%) and most susceptible to gentamicin (%S=74.1, 95% C.I:53.4-88.1). Escherichia coli and unspecified Coliforms together showed high resistance to ampicillin (87.5%) and third-generation cephalosporins (100%). The least resistance was to chloramphenicol and carbapenems.
Conclusion
Staphylococcus aureus highly sensitive to gentamicin was the commonest cause of BSIs in this setting. Therefore, empirical management of suspected BSI cases in the region should include gentamicin. Use of Microbiology services including culture and sensitivity to guide targeted antimicrobial use and monitor resistance trends is required to strengthen antimicrobial stewardship.
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