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Multi-Drug Resistant, Extended Spectrum β-Lactamase and Carbapenemase Producing Bacterial Isolates from Blood Culture and Associated Factors among Children Suspected of Bloodstream Infection at Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia

Abstract

Background: Bloodstream Infections (BSI) due to bacterial pathogens are a major cause of morbidity and mortality among pediatric patients. Emergence of drug resistance from first line to last line antibiotics among bacterial pathogens is another issue of public health concern. In Ethiopia, particularly in Tikur Anbessa specialized hospital, antimicrobial resistance reports are progressively increasing in children with sepsis. Therefore, the study aimed at determines the magnitude of multidrug resistance bacterial isolates from children. Methods: A cross-sectional study was conducted from September 2017 to June 2018 among pediatric patients with febrile illness aged less than five years at Tikur Anbessa Specialized Hospital (TASH). Three-hundred forty blood samples were collected and processed following standard microbiological techniques. Each sample was incubated with automated BacT/ALERT system for initial growth indicator and followed by identification of bacteria with conventional methods. Antimicrobial susceptibility testing of the isolates was performed by Kirby-Bauer disc diffusion method and the E-Test to obtain the Minimum Inhibitory Concentration (MIC) for vancomycin. Results: A total of 137 (40.2%) bacterial pathogens were isolated from pediatric patients. Of these isolates, 46% were gram positive and 54% were gram negative bacteria. The predominant microorganisms isolated from blood samples were Klebsiella pneumoniae (31.4%), Staphylococcus aureus (21.2%), coagulase negative Staphylococcus species (10.9%) and Acinetobacter species (8.0%). Among K. pneumoniae isolates, 90.7%, 30.2%, 7.0%, 32.5% and 34.8% were Multi-Drug Resistane (MDR), Extended Drug Resistance (XDR), Pan-Drug Resistance (PDR), Extended Spectrum Beta Lactamase (ESBL) and Carbapenem Resistant Entobacteralces (CRE) respectively. The frequency of Methicillin Resistant Staphylococcus aureus (MRSA) was 55.2%. Among clinical conditions, high grade fever (AOR=3.2; (1.4, 7.3)), previous hospitalization (AOR=25.0, 95% CI (5.0, 111.1)) and complication of bacteremia for development of sepsis/septic shock/septicemia (AOR=20.0; 95% CI (6.25, 50.0)) were independent risk factors for positive blood culture (P<0.05). Conclusion: In our study, K. pneumoniae and S. aureus are common pathogens associated with bloodstream infections. The existence of MDR, CRE and ESBL producing isolates calls for intervention measures for infection prevention and antibiotic stewardship in TASH and beyond.

Mequanit Mitiku, Zeleke Ayenew*, Martin Evans, Kassu Desta

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