Laboratory-Confirmed Blood Stream Infections and Antimicrobial Resistance Pattern of Isolates from Febrile Pediatric Patients at Tertiary Hospital in Tanzania

Abstract

Background: Bloodstream infection (BSI) is one of the major causes of morbidity and mortality among children in Low and Middle-Income Countries. Febrile illness in pediatric patients requires urgent management; detecting the causative agent provides valuable information for appropriate management thus preventing the emergence of antimicrobial resistance (AMR). This study aimed to determine the magnitude of BSI and antimicrobial susceptibility pattern (AST) of bacteria among febrile pediatric patients. Method: A cross-sectional study involving febrile pediatric patients was conducted between January and May 2021 at a tertiary hospital in Dar es Salaam. Blood culture was performed in an automated system, isolates were identified using conventional biochemical tests and AST was performed. Result: The proportion of laboratory-confirmed BSI was 12.3% (95% CI: 8.2–17.5), with the pediatric intensive care unit (PICU) having the highest frequency (27%). S. aureus (38.5%) and K.pneumoniae (26.9%) were the predominant bacterial pathogens. Overall, resistance to common antibiotics was more than 50%. Majority of gram-negative bacteria (GNR) (56.3%) were resistant to meropenem. Sixty per cent of S. aureus were MRSA, 50% of GNR were Extended-spectrum beta-lactamase (ESBL) producers, and 65.4% of the isolates were multi-drug resistant (MDR). Children admitted to PICU had 5 times more adjusted odds of having laboratory-confirmed BSI than children at other wards (aOR = 4.8, 95% CI, 1.5 –16.1, p =0.010). Conclusion: Laboratory confirmed BSI was relatively high among febrile pediatric patients; significantly found in infants and those admitted to PICU. Most isolated bacteria were MDR calling for routine blood culture and AST for appropriate management of BSI.