Blood stream infections and antimicrobial susceptibility patterns in critical care patients at Nakasero hospital

Abstract

Blood stream infection contributes to mortality and morbidity among inpatients. Antimicrobial resistance further complicates sepsis management across all settings, particularly neonates and patients in critical care units (ICUs). A laboratory based cross-sectional study was conducted at Nakasero hospital critical care units involving 181 patients suspected to have blood stream infection. Majority of the participants were from intensive care unit (ICU), 137/181 (75.69%) followed by High Dependency Unit (HDU), 25/181 (13.81%) and Neonatal Intensive Care Unit (NICU), 19/181(10.5%). The overall prevalence of blood stream infection was 22/181 (12.15% 95% CI 8.11-17.83). The prevalence was higher among females 10/66 (15.15% 95% CI 6.5-23.8) and 12/115 (10.43% 95% CI 8.8-16.0). The highest Prevalence of BSI was at the neonatal intensive care unit (NICU) constituting 7/12 (36.84%). The commonly isolated bacteria were Klebsiella pneumoniae 4/22 (18.18%) followed by Escherichia coli, 3/22 (13.64%). Candida albicans and Pseudomonas aeruginosa each constituted 9.09% of the total isolates. Except for Acinetobacter baumanii, the bacterial isolates showed high susceptibility to Piperacillin tazobactam ranging from 75% (for K. pneumonia) to 100% (for E. coli and Acinetobacter haemolyticus). There was 100% resistance to Cefuroxime except for Serratia marcescens which showed 100% susceptibility. K. pneumonia and P. aeruginosa showed 50% susceptibility to Cefepime and Ceftriaxone with E. coli showing 66.7% resistance to Cefepime and Ceftriaxone Acinetobacter baumanii isolate showed resistance to all the Cephalosporins. S. aureus showed susceptibility to Gentamycin, Levofloxacin, Tobramycin, Nitrofurantoin, Teicoplanin and Rifampicin. Enterococcus sp. was resistant to most antibacterial except Lincomycin (100%), Nitrofurantoin and Teicoplanin at 50%. All candida isolates were susceptible to Ketoconazole, Miconazole, Nystatin, Itraconazole and Tobramycin. Antifungal resistance was recorded for Caspofungin, Fluconazole, Micafungin and Voriconazole. With high prevalence of blood stream infection, there is need for establishment and implementation of a robust strategies to improve and monitor the different infection prevention and control (IPC) guidelines.