Multi-drug resistance bacteria predict mortality in blood stream infection in a tertiary setting in Tanzania

BackgroundBlood-stream infections (BSIs) are serious and life-threatening infections associated with high mortality and morbidity. In resource limited settings, there is paucity of data on predictors of outcome in patients with BSI. This study aimed at examining the predictors of mortality in patients with BSI as well as bacteria causing BSI.\n\nMethods and MaterialsThis was cross-sectional study conducted in Muhimbili National Hospital between April and May 2018. Blood culture results from all inpatients at clinical microbiology laboratory were recorded and clinical information were retrieved retrospectively from the files. Bacteria from positive blood culture were identified and antimicrobial susceptibility was performed.\n\nResultsThe overall prevalence of BSI was 11.4% (46/402), with case fatality rate of 37%. There was significant high rate of BSI in patient who had died compared to those survived p= 0.008. Gram-negative bacteria (74%) were the common cause of BSI, with predominance of Enterobacteriaceae (22), followed by Pseudomonas aeruginosa (11). Majority (70.5%) of the bacteria isolated from patients with BSI were multi-drug resistant. Forty six percent of Pseudomonas aeruginosa were resistance to meropenem. Sixty eight percent 68.2% (15/22) of Enterobacteriaceae were ESBL producers. Carbapenemases production were detected in 27% (3/11) of Pseudomonas aeruginosa and in one Proteus mirabillis. Forty percent (40%) of Staphylococcus aureus were methicillin resistant Staphylococcus aureus (MRSA). Positive blood culture (cOR 7.4, 95%CI 1.24 - 43.83, p 0.03) and admission in ICU cOR 4 (95%CI 1.7 - 9.41, p 0.001) were independent factors for mortality in suspected BSI. Isolation of Multi-drug resistant bacteria was independent predictor for mortality in confirmed BSI (cOR 7.4, 95%CI 1.24 - 43.83, p 0.03).\n\nConclusionThe prevalence of BSI was 11.4%, with majority of bacteria in BSI were MDR. Positive blood culture and MDR were predictors for mortality.