Multi-drug resistant, extended spectrum beta-lactamase and carbapenemase producing bacterial isolates among children under five years old with suspected bloodstream infection in a specialized hospital in Ethiopia: Cross-sectional study

Abstract

BackgroundBloodstream infections due to bacterial pathogens are a major cause of morbidity and mortality among pediatric patients. Emergence of drug resistance in high classes to antibiotics among the bacterial pathogens is another issue of public health concern. Therefore, this study was conducted to determine multi-drug resistant, extended spectrum β-lactamase and carbapenemase producing bacterial isolates among suspected bloodsteam infection patients in children under five years of age at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia.MethodsA cross-sectional study was conducted from September 2017 to June 2018 among pediatric patients with febrile illness under five years of age at Tikur Anbessa Specialized Hospital. Three hundred and forty blood samples were collected and processed following standard microbiological techniques and blood culture was performed using a BacT/Alert instrument in combination with conventional methods for identification. Antimicrobial susceptibility testing of the isolates was performed using the Kirby-Bauer disc diffusion method to determine the minimum inhibitory concentration (MIC).ResultA total of 137 (40.2%) bacterial pathogens were isolated from 340 pediatric patients suspected of bloodstream infection with febrile illness. Of these isolates, 54% were Gram negative bacteria. Among gram negative isolates 43 (31.4%) were identified as Klebsiella pneumoniae and 8.7% Acinetobacter species were the most frequently isolated pathogens. Klebsiella pneumoniae isolates were 88.4 % (38/43) MDR, 32.5% (14/43) ESBL, and 37.2 %( 16/43) CRE .ConclusionIn this study, highly resistant Klebsiella pneumoniae are common pathogen associated with BSI. Extended spectrum beta-lactamase (ESBL) producing strains were common in Klebsiella species and Escherichia coli isolates. Since most of isolates exhibit multidrug resistance, in vitro antimicrobial susceptibility testing is mandatory. A strengthened antimicrobial surveillance system and antimicrobial stewardship programs are necessary for better selection of antibiotics in addition to improved infection prevention practices in hospital settings.