Auditing Bloodstream infection in an Intensive Care Unit in Botswana
Keywords:
bloodstream infection, mortality rate, antimicrobial resistanceAbstract
Introduction: Nosocomial infections are a significant problem in Intensive Care units (ICUs) worldwide; however, very little research exists into their epidemiology and characteristics in subSaharan Africa. The largest public hospital ICU in Botswana underwent its first internal audit in 2017-18 and nosocomial infections were one of the defined study parameters.
Objectives: ICU admissions over 12 months were analyzed to establish the principal causative microorganisms responsible for bloodstream infection (BSI), sensitivity patterns to common antibiotics used, as well as patient outcomes.
Methods: Data from patients over the age of 14 admitted between April, 1st 2017 and March, 31st 2018 were retrospectively analyzed for the presence of BSI, BSI organisms and sensitivities and patient mortality.
Results: 182 patients were enrolled, and there were 13 BSI recorded (7.4%). There was no significant difference in mean APACHE II scores noted in the patients with BSI and without BSI (25.8±4 vs 25±5; p=0.50). The principal causative microorganism for BSI was the Klebsiella species. BSI was associated with a higher risk of dying in ICU (61.5% vs 40.1%, OR 2.38; p= 0.14) as well as a higher 30-day mortality rate of 92.3% for patients with BSI vs 46.1% without BSI (OR 13.43; 95%; p=0.01).
Conclusions: BSI impacts negatively on the ICU length of stay, ICU and 30-day mortality rate. HIV-infection is associated with a higher risk of bacteriaemia. There is a high resistance pattern to the use of β-lactams including the third-generation cephalosporins.
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