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A prospective observational study of bacteraemia in adults admitted to an urban Mozambican hospital

Michael Preziosi, Tomas Francisco Zimba, Kristen Lee, Manuel Tomas, Suraida Kinlin, Clotilde Nhatave-Paiva, Rosa Bene, Tania Paunde, Helder Lopes, Stephen Kalkhoff, Vishnu Prathap, Kevan Akrami, Emilia Virginia Noormahomed, Robert Turner Schooley, Eliah Aronoff-Spencer

Abstract


Background. Bacteraemia is a common cause of fever among patients presenting to hospitals in sub-Saharan Africa. The worldwide rise of antibiotic resistance makes empirical therapy increasingly difficult, especially in resource-limited settings.

Objectives. To describe the incidence of bacteraemia in febrile adults presenting to Maputo Central Hospital (MCH), an urban referral hospital in the capital of Mozambique, and characterise the causative organisms and antibiotic susceptibilities. We aimed to describe the antibiotic prescribing habits of local doctors, to identify areas for quality improvement.

Methods. Inclusion criteria were: (i) ≥18 years of age; (ii) axillary temperature ≥38°C or ≤35°C; (iii) admission to MCH medical wards in the past 24 hours; and (iv) no receipt of antibiotics as an inpatient. Blood cultures were drawn from enrolled patients and incubated using the BacT/Alert automated system (bioMérieux, France). Antibiotic susceptibilities were tested using the Kirby-Bauer disc diffusion method. Results. Of the 841 patients enrolled, 63 (7.5%) had a bloodstream infection. The most common isolates were Staphylococcus aureus, Escherichia coli, and non-typhoidal Salmonella. Antibiotic resistance was common, with 20/59 (33.9%) of all bacterial isolates showing resistance to ceftriaxone, the broadest-spectrum antibiotic commonly available at MCH. Receipt of insufficiently broad empirical antibiotics was associated with poor in-hospital outcomes (odds ratio 8.05; 95% confidence interval 1.62 - 39.91; p=0.04).

Conclusion. This study highlights several opportunities for quality improvement, including educating doctors to have a higher index of suspicion for bacteraemia, improving local antibiotic guidelines, improving communication between laboratory and doctors, and increasing the supply of some key antibiotics. 


Authors' affiliations

Michael Preziosi, University of California, San Diego, USA

Tomas Francisco Zimba, Universidade Eduardo Mondlane, Maputo, Mozambique

Kristen Lee, Emory University, Atlanta, GA, USA

Manuel Tomas, Universidade Eduardo Mondlane, Maputo, Mozambique

Suraida Kinlin, Universidade Eduardo Mondlane, Maputo, Mozambique

Clotilde Nhatave-Paiva, Universidade Eduardo Mondlane, Maputo, Mozambique

Rosa Bene, Universidade Eduardo Mondlane, Maputo, Mozambique

Tania Paunde, Universidade Eduardo Mondlane, Maputo, Mozambique

Helder Lopes, Universidade Eduardo Mondlane, Maputo, Mozambique

Stephen Kalkhoff, University of Iowa, Iowa City, USA

Vishnu Prathap, University of California, San Diego, USA

Kevan Akrami, National Institutes of Health, Bethesda, MD, USA

Emilia Virginia Noormahomed, University of California, San Diego, USA; Uiversidade Eduardo Mondlane, Maputo, Mozambique

Robert Turner Schooley, University of California, San Diego, USA

Eliah Aronoff-Spencer, University of California, San Diego, USA

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Keywords

Bacteraemia; Sub-Saharan Africa; Mozambique; Non-typhoidal Salmonella; ESBL; MRSA; Extended-spectrum beta-lactamase

Cite this article

South African Medical Journal 2015;105(5):370-374. DOI:10.7196/SAMJ.8780

Article History

Date submitted: 2014-08-07
Date published: 2015-05-27

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