An alarming prevalence of multidrug-resistant (MDR) ESKAPE pathogens and other drug-resistant bacteria isolated from patients with bloodstream infections hospitalized at Muhimbili National Hospital in Dar es Salaam, Tanzania

Abstract

This study was conducted between April and May 2023 at the Muhimbili National Hospital in Tanzania to determine the prevalence of multidrug-resistant (MDR) ESKAPE, and other drug-resistant bacteria isolated from 856 patients with bloodstream infections (BSIs). The prevalence of BSIs was 37.3% (319/856), with 5% (17/319) of the patients having polymicrobial infections. The prevalence of BSIs was slightly greater among males (38.3%, 162/423) than females (36.3%, 157/433) (p= 0.585. Most of the infections occurred in children aged <1 year (45.3%, 149/329) or adults aged ≥61 years (45.7%, 37/81) (p= 0.001). Patients admitted to the intensive care unit (ICU) had significantly greater BSIs (44%; 113/258) than those admitted to other wards (34.4%; 206/599) (p= 0.006). The ESKAPE pathogens accounted for 43.28% of all the isolates, predominantly Staphylococcus aureus (16.4%), followed by Klebsiella pneumoniae (9.25%), Acinetobacter spp. (6.86%), and Pseudomonas aeruginosa (4.77%). The overall proportion of MDR bacteria was 83.8%, and 63.64% were resistant to more than four classes of antibiotics. Among the remaining strains, 23.4% of the ESKAPE pathogens and 10% of the MDR Enterobacterales were resistant to eight different classes of the tested antibiotics and were regarded as extensively drug-resistant (XDR). Resistance to 3rd generation cephalosporins was observed in 91% of the Klebsiella pneumoniae isolates and all the Enterobacter spp. The proportion of methicillin-resistant S. aureus (MRSA) was 71.4%. Based on these results, we strongly discourage empiric treatment of BSIs and recommend that laboratory results guide all prescriptions. Immediate action is undoubtedly needed to introduce rapid drug resistance tests and review the existing management guidelines.