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Polymicrobial bloodstream infections a risk factor for mortality in neonates at the national hospital, Tanzania: A
Joel Manyahi1, Agricola Joachim1, Frank Msafiri1
1Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Background:
Polymicrobial bloodstream infections (BSI) are difficult to treat since empiric antibiotics treatment are frequently less effective against multiple pathogens. The study aimed to compare outcomes in patients with polymicrobial and monomicrobial BSIs.
Methods:
The study was a retrospective case-control design conducted at Muhimbili National Hospital for data processed between July 2021 and June 2022. Cases were patients with polymicrobial BSI, and controls had monomicrobial BSI. Each case was matched to three controls by age, admitting ward, and duration of admission. Logistic regression was performed to determine independent risk factors for in-hospital and 30-day mortality.
Results:
Fifty patients with polymicrobial BSI and 150 with monomicrobial BSI were compared: the two arms had no significant differences in sex and comorbidities. The most frequent bacteria in polymicrobial BSI were Klebsiella pneumoniae 17% (17/100) and Enterobacter species 15% (15/100). In monomicrobial BSI, S. aureus 17.33% (26/150), Klebsiella pneumoniae 16.67% (25/150), and Acinetobacter species 15% (15/150) were more prevalent. Overall, isolates were frequently resistant to multiple antibiotics tested, and 52% (130/250) were multidrug resistance. The 30-day and in-hospital mortality were 33.5% (67/200) and 36% (72/200), respectively. On multivariable analysis, polymicrobial BSIs were independent risk factors for both in-hospital mortality (aOR 2.37, 95%CI 1.20-4.69, p = 0.01) and 30-day mortality (aOR 2.05, 95%CI 1.03-4.08), p = 0.04). In sub-analyses involving only neonates, polymicrobial BSI was an independent risk factor for both 30-day mortality (aOR 3.13, 95%CI 1.07-9.10, p = 0.04) and in-hospital mortality (aOR 5.08, 95%CI 1.60-16.14, p = 0.006). Overall, the median length of hospital stay post-BSIs was numerically longer in patients with polymicrobial BSIs.
Conclusion:
Overall, polymicrobial BSI was a significant risk for mortality. Patients with polymicrobial BSI stay longer at the hospital than those with monomicrobial BSI. These findings call for clinicians to be more aggressive in managing polymicrobial BSI.
Insights
Polymicrobial bloodstream infections (BSI) significantly increase mortality risk compared to monomicrobial BSI. Aggressive management is crucial for better patient outcomes and reduced hospital stays.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Public Health
Background:
- Polymicrobial bloodstream infections (BSI) present treatment challenges due to reduced empiric antibiotic efficacy against multiple pathogens.
- Understanding the comparative outcomes of polymicrobial versus monomicrobial BSIs is critical for optimizing patient care.
Purpose of the Study:
- To compare clinical outcomes between patients diagnosed with polymicrobial BSI and those with monomicrobial BSI.
- To identify independent risk factors associated with mortality in patients with BSIs.
Main Methods:
- A retrospective case-control study was conducted at Muhimbili National Hospital from July 2021 to June 2022.
- Patients with polymicrobial BSI (cases) were matched with three controls having monomicrobial BSI based on age, ward, and admission duration.
- Logistic regression analysis was employed to determine independent risk factors for in-hospital and 30-day mortality.
Main Results:
- Polymicrobial BSIs were independently associated with increased in-hospital mortality (aOR 2.37) and 30-day mortality (aOR 2.05).
- In neonates, polymicrobial BSI was a significant risk factor for both in-hospital (aOR 5.08) and 30-day mortality (aOR 3.13).
- Isolates frequently exhibited multidrug resistance (52%), and patients with polymicrobial BSI had a numerically longer hospital stay.
Conclusions:
- Polymicrobial BSI is a significant independent risk factor for mortality.
- Patients with polymicrobial BSI experience longer hospitalizations compared to those with monomicrobial BSI.
- Clinicians should adopt a more aggressive management strategy for polymicrobial BSIs.
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