Bacteraemia in a Nigerian hospital: Implementing antimicrobial resistance surveillance

Surveillance of drug-resistant infections is crucial for antimicrobial resistance (AMR) control. Implementing surveillance in low- and middle-income countries (LMICs) is challenging.

To investigate bacteraemia and describe AMR surveillance.

Tertiary healthcare facility.

Case finding was by WHO Global AMR and Use Surveillance System (GLASS). Blood samples were processed between May 2017 and June 2018, using BACTEC blood culture system. Bacterial identification, antibiotic susceptibility testing and detection of AMR genes followed standard protocols.

Aerobic blood cultures were conducted in a third of clinical sepsis cases (n = 601/1851), of which 114 (19.0%) were true positives, with a 2.2% contamination rate. Pathogens recovered included six priority blood pathogens reportable to WHO GLASS. Sixteen (30.2%) of 53 Gram-negative isolates were extended-spectrum beta-lactamase producers, predominantly harbouring bla _CTX-M, three (5.7%) were AmpC beta-lactamase producers, and 20 (37.7%) were carbapenem-resistant, predominantly harbouring bla _KPC. Twenty-nine (50.9%) of 57 Staphylococcus aureus isolates were methicillin-resistant; 17 (58.6%) of these harboured mecA genes. Hospital-acquired infection (odds ratio [OR] = 0.3, 95% confidence interval [CI]=0.1-0.7, p = 0.004) was identified as a predisposing factor for the development of multidrug-resistant (MDR) bacteraemia. Bacteraemia with MDR organisms was significantly associated with mortality (OR = 3.8, 95% CI = 1.6-9.1, p = 0.001).

A wide variety of bacteria are responsible for bacteraemia in our setting, with more than half being multidrug-resistant. Bacteraemia with multidrug-resistant organisms was significantly associated with mortality, hence, the need for this AMR surveillance initiative.

Implementing healthcare facility-based surveillance of AMR in LMICs is achievable despite limited microbiological laboratory capacity.