High Mortality from Blood Stream Infection in Addis Ababa, Ethiopia, Is Due to Antimicrobial Resistance

Seboxa, Teshale; Amogne, Wondwossen; Abebe, Workeabeba; Tsegaye, Tewodros; Azazh, Aklilu; Hailu, Workagegnehu; Fufa, Kebede; Grude, Nils; Henriksen, Thor-Henrik
December 2015
PLoS ONE;12/15/2015, Vol. 10 Issue 12, p1
Academic Journal
Background: Managing blood stream infection in Africa is hampered by lack of bacteriological support needed for antimicrobial stewardship, and background data needed for empirical treatment. A combined pro- and retrospective approach was used to overcome thresholds in clinical research in Africa. Methods: Outcome and characteristics including age, HIV infection, pancytopenia and bacteriological results were studied in 292 adult patients with two or more SIRS criteria using univariate and confirming multivariate logistic regression models. Expected randomly distributed resistance covariation was compared with observed co-resistance among gram-negative enteric bacteria in 92 paediatric blood culture isolates that had been harvested in the same hospital during the same period of time. Results: Mortality was fivefold increased among patients with positive blood culture results [50.0% vs. 9.8%; OR 11.24 (4.38–25.88), p < 0.0001], and for this group of patients mortality was significantly associated with antimicrobial resistance [OR 23.28 (3.3–164.4), p = 0.002]. All 11 patients with Enterobacteriaceae resistant to 3rd. generation cephalosporins died. Eighty-nine patients had pancytopenia grade 3–4. Among patients with negative blood culture results, mortality was significantly associated with pancytopenia [OR 3.12 (1.32–7.39), p = 0.01]. HIV positivity was not associated with increased mortality. Antimicrobial resistance that concerned gram-negative enteric bacteria, regardless of species, was characterized by co-resistance between third generation cephalosporins, gentamicin, chloramphenicol, and co-trimoxazole. Conclusion: Mortality was strongly associated with growth of bacteria resistant to empirical treatment, and these patients were dead or dying when bacteriological reports arrived. Because of co-resistance, alternative efficient antibiotics would not have been available in Ethiopia for 8/11 Enterobacteriaceae-infected patients with isolates resistant to third generation cephalosporins. Strong and significant resistance covariation between 3rd. generation cephalosporins, chloramphenicol, gentamicin, and co-trimoxazole was identified. Pronounced pancytopenia was common and associated with increased mortality. HIV positive patients had no excess mortality.


Related Articles

  • Reevaluating Fluoroquinolone Breakpoints for Salmonella enterica Serotype Typhi and for Non-Typhi Salmonellae. Crump, John A.; Barrett, Timothy J.; Nelson, Jennifer T.; Angulo, Frederick J. // Clinical Infectious Diseases;7/1/2003, Vol. 37 Issue 1, p75 

    Salmonella enterica infections cause considerable morbidity and mortality worldwide. Antimicrobial therapy may be lifesaving for patients with extraintestinal infections with S. enterica serotype Typhi or non-Typhi salmonellae. Because antimicrobial resistance to several classes of traditional...

  • Snapshot of Antimicrobial Stewardship in Australian Hospitals. Chen, Alex W. J.; Khumra, Sharmila; Eaton, Vaughn; Kong, David C. M. // Journal of Pharmacy Practice & Research;Mar2010, Vol. 40 Issue 1, p19 

    Background: The diminishing investment into the development of new antimicrobials is of significant global concern. This, coupled with the emergence of anti-infective drug resistance, highlights the need to both prolong and optimise the use of existing antimicrobials. Strategies or programs to...

  • European Surveillance of Antibiotic Consumption (ESAC) point prevalence survey 2008: paediatric antimicrobial prescribing in 32 hospitals of 21 European countries. Amadeo, Brice; Zarb, Peter; Muller, Arno; Drapier, Nico; Vankerckhoven, Vanessa; Rogues, Anne-Marie; Davey, Peter; Goossens, Herman // Journal of Antimicrobial Chemotherapy (JAC);Oct2010, Vol. 65 Issue 10, p2247 

    Background: Antimicrobials are the most common medicines prescribed to children, but very little is known about patterns of hospital paediatric antimicrobial prescribing. This study aimed at describing paediatric antimicrobial prescribing in European hospitals to identify targets for quality...

  • Failing to tackle drug-resistant superbugs will cost up to $100 trillion.  // Healthcare Purchasing News;Jan2015, Vol. 39 Issue 1, p18 

    The article discusses the Review on Antimicrobial Resistance study conducted by economist Jim O'Neill for British Prime Minister David Cameron to assess the global mortality and morbidity impact of superbug infection.

  • Possible Role of Curcumin as an Efflux Pump Inhibitor in Multi Drug Resistant Clinical Isolates of Pseudomonas aeruginosa. NEGI, NIDHI; PRAKASH, PRADYOT; GUPTA, MOHAN LAL; MOHAPATRA, TRIBHUBAN MOHAN // Journal of Clinical & Diagnostic Research;Oct2014, Vol. 8 Issue 10, p4 

    Introduction: Multidrug resistant non-fermenters are continuously increasing in hospital and ICU settings. One of the mechanisms of developing drug resistance is possession of efflux pump through which bacteria extrude antimicrobial agents and other toxic substances. If these efflux channels are...

  • Bacterial pericarditis and antimicrobial resistance at the Tehran Heart Center, Iran. Anvari, Maryam Sotoudeh; Kianinejad, Rezvan; Boroumand, Mohammad Ali; Arzhan, Soraya; Jalali, Arash // Journal of Infection in Developing Countries;Jul2015, Vol. 9 Issue 7, p780 

    Introduction: When bacterial pericarditis is suspected, urgent pericardial drainage combined with intravenous antibacterial therapy is mandatory to avert devastating, life-threatening complications. There have been scanty results on antimicrobial susceptibility of common causative microorganisms...

  • Applications of ozone therapy in dentistry. Gupta, Shiva; Deepa, D. // Journal of Oral Research & Review;Jul-Dec2016, Vol. 8 Issue 2, p86 

    Ozone is an allotropic form of oxygen, which is effectively used in the treatment of different diseases for more than 100 years. In the present era of increasing antibiotic resistance, ozone therapy is an alternative medical treatment that rationales to increase the amount of oxygen to the body...

  • CTX-M enzymes are the predominant extended-spectrum β-lactamases produced by Enterobacteriaceae in Ireland. Morris, Dearbháile; Boyle, Fiona; Buckley, Victoria; Li Xu; Hanahoe, Belinda; Hawkey, Peter; Cormican, Martin // Journal of Antimicrobial Chemotherapy (JAC);Oct2009, Vol. 64 Issue 4, p864 

    The article presents a study that deals with the predominance of CTX-M ß-lactamases among extended-spectrum ß-lactamase-producing Enterobacteriaceae in Ireland. Focal to the study was a nationwide survey of ESBL-PE collected throughout Ireland over an 11 year period. It highlighted the...

  • In the Literature.  // Clinical Infectious Diseases;Mar2014, Vol. 58 Issue 5, piii 

    The article presents abstracts on clinical infectious disease which includes the research study on the severe sepsis and septic shock and mycobacterium tuberculosis infection and the medical study on the prevention of empiric anti-methicillin-resistant staphylococcus aureus antibiotics.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics