Antimicrobial Resistance in Hospital-acquired Bloodstream Infections among Children in a Pediatric Hospital in Bolivia

Abstract

Introduction: Antimicrobial resistance (AMR) is a growing threat to global public health. In hospitals, infant mortality due to bacterial sepsis is associated with AMR. The epidemiology of AMR in Bolivia (a lower-middle-income country) has not been sufficiently discussed. The aim of this study was to analyze AMR patterns over 8 years at a pediatric hospital in patients with hospital-acquired bloodstream infections.

Methods: This is a retrospective and analytical revision of AMR in bacteria isolated from blood cultures, performed between 2012 and 2019, in a pediatric hospital in Bolivia. Data analysis was conducted with Stata v14.0, and Fisher's exact tests were used to determine statistical significance.

Results: Four hundred and fifty-five (7.2%) positive blood cultures were identified from 6315 blood culture reports between 2012 and 2019. Klebsiella pneumoniae was the most frequently isolated bacteria and showed a significant change in its AMR profile over the 8 years of the study. Gram-negative bacteria and Staphylococcus aureus were also frequently isolated, and all demonstrated high levels of resistance to commonly used antibiotics. Overall, most of the clinically important microorganisms had high rates of AMR.

Conclusions: In the present study, we report that isolated bacteria showed significant resistance to multiple drugs, and most demonstrated increased resistance over time. Worryingly, K. pneumoniae showed an increasing resistance to commonly used antibiotics. Overall, despite the limitations, our study, which is one of the first of its kind in Bolivia, demonstrates the need for stricter policies of antibiotic stewardship in similar settings due to the global threat of AMR.

Keywords: Bacteria; blood culture; drug resistance; epidemiology; pediatrics; sepsis.