Etiology and Antibiotic Resistance of Pediatric Bloodstream Infections and Their Environmental Correlates at Sally Mugabe Central Hospital from January 2025 to July 2025

Abstract

This study at Sally Mugabe Central Hospital from January to July 2025 investigated the etiology, antimicrobial susceptibility, and environmental correlation of pediatric bloodstream infections (BSIs). This cross-sectional study analyzed 182 clinical BSI isolates from the hospital's database and compared them to prospectively collected environmental swabs from high-touch surfaces. Standard culture and CLSI disc diffusion methods were used. The results revealed two distinct epidemiological profiles. The predominant pathogen causing clinical BSIs was Klebsiella species (47.8%), while environmental surfaces were overwhelmingly dominated by Staphylococcus aureus (67.9%). The antibiogram for clinical isolates analysis showed very high resistance to standard EDLIZ first-line empirical therapies: Gentamicin resistance was 43.4% and Ceftriaxone resistance was 33.3%. These rates are far above the 15-20% threshold recommended for safe empirical use. The only highly effective agents safe for empiric therapy use were Amikacin (16.7% resistance) and Imipenem (15.6% resistance). The study also found a significant mismatch between the dominant clinical and environmental pathogens. A Pearson correlation test confirmed there was no statistically significant correlation (p=0.178) between the resistance profiles of clinical and environmental isolates. This key finding suggests that the sampled high touch surfaces are not the primary reservoir driving the dominant Klebsiella BSIs. The study thus concluded that the high resistance to first-line agents necessitates an urgent re-evaluation of empirical therapy guidelines at the hospital, with consideration for Amikacin over Gentamicin. Additionally, the source of the Klebsiella outbreak is likely from a different transmission pathway which warrants further investigations.