Peer-reviewed article
Bloodstream infections and antimicrobial resistance patterns among under-fives children with suspected bloodstream infections attending the pediatric clinic of Felege Hiwot Comprehensive Specialized Hospital in Bahir Dar, northwest Ethiopia.
Alemayehu Abate, Melkamnesh Azage ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined bloodstream infections and antibiotic resistance in 281 children under five attending a hospital in Bahir Dar, Ethiopia. Nearly one in five children had a bloodstream infection, mostly caused by resistant gram-negative bacteria like Klebsiella pneumoniae. Children who were not immunized or only partially immunized, were under one year old, or had fever lasting more than a week were at significantly higher risk. The bacteria showed high resistance to commonly used antibiotics but lower resistance to newer drugs like meropenem.
Key points
- Bloodstream infection prevalence was 19.2% (54 out of 281 febrile children under five)
- Non-immunized children had 9.87 times higher odds of bloodstream infection compared to fully immunized children
- Partially immunized children had 3.21 times higher odds of bloodstream infection
- Klebsiella pneumoniae was the most common cause (31%), with 80% of infections caused by gram-negative bacteria
- High resistance rates observed to ampicillin (87%), trimethoprim-sulfamethoxazole (86.3%), and cefepime (77.8%), but lower resistance to meropenem (20.4%)
Limitations
This is a hospital-based cross-sectional study of febrile children attending one facility, so results may not represent all children with bloodstream infections in the community or other regions. The study cannot establish causation or determine whether immunization status directly prevented infection or was a marker of other protective factors.
Abstract
BACKGROUND: Antibiotic-resistant bloodstream infections are a major public health concern, particularly in children under five years of age. The objective of this study was to determine the prevalence of bloodstream infections and assess the antimicrobial resistance profiles and their associated factors among febrile children under five years of age in Bahir Dar, northwest Ethiopia. METHODS: A cross-sectional study was conducted from November to December 2025 among 281 children under five years of age who attended the pediatric clinic of Felege Hiwot Comprehensive Specialized Hospital in Bahir Dar. Sociodemographic and clinical data were collected using a structured questionnaire through face-to-face interviews with the parents or guardians. Approximately 3 mL of venous blood was aseptically collected and cultured using standard microbiological techniques. Bacterial identification was performed based on colony characteristics and biochemical tests. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method. Data were entered into EpiData version 3.1 and analyzed using SPSS version 26. Logistic regression analysis was used to identify factors associated with bloodstream infections, and statistical significance was set at p < 0.05. RESULTS: The prevalence of bloodstream infection was 19.2% (54/281; 95% CI: 14.0%-24.4%). The most common isolate was Klebsiella pneumoniae (31%), followed by Enterobacter cloacae (11%), Escherichia coli (9%), and Acinetobacter baumannii (9) %. Gram-negative bacteria accounted for 80% of the isolates. Antimicrobial susceptibility testing revealed high resistance rates to commonly used antibiotics, particularly ampicillin (87.0%, 40/46), trimethoprim-sulfamethoxazole (86.3%, 44/51), and cefepime 42/54 (77.8). Resistance was also high to ciprofloxacin (68.5%, 37/54), tobramycin (68.6%, 35/51), amoxicillin-clavulanic acid (66.0%, 31/47), gentamicin (63.3%, 31/49), tetracycline (61.1%, 33/54), and chloramphenicol (60.5%, 26/43). In contrast, lower resistance rates were observed for cefotaxime (37.0%, 20/54) and meropenem (20.4%, 11/54). Significant associated factors of blood stream infections included age < 1 year (AOR = 2.11; 95% CI: 1.46-2.86), fever duration > 7 days (AOR = 2.74; 95% CI: 1.22-6.15), partially immunized children (AOR = 3.21; 95% CI: 1.08-9.51; p = 0.036), and non-immunized children (AOR = 9.87; 95% CI: 3.61-26.9; p < 0.001). CONCLUSION: The prevalence of bloodstream infections among febrile children under five years of age was high. Younger age, fever duration > 7 days, and partially immunization and non-immunization were significant predictors of bloodstream infection. Strengthening antimicrobial stewardship, improving immunization coverage, and enhancing early diagnosis are essential to reduce the burden of bloodstream infections and combat antimicrobial resistance.