Causes of bloodstream infections in adult intensive care patients at eThekwini KwaZulu-Natal hospitals.

Abstract

Background: Bloodstream infections (BSIs) are a major cause of morbidity and mortality among critically ill patients, particularly in intensive care units (ICUs). The rise of multidrug-resistant organisms (CRE, ESBL, MRSA, and XDR strains), poses serious treatment challenges, making timely identification and susceptibility profiling essential for effective management. Aim: This study aimed to describe the distribution of pathogenic organisms and their antimicrobial resistance patterns in adult ICU patients diagnosed with BSIs at three public-sector hospitals in KwaZulu-Natal over a three-year period (2020–2022). Methods: A retrospective, quantitative, descriptive study was conducted using data from the National Health Laboratory Services (NHLS) TrakCare system. Positive blood cultures from patients aged 18 years and above, admitted to ICUs at regional, tertiary and quaternary hospitals; Prince Mshiyeni Memorial Hospital (PMMH), King Edward VIII Hospital (KEH), and Inkosi Albert Luthuli Central Hospital (IALCH), respectively, were analysed. Organism distribution, antimicrobial susceptibility, and resistance trends were assessed using STATA software. Results: A total of 739 clinically significant isolates were analyzed. Gram-negative organisms accounted for the majority (65.09%), followed by Gram-positive organisms (25.17%), while fungal isolates, mainly Candida spp., comprised 9.47%. Acinetobacter baumannii (26.25%), Klebsiella pneumoniae (14.34%), and Pseudomonas aeruginosa (6.49%) were the common Gram-negative pathogens. Coagulase-negative Staphylococcus (8.93%) and Staphylococcus aureus (7.16%) were the common Gram-positive isolates. High rates of antimicrobial resistance were observed, with 66.11% of A. baumannii isolates classified as possible XDR and 19.09% of K. pneumoniae isolates identified as CRE. Multidrug resistant (13.89%) and ESBLproducing organisms (23.68%) were high at PMMH, and surprisingly no MRSA was detected. High CRE rates were noted at KEH and IALCH (24.19% and 20.83%, respectively). Also, XDR (73.12%) was high at KEH, while MRSA detection was high at both facilities (23.08% - IALCH; 21.05% - KEH). Conclusion: The findings highlight a concerning burden of multidrug-resistant organisms in ICU settings across all levels of care, including regional facilities, which are traditionally assumed to have lower resistance rates. These results necessitate urgent improvements in antimicrobial stewardship programs, infection prevention, microbiological surveillance to contain the spread of resistant pathogens, guidance in effective treatment and control strategies to improve patient outcomes in KwaZulu-Natal ICUs.