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Background Bacteria of the order Enterobacterales are common pathogens causing bloodstream infections in sub-Saharan Africa and are frequently resistant to third-generation cephalosporin antibiotics. Although third-generation cephalosporin resistance is believed to lead to adverse outcomes, this relationship is difficult to quantify and has rarely been studied in this region. We aimed to measure the effects associated with resistance to third-generation cephalosporins in hospitalised patients with Enterobacterales bloodstream infection in Africa. Methods We conducted a prospective, matched, parallel cohort study at eight hospitals across sub-Saharan Africa. We recruited consecutive patients of all age groups with laboratory-confirmed Enterobacterales bloodstream infection and matched them to at least one patient without bloodstream infection on the basis of age group, hospital ward, and admission date. Date of infection onset (and enrolment) was defined as the day of blood sample collection for culturing. Patients infected with bacteria with a cefotaxime minimum inhibitory concentration of 1 mg/L or lower were included in the third-generation cephalosporin-susceptible (3GC-S) cohort, and the remainder were included in the third-generation cephalosporin-resistant (3GC-R) cohort. The primary outcomes were in-hospital death and death within 30 days of enrolment. We used adjusted multivariable regression models to first compare patients with bloodstream infection against matched patients within the 3GC-S and 3GC-R cohorts, then compared estimates between cohorts. Findings Between Nov 1, 2020, and Jan 31, 2022, we recruited 878 patients with Enterobacterales bloodstream infection (221 [25·2%] to the 3GC-S cohort and 657 [74·8%] to the 3GC-R cohort) and 1634 matched patients (420 [25·7%] and 1214 [74·3%], respectively). 502 (57·2%) bloodstream infections occurred in neonates and infants (age 0-364 days). Klebsiella pneumoniae (393 [44·8%] infections) and Escherichia coli (224 [25·5%] infections) were the most common ... |
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Collapse authors list. Aiken, Alexander M, Rehman, Andrea M, de Kraker, Marlieke EA, Madrid, Lola, Kebede, Meron, Labi, Appiah-Korang, Obeng-Nkrumah, Noah, Nyamwaya, Brian, Kagucia, Eunice, Cocker, Derek orcid:0000-0002-6670-2713 et al (show 13 more authors) , Kawaza, Kondwani, Lester, Rebecca, Iregbu, Kenneth C, Medugu, Nubwa, Nwajiobi-Princewill, Philip I, Dramowski, Angela, Sonda, Tolbert, Hemed, Asia, Fwoloshi, Sombo, Ojok, David, Scott, J Anthony G, Whitelaw, Andrew and MBIRA study collaborators (2023) Mortality associated with third-generation cephalosporin resistance in Enterobacterales bloodstream infections at eight sub-Saharan African hospitals (MBIRA): a prospective cohort study. The Lancet. Infectious diseases, 23 (11). S1473-3099(23)00233-5-S1473-3099(23)00233-5. ISSN 1473-3099, 1474-4457 |