Bacterial resistance and its impact on mortality in a population of people living with HIV at the Infectious Diseases ward of the Institut Professeur Daniel GAHOUMA in Libreville

Manomba Boulingui C, Ntsame Owono MM, Essomeyo Ngui Mebale M, Moutombi Ditombi BC, Sibi Matotou R, Mihindou JC, Kombila UD.

Abstract

Background: Antibiotic resistance poses a growing threat to the management of sepsis in sub-Saharan Africa. The emergence of multidrug-resistant bacteria (MDR), particularly extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-producing Enterobacteriaceae), undermines the effectiveness of empirical antibiotic therapy. This study aimed to describe the antibiotic resistance profile of bacteria isolated from patients with sepsis, assess the prevalence of multidrug-resistant bacteria, and analyze their impact on in-hospital mortality.

Methods: A retrospective study of 154 patients hospitalized for sepsis. Microbiological data (blood cultures, pathogen identification, and antibiotic susceptibility testing for five classes of antibiotics) were analyzed. MDR bacteria was defined as resistance to ≥ 3 classes, including third-generation cephalosporins (3GC). The statistical analysis included the chi-square test, the Mann-Whitney test, and the calculation of odds ratios (OR) with 95% confidence intervals.

Results: Blood cultures were positive in 73.9% of patients (65/88). Resistance to third-generation cephalosporins (C3G) was 95.4%, (n=62/65), to fluoroquinolones 33.0%, to fourth-generation cephalosporins (C4G) 28.4%, to aminoglycosides 14.8%, and to carbapenems 12.5%. Klebsiella pneumoniae showed 100% resistance to C3Gs and a case-fatality rate of 52.6%. The prevalence of multidrug-resistant (MDR) bacteria was 23.9% among positive blood cultures (32.3% among identified pathogens). Mortality was significantly higher for each resistance class: C3G (35.4% vs. 4.6%, p < 0.001), carbapenems (50.0% vs. 17.5%, p = 0.040), and aminoglycosides (46.7% vs. 16.5%, p = 0.016). MDR-positive patients had a mortality rate of 47.6% compared with 25.4% for non-MDR patients (OR = 2.67; 95% CI [0.97-7.40]; p = 0.097).

Conclusion: Antibiotic resistance is a problem in our country. It is essential to develop local protocols that take into account epidemiological data on resistance.