title: Trends in paediatric and adult bloodstream infections at a Ghanaian referral hospital: a retrospective study.
abstract: BACKGROUND
  Bloodstream infections (BSI) are life-threatening emergencies. Identification of the common pathogens and their susceptibility patterns is necessary for timely empirical intervention.
  
  
  METHODS
  We conducted a 4-year retrospective analysis of blood cultures from all patients excluding neonates at the Korle-Bu Teaching hospital, Ghana, from January 2010 through December 2013. Laboratory report data were used to determine BSI, blood culture contamination, pathogen profile, and antimicrobial resistance patterns.
  
  
  RESULTS
  Overall, 3633 (23.16 %) out of 15,683 blood cultures were positive for various organisms. Pathogen-positive cultures accounted for 1451 (9.3 %, 95 % CI 8.5-9.8 %). Infants recorded the highest true blood culture positivity (20.9 %, n = 226/1083), followed by the elderly (13.3 %, n = 80/601), children (8.9 %, n = 708/8000) and adults (7.2 %, n = 437/6000) (p = 0.001 for Marascuilo's post hoc). Overall occurrence of BSI declined with increasing age-group (p = 0.001) but the type of isolates did not vary with age except for Citrobacter, Escherichia coli, Klebsiella, Salmonella, and Enterococcus species. Gram negative bacteria predominated in our study (59.8 %, n = 867/1451), but the commonest bacterial isolate was Staphylococcus aureus (21.9 %, n = 318/1451)-and this trend run through the various age-groups. From 2010 to 2013, we observed a significant trend of yearly increase in the frequency of BSI caused by cephalosporin-resistant enterobacteria (Chi square for trend, p = 0.001). Meropenem maintained high susceptibility among all Gram-negative organisms ranging from 96 to 100 %. Among Staphylococcus aureus, susceptibility to cloxacillin was 76.6 %.
  
  
  CONCLUSIONS
  Our study shows a significantly high blood culture positivity in infants as compared to children, adults and the elderly. There was a preponderance of S. aureus and Gram-negative bacteria across all age-groups. Meropenem was the most active antibiotic for Gram-negative bacteria. Cloxacillin remains a very useful anti-staphylococcal agent.
authors.affiliation: Microbiology Department, School of Biomedical and Allied Health Sciences, University of Ghana, P.O. Box 4326, Accra, Ghana, West Africa.
authors.forename: Noah
authors.initials: N
authors.lastname: Obeng-Nkrumah
authors.affiliation: Department of Microbiology, Korle-Bu Teaching Hospital, P.O. Box 77, Accra, Ghana, West Africa. appiahl@yahoo.com.
authors.forename: Appiah-Korang
authors.initials: AK
authors.lastname: Labi
authors.affiliation: Department of Microbiology, Korle-Bu Teaching Hospital, P.O. Box 77, Accra, Ghana, West Africa.
authors.forename: Naa Okaikor
authors.initials: NO
authors.lastname: Addison
authors.affiliation: Department of Internal Medicine, La General Hospital, P.O.Box PMB La, Accra, Ghana, West Africa.
authors.forename: Juliana Ewuramma Mbiriba
authors.initials: JE
authors.lastname: Labi
authors.affiliation: Microbiology Department, School of Biomedical and Allied Health Sciences, University of Ghana, P.O. Box 4326, Accra, Ghana, West Africa.
authors.forename: Georgina
authors.initials: G
authors.lastname: Awuah-Mensah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D000071997:Blood Culture; D002511:Cephalosporins / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D003023:Cloxacillin / Q000494:pharmacology; D024881:Drug Resistance, Bacterial; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000502:physiology*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000502:physiology*; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D008297:Male; D000077731:Meropenem; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D013845:Thienamycins / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D013845:Thienamycins; D000077731:Meropenem; D003023:Cloxacillin
keywords: Adults; Antibiotic susceptibility; Bloodstream; Ghana; Infants; Infections