Abstract:

Background: The impact of delayed diagnosis and treatment of BSI includes high morbidity and mortality towards said patients. Though, the outcome of delayed blood culture for diagnosis and management of patients with clinical presentations of BSI is not known in our setting. Therefore, this study is designed to determine the outcome of delayed blood culture in neonates at this setting.

Methodology: It is a hospital-based cross-sectional analytical study which will be conducted among patients with clinical diagnosis of bloodstream infections between May and August 2023 at Bugando Medical Centre in Mwanza, Tanzania. Pre-tested structured questionnaire will be used for collection of social demographic and clinical information from consented study participants. Conventional manual blood culture will be performed on 5% sheep blood agar and MacConkey agar plates for isolation of implicating bacteria. Then, bacteria will be identified by in-house prepared biochemical identification tests followed by disk diffusion method for testing antimicrobial susceptibility. Data analysis will be done using STATA version 15.0 according to objectives of the study.

Implication of the study: This information was useful in guiding empiric therapy for treatment of blood stream infections among neonates admitted at our setting as well as obtaining cultures before antibiotic use improves the chances of identifying the offending microorganism, which improves patient care.

Results: A total of 225 blood samples processed. The median [Inter-quartile range; IQR] age in days was 5 [0 – 28]. The majority of them were males (55.1%, n=124). Majority of the participants were from urban areas (79.6%, n=179) and most of them had their payments through waiver form (153%, n=68.0).
Among the study participants, all of them (100%, n=225) were already being subjected to antibiotics before the samples were collected. (24.0%, n=54) were positive, of which the most frequently isolated bacteria spp was Klebsiella pneumoniae (85.2%, n=46) followed by Enterobacter aerogenes (5.6%, n=3) and Pseudomonas aeruginosa (3.7%, n=2). (84%, n=189) of samples were delayed to be collected with the median [IQR] delay days of 1 [1 – 2] days. Parents/guardians lacking money for culture and sensitivity was the significant commonest reason for delayed blood culture collection compared to empiric treatment [85.1% (161/189) vs. 14.8% (28/189), p<0.0001]. (20%, n=45) of neonates died, where majority of them had delayed blood culture collection compared to those whose samples weren’t delayed to be collected [93.3% (42/45) vs. 6.7% (3/45), p=0.056].

Conclusion: The prevalence of laboratory confirmed BSI among neonates admitted in neonatal units at BMC is low compared to previous studies. The prevalence of delayed blood culture collection is high and the main reasons being parents/guardians lack of money for laboratory investigations particularly blood culture. This study recommends that, government provides free medical care among neonates and introduce cheap health insurance funding for under-five children