Original Research

ESKAPE pathogen incidence and antibiotic resistance in patients with bloodstream infections at a referral hospital in Limpopo, South Africa, 2014–2019: A cross-sectional study

Tiyani C. Mthombeni, Johanita R. Burger, Martha S. Lubbe, Marlene Julyan, Molebogeng R. Lekalakala-Mokaba
African Journal of Laboratory Medicine | Vol 13, No 1 | a2519 | DOI: https://doi.org/10.4102/ajlm.v13i1.2519 | © 2024 Tiyani C. Mthombeni, Johanita R. Burger, Martha S. Lubbe, Marlene Julyan, Molebogeng R. Lekalakala-Mokaba | This work is licensed under CC Attribution 4.0
Submitted: 03 June 2024 | Published: 29 November 2024

About the author(s)

Tiyani C. Mthombeni, Department of Medicine Usage in South Africa (MUSA), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
Johanita R. Burger, Department of Medicine Usage in South Africa (MUSA), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
Martha S. Lubbe, Department of Medicine Usage in South Africa (MUSA), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
Marlene Julyan, Department of Medicine Usage in South Africa (MUSA), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
Molebogeng R. Lekalakala-Mokaba, Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa; and, Polokwane Laboratory, National Health Laboratory Service, Polokwane, South Africa

Abstract

Background: There is a paucity of research on the incidence and antimicrobial resistance (AMR) of Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. (ESKAPE) pathogens in Africa because of the inadequate establishment of AMR surveillance systems.

Objective: This study reports on the incidence and AMR of bloodstream ESKAPE pathogens at a referral hospital in northern South Africa.

Methods: This retrospective descriptive study used routinely collected bloodstream isolates (pathogen identification and antimicrobial susceptibility testing performed using automated systems) from the South African National Health Laboratory Service, from January 2014 to December 2019. Resistant phenotypes analysed included methicillin-resistant S. aureus and carbapenem-resistant A. baumannii.

Results: The ESKAPE pathogen incidence rate was stable from 2014 to 2019 (p = 0.133). The most isolated pathogens were S. aureus (268/746; 35.9%) and A. baumannii (200/746; 26.8%). Staphylococcus aureus increased from 39 isolates in 2014 to 75 in 2019 (p = 0.132). The incidence rate of A. baumannii increased from 11.9% (16/134) in 2015 to 37.8% (68/180) in 2019 (p = 0.009). Most isolates (417/746; 55.9%) were from the neonatal ward. Carbapenem-resistant A. baumannii increased from 68.8% (11/16) in 2014 to 75.0% (51/68) in 2019 (p = 0.009). Methicillin-resistant S. aureus decreased from 56.0% (14/25) in 2016 to 17.3% (13/75) in 2019 (p = 0.260).

Conclusion: Routine data provide essential information on the incidence of ESKAPE pathogens and AMR phenotypes, serving as a basis for an antibiogram, a surveillance tool in antibiotic stewardship programmes.

What this study adds: The study provided local information on the incidence and AMR pattern of ESKAPE pathogens, which is essential when developing empiric treatment protocols for appropriate antibiotic prescribing and infection prevention and control practices.


Keywords

Acinetobacter baumannii; bloodstream infections; antibiotic resistance; Klebsiella pneumoniae; South Africa; Staphylococcus aureus

Sustainable Development Goal

Goal 3: Good health and well-being

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