Effect of the incubation time on blood culture results and bacterial pathogens causing bloodstream infections among children attending Sekou Toure Regional Referral Hospital in Mwanza, Tanzania

  1. James Thomas
  2. Albert Wasira
  3. Darus Maarafu
  4. Faustin Igogo
  5. Eunice Emmanuel
  6. Roza Ernest
  7. Martha F. Mushi
  8. Stephen E. Mshana

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Abstract

Background. A one hour delay in initiating appropriate antimicrobial treatment increases the mortality rate of patients with bloodstream infections by 2%. This highlights the risk associated with manual blood culture methods, as they tend to have long turnaround time, with an initial incubation period of 18–24 h, leading to delays in obtaining diagnostic results. This study examined the impact of incubation time on blood culture results and analysed the patterns of the pathogens causing bloodstream infections (BSIs) among children attending Sekou Toure Regional Referral Hospital (SRRH), Mwanza, Tanzania

Methodology. A hospital-based, descriptive cross-sectional study was conducted at SRRH from May to July 2024. The conventional blood culture method, using in-house prepared brain heart infusion broth with slight modifications on the initial time of the blind subculture (at 8, 24 and 120 h) was done to isolate the pathogens causing BSIs. Descriptive data analysis was performed using STATA software version 15.

Results. The study enrolled 302 children with clinical diagnosis of BSIs. Of these, 160 (53%) were male, with a median age of 6 years interquartile range [IQR] 1–7 years. Fever was the predominant clinical sign reported in 259 (85.8%) children. Microbiologically confirmed BSIs were detected in 90 (29.8%) children. Among them, 51.1% (46/90) were detected through blind subculture after 8 h of initial incubation. An additional 31 (34.4%) and 13 (14.4%) were detected after 24 h and 120 h of incubation, respectively. The most frequently isolated pathogens were Klebsiella pneumoniae (25.6%, 23/90) and Staphylococcus aureus (24.4%, 22/90). Gram-negative bacteria (GNB) formed the majority (71.1%, 64/90) of the isolated pathogens, with 62.5% (40/64) showing resistance to third-generation cephalosporin (3GC). Additionally, 45.5% (10/22) of the S. aureus strains were methicillin-resistant S. aureus .

Conclusion. Blind subculture after 8 h of initial incubation correctly detected more than half of the children with microbiologically confirmed BSIs. Incorporating blind subculture on MacConkey agar supplemented with 2 µg ml −1 cefotaxime (MCA-C) after 8 h of incubation resulted in the correct treatment of half of the children with BSIs caused by GNB within 24 h. In areas with high prevalence of 3GC resistance, blind subculture within 8 h should include MCA-C for appropriate treatment within 24 h.

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  1. Version published to 10.1099/acmi.0.000942.v3 on Access Microbiology
  3. Version published to 10.1099/acmi.0.000942.v2 on Access Microbiology
  5. Access Microbiology

    Comments to Author

    An interesting research focusing on issues during blood culture in resources-limited setting for rapid diagnosis of sepsis. The manuscript is well-designed and written with an important conclusion giving a clear message for microbiologists and laboratory staff and would help diagnose sepsis in a fast schedule.

    Please rate the manuscript for methodological rigour

    Very good

    Please rate the quality of the presentation and structure of the manuscript

    Very good

    To what extent are the conclusions supported by the data?

    Strongly support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  6. Access Microbiology

    Comments to Author

    1.Nice concept 2.study adds value to routine blood culture practices 3. flowchart is very well decipted Suggest to compare outcomes between groups suggest to form two groups (8 hour incubation) and (>8 hour incubation) and compare two outcomes, this will add more value to study

    Please rate the manuscript for methodological rigour

    Good

    Please rate the quality of the presentation and structure of the manuscript

    Good

    To what extent are the conclusions supported by the data?

    Strongly support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  7. Version published to 10.1099/acmi.0.000942.v1 on Access Microbiology