Mortality and associated factors among in-patients with multi-drug (antibiotic) resistant bacterial infections at Kiruddu National Referral Hospital, Uganda

Abstract

Background: Antimicrobial resistance (AMR) in bacterial infections is an emerging public health threat that caused nearly five million annual deaths as of 2019. Multi-drug resistant (MDR) bacterial infections (resistance to two or more antibiotic classes) are often associated with poor survival outcomes but such data from low-resource settings is generally limited. This study describes the mortality and associated clinical-demographic factors among hospitalized patients diagnosed with MDR bacterial infections at a tertiary-level hospital in Uganda. Methods: In this retrospective study, hospital records for patients diagnosed with MDR-bacterial infections at Kiruddu National Referral Hospital between January 2021 and January 2024 were analyzed. Data retrieved from the microbiology register and patient clinical records comprised bacterial pathogen and associated antimicrobial susceptibility patterns, social-demographic data, clinical and treatment data as well as vital status at time of discharge (alive or dead). We estimated the proportion of patients diagnosed with MDR bacterial infections who died and performed logistic regression modeling to determine the predictors of mortality compared to the survivors. Results: Of the 4,102 culture and sensitivity tests performed at Kiruddu National Referral Hospital between January 2021 and January 2024; 1,392 (34%) had bacterial growth for which 1,310 (94%) had resistance to two or more antibiotics. The median age was 36, interquartile range (IQR); [21-49] years, with predominance of males (63%, n=124). Mortality among patients with MDR-bacterial infections was 31% (61/198). The factors statistically associated with mortality included; fever (adjusted Odds Ratio[aOR] 4.96, 95% Confidence Interval [C.I.] 1.78 – 13.78, p= 0.002); anemia (aOR 7.24, 95% C.I. 2.10 – 24.99, p=0.002); Proteus mirabilis infection (aOR 5.78, 95% C.I. 1.01 – 32.99, p= 0.048); and bloodstream infections (aOR 3.36, 95% C.I. 1.02 – 11.09, p=0.046). Conclusion: Approximately one-third of hospitalized patients diagnosed with MDR-bacterial infections died, and this was associated with documented fever, anemia, bloodstream infections and Proteus mirabilis infection