Multidrug-resistant bacterial infections and their clinical impact at the University Teaching Hospital of Kigali in Rwanda: a retrospective descriptive-analytical study

TL;DR

This study found that multidrug-resistant bacterial infections are common at a hospital in Rwanda, leading to longer hospital stays and higher mortality, with some antibiotics still effective.

Contribution

The study provides local data on MDR bacterial infections in Rwanda, highlighting resistance patterns and effective treatment options.

Findings

MDR bacterial infections accounted for 22% of positive cultures, with surgical patients most affected.

Escherichia coli was the most common MDR isolate, particularly in urine samples.

Amikacin, vancomycin, imipenem, and polymyxin B showed the lowest resistance rates.

Abstract

Multidrug-resistant (MDR) bacterial infections pose a serious global health threat, particularly in low-resource settings where empirical antimicrobial use is common, while associated with poor outcomes and increased resistance. This study evaluated the prevalence, resistance profiles, clinical impact, and treatment options for MDR bacterial infections at the University Teaching Hospital of Kigali, Rwanda.

A retrospective descriptive-analytical study reviewed patient records and microbiology logbooks for culture-confirmed MDR infections from 1st January to 31st December 2023. Data were analyzed using SPSS, with significance set at p < 0.05.

Out of 1,676 positive cultures, 368 (22%) were MDR cases, mostly from surgical patients (30.4%). Urine samples yielded the majority of MDR isolates (52.2%), with Escherichia coli as the most common (45.4%), particularly in urine (71.3%). MDR isolates showed high resistance rates to ampicillin, doxycycline (100%), third-generation cephalosporins (98%), amoxicillin-clavulanic acid (96%), clindamycin (88%), and ciprofloxacin (74%). Resistance was lowest against amikacin (6%), vancomycin (14%), imipenem (24%), and polymyxin B (26%). The mean hospital stay was 8.6 days, and the mortality rate was 22% among patients with MDR bacterial infection.

MDR bacterial infections were prevalent with longer hospital stays and poor outcomes. Despite high resistance to common antibiotics, amikacin, vancomycin, imipenem, and polymyxin B were effective treatment options. Continuous surveillance, antimicrobial stewardship, and treatment guideline development are crucial.

The global rise in antimicrobial resistance is a major public health threat requiring local surveillance for targeted interventions and guideline creation. This study at the University Teaching Hospital of Kigali found a 21.9% prevalence of MDR infections, reflecting global trends. Strengthening infection prevention and control and antimicrobial stewardship programs is needed to break transmission chains and optimize antimicrobial use.

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