Microbiological profile of sterile site organisms and culture positivity rates from a decade of paediatric admissions at a tertiary hospital in South Africa: A lower and middle-income country perspective.

Background: Sterile site (SS (blood and cerebrospinal fluid)) infections are formidable causes of childhood morbidity and fatality. This study aimed to determine aetiological organisms, antimicrobial resistance patterns and sepsis trend rates in paediatric inpatients from a low-and middle-income country. Methods: A retrospective review of SS culture results of inpatients from the neonatal unit (NNU), general paediatric (GPW) and paediatric haematology-oncology wards (PHOW) at Chris Hani Baragwanath Academic Hospital, South Africa, from January 2013 to December 2022. Results: A total of 58 053 SS specimens were submitted for analysis. Culture-positivity rate was 36.0 %, comprising 22.8 % and 13.2 % for pathogens and contaminants. Pathogen culture-positivity rate was higher in the NNU when compared to GPW (35.5 % vs 17.6 %; OR-5.38; 95 % CI 4.99-5.81) but lower than PHOW (35.5 % vs 46.6 %; OR-0.47; 95 % CI 0.39-0.52). Infection rates per 1000 patient-days increased from 1.74 in 2013 to 3.11 in 2022. Gram-negative bacteria (GNB) (66.0 % vs 18.7 %, OR-5.70; 95 % CI 5.23-6.19) and yeast (12.4 % vs 8.4 %, OR-7.66; 95 % CI 6.13-9.57) were more common in NNU than GPW. Multidrug-resistant (MDR) pathogen prevalence was 35.1 % with extended-spectrum beta-lactamase Enterobacterales contributing 40-50 %. Carbapenem-resistant Acinetobacter species increased from 40 % to 60 % from 2013 to 2022 (p = 0.004). MRSA prevalence decreased from 30 % to 10 % from 2013 to 2022 (p = 0.004). Conclusion: The burden of paediatric MDR gram-negative SS infection was relatively high requiring ongoing surveillance, judicious antimicrobial use, while reinforcing infection control contact-based transmission precautions. Further studies on drivers of antimicrobial resistance such as unit specific antimicrobial consumption rates and prescriber practices, should be explored.