Publication:

Bacteremia and antimicrobial resistance among febrile under five children attending pediatric clinic in Bahir Dar, Northwest Ethiopia: a retrospective study (2018–2024)

Background Bacteremia is a major cause of illness and death in febrile under-five children, particularly in low- and middle-income countries like Ethiopia. Rising antimicrobial resistance (AMR) further complicates treatment. This study assessed bacteremia prevalence and AMR patterns among febrile under-five children at the Amhara Public Health Institute, northwest Ethiopia.

Methods A retrospective review was conducted using blood culture and antimicrobial susceptibility data (2018–2024) from febrile children under five. Bacterial identification and susceptibility testing followed the modified Kirby–Bauer disk diffusion method per CLSI 2020 guidelines. Data were analyzed with statistical package for the social sciences (SPSS) v26.0.

Results Of 746 blood cultures, 157 (21.0%) were positive. Gram-negative bacteria predominated (76.5%), with Klebsiella pneumoniae (31.8%) most common, followed by Acinetobacter baumannii (10.8%) and Enterococcus spp. (10.8%). Infants under one year accounted for 82.2% of cases; males comprised 56.1%. High resistance was observed to ampicillin (90.6% Gram-negatives; 79.1% Gram-positives), ceftriaxone (77.6%), cotrimoxazole (72.8%), and gentamicin (60.3%). Meropenem resistance in Gram-negatives was lower (19%). K. pneumoniae showed 100% resistance to ampicillin, 88% to ceftriaxone and cotrimoxazole, and 82% to gentamicin. Staphylococcus aureus exhibited 100% resistance to ceftazidime and 87.5% to ciprofloxacin.

Conclusion Bacteremia remains a significant burden in febrile under-five children, with high AMR rates limiting treatment options. Strengthening antimicrobial stewardship, implementing local AMR surveillance, and updating empirical treatment guidelines are critical to improving outcomes and reducing preventable child mortality in Ethiopia.