Blood Stream Infection in Stroke Patients: Spectrum of Microbial Isolates and Antimicrobial Resistance

Abstract

Background: Bloodstream infection (BSI) is frequent in stroke, with poorer outcomes when microbial isolates are multi-drug resistant. There is a shortage of published data on BSI amongst stroke patients in Nigeria.

Objective: To describe the microbial isolates and the antimicrobial resistance pattern among microbial isolates in BSI in stroke patients. 

Methods: This retrospective study of all hospitalized stroke patients with BSI at the University of Benin Teaching Hospital, Benin City, Nigeria covered July 2018 to June 2022. The demographics, stroke type, microbial isolates and antimicrobial resistance patterns were studied.

Results: Blood culture studies were conducted among 834 stroke patients with infections; 410 (49.2%) had positive growth for microbial organisms. Amongst those with positive blood cultures, 53% (217/410) were females, while 56% had a haemorrhagic stroke. The mean age was 76.9±13.9 years, with about 80% of them aged ≥ 65. Infections of the respiratory tract (45%) and the urinary tract (33%) were the possible primary sources of BSI. The leading isolates included Enterococcus faecalis (18.5%), Klebsiella oxotyca (12.9%), Proteus mirabilis (12.9%), Staphylococcus aureus (11.5%), and Escherichia coli (11.2%). Approximately 88% of the isolates were multi-drug resistant, with 100% resistance to cefuroxime, ceftazidime, and co-trimoxazole, 83.3% to erythromycin and 75% resistance to ampicillin. The elderly patients were significantly more likely to acquire multi-drug resistant micro-organisms (p = 0.007).

Conclusion: Stroke patients, especially the older ones, are susceptible to bloodstream infection from multi-drug-resistant micro-organisms, contributing to increased morbidity and mortality among stroke patients.