Healthcare associated infections and associated antimicrobial resistance in four African countries

<ns3:p> Background Healthcare-associated infections (HAIs) significantly contribute to patient morbidity and mortality worldwide, particularly in sub-Saharan Africa (sSA), where prevalence rates range between 6.7% and 28%. HAI are particularly associated with extensive antimicrobial resistance (AMR), which may potentially render HAI untreatable in settings with poor access to Watch and Reserve antibiotics. Methods This observational cohort study, conducted across hospitals in Kenya, Ghana, Malawi, and Uganda, aimed to estimate antimicrobial resistance (AMR) rates in HAIs, describe clinical outcomes, and assess hospital length of stay (LoS) among hospitalized patients with HAIs. Kaplan Meir plots were used to explore the impact of treatment adequacy on survival rate for different HAIs. Mixed-effect logistic regression models were used to assess the impact of drug resistance or treatment inadequacy on odds of survival. Results Of 336 participants enrolled between October 2021 and January 2023, 207 had at least one positive microbiological test, contributing 244 isolates. The highest AMR prevalence was observed in the Enterobacterales family, <ns3:italic>Staphylococcus aureus</ns3:italic> , and <ns3:italic>Acinetobacter</ns3:italic> spp. of which 85.3% (116/136), 78.6% (11/14) and 72.7% (16/22) exhibited AMR, respectively. Over 80.9% (114/141) of pathogenic isolates were either 3GC-R or MDR and 88.6% of those (101/114) were both MDR and 3GC-R. There was a 16.7% case fatality rate, with inadequate or unknown adequacy of antimicrobial treatment significantly associated with increased odds of death in patients with bloodstream infection, hospital acquired pneumonia or complicated skin and soft tissue infection (OR 2.90, 95% CI 0.99–8.36). Increased odds of death were also associated with hospital stay in an ICU ward (OR 4.70, 95%CI 1.80–12.32) and with increasing years of age (OR 1.01, 95%CI 1.01–1.04). Conclusion The findings highlight the urgent need for local treatment guidelines, improved infection prevention and control measures, and antimicrobial stewardship in sSA to reduce the burden of AMR and improve patient outcomes. </ns3:p>