Molecular investigation of ß-lactamase producing Enterobacterales towards improving diagnosis and treatment of bloodstream infections in tertiary hospitals in Rwanda.

β-lactamase producing Enterobacterales (BLPE) are a global public health threat as highlighted by WHO due to their association with high mortality, morbidity, long hospital stays and limited treatment options. Those pathogens have been among the commonly reported resistant pathogens causing bloodstream infections (BSIs), especially in low- and middle-income countries (LMICs). In Rwanda, some studies demonstrated a burden of BLPE in tertiary hospitals. However, limited information is known on the real burden of BLPE in BSIs and the respective circulating genes, which is crucial in diagnosis and clinical management of BLPE. Therefore, reliable data are needed for evidence-based practice in management and containment of resistant Enterobacterales. The main objective of this study is to enhance patient clinical outcome by improving the diagnosis and treatment of BLPE in BSI in Rwandan tertiary hospitals.
This will be a lab-based cross-sectional study and clinical longitudinal study, that will be conducted in four tertiary hospitals in Rwanda. Blood samples from patients suspected to have BSI will be cultured for pathogen isolation and identification using phenotypic and genotypic techniques. Identifying BLPE and antimicrobial susceptibility testing will be done using Kirby-Bauer techniques and automated systems. To improve diagnosis, a head-to-head comparative study will be conducted using novel approaches to reduce turnaround time of diagnosis of BLPE.
This study will provide reliable AMR surveillance data in BSI that will inform evidence-based empirical and directed treatments of BLPE in Rwanda, hence reduce the rate of associated treatment failure and its consequences. Furthermore, it will provide rapid and accurate diagnosis of BLPE from BSIs in Rwanda that can be adopted in other LMICS.