{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T01:50:55Z","timestamp":1780624255788,"version":"3.54.1"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T00:00:00Z","timestamp":1713225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Polymicrobial bloodstream infections (BSI) are difficult to treat since empiric antibiotics treatment are frequently less effective against multiple pathogens. The study aimed to compare outcomes in patients with polymicrobial and monomicrobial BSIs.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>The study was a retrospective case-control design conducted at Muhimbili National Hospital for data processed between July 2021 and June 2022. Cases were patients with polymicrobial BSI, and controls had monomicrobial BSI. Each case was matched to three controls by age, admitting ward, and duration of admission. Logistic regression was performed to determine independent risk factors for in-hospital and 30-day mortality.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Fifty patients with polymicrobial BSI and 150 with monomicrobial BSI were compared: the two arms had no significant differences in sex and comorbidities. The most frequent bacteria in polymicrobial BSI were <jats:italic>Klebsiella pneumoniae<\/jats:italic> 17% (17\/100) and <jats:italic>Enterobacter<\/jats:italic> species 15% (15\/100). In monomicrobial BSI, <jats:italic>S<\/jats:italic>. <jats:italic>aureus<\/jats:italic> 17.33% (26\/150), <jats:italic>Klebsiella pneumoniae<\/jats:italic> 16.67% (25\/150), and <jats:italic>Acinetobacter<\/jats:italic> species 15% (15\/150) were more prevalent. Overall, isolates were frequently resistant to multiple antibiotics tested, and 52% (130\/250) were multidrug resistance. The 30-day and in-hospital mortality were 33.5% (67\/200) and 36% (72\/200), respectively. On multivariable analysis, polymicrobial BSIs were independent risk factors for both in-hospital mortality (aOR 2.37, 95%CI 1.20\u20134.69, p = 0.01) and 30-day mortality (aOR 2.05, 95%CI 1.03\u20134.08), p = 0.04). In sub-analyses involving only neonates, polymicrobial BSI was an independent risk factor for both 30-day mortality (aOR 3.13, 95%CI 1.07\u20139.10, p = 0.04) and in-hospital mortality (aOR 5.08, 95%CI 1.60\u201316.14, p = 0.006). Overall, the median length of hospital stay post-BSIs was numerically longer in patients with polymicrobial BSIs.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Overall, polymicrobial BSI was a significant risk for mortality. Patients with polymicrobial BSI stay longer at the hospital than those with monomicrobial BSI. These findings call for clinicians to be more aggressive in managing polymicrobial BSI.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0302076","type":"journal-article","created":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T17:44:39Z","timestamp":1713289479000},"page":"e0302076","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Polymicrobial bloodstream infections a risk factor for mortality in neonates at the national hospital, Tanzania: A case-control study"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1388-3901","authenticated-orcid":true,"given":"Joel","family":"Manyahi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Agricola","family":"Joachim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Msafiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Migiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthon","family":"Mwingwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mabula","family":"Kasubi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helga","family":"Naburi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mtebe Venance","family":"Majigo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,4,16]]},"reference":[{"issue":"6","key":"pone.0302076.ref001","doi-asserted-by":"crossref","first-page":"e0127962","DOI":"10.1371\/journal.pone.0127962","article-title":"Etiology of Severe Febrile Illness in Low- and Middle-Income Countries: A Systematic Review","volume":"10","author":"N Prasad","year":"2015","journal-title":"PLoS One"},{"issue":"1","key":"pone.0302076.ref002","doi-asserted-by":"crossref","DOI":"10.1128\/AAC.01974-19","article-title":"A Systematic Review and Meta-analysis of the Prevalence of Community-Onset Bloodstream Infections among Hospitalized Patients in Africa and Asia","volume":"64","author":"CS Marchello","year":"2019","journal-title":"Antimicrob Agents Chemother"},{"key":"pone.0302076.ref003","doi-asserted-by":"crossref","first-page":"2118","DOI":"10.3389\/fmicb.2020.02118","article-title":"Bacteraemia, Malaria, and Case Fatality Among Children Hospitalized With Fever in Dar es Salaam, Tanzania","volume":"11","author":"SJ Moyo","year":"2020","journal-title":"Front Microbiol"},{"issue":"1","key":"pone.0302076.ref004","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s12887-019-1411-0","article-title":"Deciphering risk factors for blood stream infections, bacteria species and antimicrobial resistance profiles among children under five years of age in North-Western Tanzania: a multicentre study in a cascade of referral health care system","volume":"19","author":"J Seni","year":"2019","journal-title":"BMC Pediatr"},{"issue":"3","key":"pone.0302076.ref005","doi-asserted-by":"crossref","first-page":"e0220424","DOI":"10.1371\/journal.pone.0220424","article-title":"Multi-drug resistant bacteria predict mortality in bloodstream infection in a tertiary setting in Tanzania","volume":"15","author":"J Manyahi","year":"2020","journal-title":"PLoS One"},{"key":"pone.0302076.ref006","first-page":"167","article-title":"Aetiology, antimicrobial susceptibility and outcome of children with sepsis, admitted at Muhimbili National Hospital, Dar es Salaam","volume":"42","author":"E Godfrey","year":"2022","journal-title":"Pan Afr Med J"},{"key":"pone.0302076.ref007","doi-asserted-by":"crossref","first-page":"278","DOI":"10.3389\/fped.2017.00278","article-title":"Clinical Presentation and Outcomes among Children with Sepsis Presenting to a Public Tertiary Hospital in Tanzania","volume":"5","author":"TB Kortz","year":"2017","journal-title":"Front Pediatr"},{"key":"pone.0302076.ref008","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/1471-2334-7-43","article-title":"Antimicrobial resistance predicts death in Tanzanian children with bloodstream infections: a prospective cohort study","volume":"7","author":"B Blomberg","year":"2007","journal-title":"BMC Infect Dis"},{"issue":"2","key":"pone.0302076.ref009","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1128\/JCM.43.2.745-749.2005","article-title":"High rate of fatal cases of pediatric septicemia caused by gram-negative bacteria with extended-spectrum beta-lactamases in Dar es Salaam, Tanzania","volume":"43","author":"B Blomberg","year":"2005","journal-title":"J Clin Microbiol"},{"key":"pone.0302076.ref010","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1186\/1471-2334-14-390","article-title":"Polymicrobial bloodstream infections in the neonatal intensive care unit are associated with increased mortality: a case-control study","volume":"14","author":"M Pammi","year":"2014","journal-title":"BMC Infect Dis"},{"issue":"5","key":"pone.0302076.ref011","first-page":"366","article-title":"The microbiological and clinical analysis of bloodstream infections with identifiable sources","volume":"51","author":"L Zhang","year":"2012","journal-title":"Zhonghua Nei Ke Za Zhi"},{"issue":"10","key":"pone.0302076.ref012","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1111\/j.1553-2712.2010.00871.x","article-title":"Characteristics and outcomes of polymicrobial bloodstream infections in the emergency department: A matched case-control study","volume":"17","author":"JN Lin","year":"2010","journal-title":"Acad Emerg Med"},{"issue":"1","key":"pone.0302076.ref013","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1186\/s13756-020-00741-6","article-title":"Clinical characteristics and risk factors of polymicrobial Staphylococcus aureus bloodstream infections","volume":"9","author":"C Zheng","year":"2020","journal-title":"Antimicrob Resist Infect Control"},{"key":"pone.0302076.ref014","unstructured":"Clinical and Laboratory Standards Institute (2018) Performance standards for antimicrobial susceptibility testing; twenty-eighth informational supplement CLSI document M100\u2013S20. Clinical and Laboratory Standards Institute W, PA."},{"key":"pone.0302076.ref015","doi-asserted-by":"crossref","first-page":"3917","DOI":"10.2147\/IDR.S412669","article-title":"Microbiological Analysis and Mortality Risk Factors in Patients with Polymicrobial Bloodstream Infections","volume":"16","author":"J Xu","year":"2023","journal-title":"Infect Drug Resist"},{"issue":"10","key":"pone.0302076.ref016","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1086\/591323","article-title":"Matched case-control analysis of polymicrobial bloodstream infection in a neonatal intensive care unit","volume":"29","author":"MJ Bizzarro","year":"2008","journal-title":"Infect Control Hosp Epidemiol"},{"issue":"1","key":"pone.0302076.ref017","doi-asserted-by":"crossref","first-page":"e83082","DOI":"10.1371\/journal.pone.0083082","article-title":"Polymicrobial bloodstream infection in neonates: microbiology, clinical characteristics, and risk factors","volume":"9","author":"MH Tsai","year":"2014","journal-title":"PLoS One"},{"key":"pone.0302076.ref018","doi-asserted-by":"crossref","first-page":"2803","DOI":"10.3389\/fmicb.2019.02803","article-title":"Polymicrobial Interactions Induce Multidrug Tolerance in Staphylococcus aureus Through Energy Depletion","volume":"10","author":"DL Nabb","year":"2019","journal-title":"Front Microbiol"},{"issue":"2","key":"pone.0302076.ref019","doi-asserted-by":"crossref","DOI":"10.3390\/pathogens10020144","article-title":"Clinical Implications of Polymicrobial Synergism Effects on Antimicrobial Susceptibility","volume":"10","author":"W Little","year":"2021","journal-title":"Pathogens"},{"issue":"17","key":"pone.0302076.ref020","doi-asserted-by":"crossref","first-page":"3355","DOI":"10.1016\/j.jmb.2016.05.006","article-title":"Polymicrobial-Host Interactions during Infection","volume":"428","author":"WH Tay","year":"2016","journal-title":"J Mol Biol"},{"issue":"5","key":"pone.0302076.ref021","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1097\/INF.0b013e31816591be","article-title":"Polymicrobial bloodstream infection in pediatric patients: risk factors, microbiology, and antimicrobial management","volume":"27","author":"D Sutter","year":"2008","journal-title":"Pediatr Infect Dis J"},{"key":"pone.0302076.ref022","doi-asserted-by":"crossref","first-page":"6619911","DOI":"10.1155\/2021\/6619911","article-title":"Clinical Characteristics, Risk Factors, and Outcomes of Patients with Polymicrobial Klebsiella pneumoniae Bloodstream Infections","volume":"2021","author":"F Song","year":"2021","journal-title":"Biomed Res Int"},{"issue":"8","key":"pone.0302076.ref023","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.1007\/s10096-011-1503-8","article-title":"Impact of nosocomial polymicrobial bloodstream infections on the outcome in critically ill patients","volume":"31","author":"S Sancho","year":"2012","journal-title":"Eur J Clin Microbiol Infect Dis"},{"issue":"5","key":"pone.0302076.ref024","first-page":"279","article-title":"Risk Factors and Outcome of Polymicrobial Bacteremia: A Retrospective Cohort Study","volume":"22","author":"S Goldman","year":"2020","journal-title":"Isr Med Assoc J"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0302076","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,16]],"date-time":"2024-04-16T17:44:52Z","timestamp":1713289492000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0302076"}},"subtitle":[],"editor":[{"given":"Iddya","family":"Karunasagar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,4,16]]},"references-count":24,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,4,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0302076","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,16]]}}}