Pan Afr Med J. 2026 Jun 4;54:29. doi: 10.11604/pamj.2026.54.29.52096. eCollection 2026.
ABSTRACT
INTRODUCTION: bloodstream infections (BSIs) are a significant cause of morbidity and mortality and are frequently complicated by kidney dysfunction. Evidence on the prevalence, predictors, and associated microbiological patterns in Zambia remains scarce. This study evaluated the burden of kidney dysfunction, its laboratory predictors, and blood culture isolate patterns at Ndola Teaching Hospital (NTH).
METHODS: a retrospective cohort study was conducted at NTH from January to December 2025. Data were extracted from the DISA laboratory database and patient registry records. Kidney dysfunction was defined as an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2 at admission. Descriptive statistics summarized demographic and microbiological characteristics. Logistic regression analyses were performed to identify independent predictors of kidney dysfunction.
RESULTS: among 232 patients with confirmed BSIs, 58.6% (n = 136; 95% CI: 52.1-64.9) had kidney dysfunction at admission. The majority were aged 18-39 years (37.9%) and ≥60 years (34.9%), and 51.3% were female. Gram-negative organisms predominated (67.1%), particularly Enterobacterales (52.2%), with Enterobacter agglomerans (15.1%), Klebsiella pneumonia (10.8%), and Escherichia coli (8.2%) most common. Gram-positive organisms accounted for 32.3%, mainly Staphylococcus aureus (16.8%). Multidrug-resistant isolates comprised 58.2%. Independent predictors of kidney dysfunction at admission included age 40-59 years (AOR 2.39; 95% CI 1.01-5.61) and age ≥60 years (AOR 5.62; 95% CI 2.41-13.08) compared with patients aged 18-39 years. Compared with patients with pre-existing chronic kidney disease (CKD), those without CKD had markedly lower odds of kidney dysfunction at admission (AOR 0.007; 95% CI 0.00-0.11). Among laboratory markers, a lower hemoglobin-to-RDW ratio (AOR 0.04; 95% CI 0.03-0.85) and lower platelet count (AOR 0.995; 95% CI 0.994-0.998) were also independently associated with kidney dysfunction at admission.
CONCLUSION: kidney dysfunction at admission is highly prevalent among adults with BSIs at NTH and is independently associated with older age, pre-existing CKD, lower hemoglobin-to-RDW ratio, and thrombocytopenia. The predominance of multidrug-resistant Gram-negative pathogens highlights the importance of early renal assessment, risk stratification, and strengthened antimicrobial stewardship in resource-limited settings.
PMID:42920723 | PMC:PMC13691203 | DOI:10.11604/pamj.2026.54.29.52096