Pediatric Bloodstream Infections in Eastern Democratic Republic of the Congo: Epidemiology, Antimicrobial Resistance Patterns, and Predictors of Mortality.

Background:Bloodstream infections (BSI) are a major cause of pediatric morbidity and mortality in low- and middle-income countries, yet microbiological surveillance data remain limited in Central Africa. We aimed to characterize the epidemiology, microbiological spectrum, antimicrobial resistance (AMR) patterns, and predictors of mortality among children with culture-confirmed BSI in eastern Democratic Republic of the Congo (DRC). Methods:We conducted a retrospective cohort study at Hôpital Provincial Général de Référence de Bukavu, a tertiary referral hospital in eastern DRC. Children aged 29 days to 18 years admitted with clinically suspected sepsis between June 2020 and December 2024 were eligible. Blood cultures classified as contaminants according to predefined microbiological criteria were excluded. Clinical, microbiological, and antimicrobial susceptibility data were extracted from hospital and laboratory records. Multivariable logistic regression was used to identify independent predictors of in-hospital mortality. Results:Among 123 children with culture-confirmed bacteremia, 123 clinically significant bacterial isolates were identified and in-hospital mortality was 9.8% (12/123). Gram-negative bacteria predominated (84/123; 68.3%), with Salmonella spp. (27/123; 22.0%) and Enterococcus spp. (25/123; 20.3%) being the most frequently isolated pathogens. Among the main Gram-negative pathogens, resistance to amoxicillin-clavulanate was 100.0% in Salmonella spp. (24/24), K. pneumoniae (11/11), and E. coli (10/10), whereas amikacin resistance ranged from 0.0% (0/24) in Salmonella spp. to 23.1% (3/13) in K. pneumoniae; no meropenem resistance was detected among isolates tested. In multivariable analysis, altered level of consciousness was associated with higher odds of in-hospital mortality (aOR 12.83; 95% CI 1.54-107.09). Model discrimination was acceptable (AUROC 0.71; 95% CI 0.55-0.87). Conclusion:Pediatric BSI in eastern DRC were predominantly caused by Gram-negative pathogens and showed substantial resistance to commonly used antibiotics. Altered level of consciousness was associated with higher odds of in-hospital mortality. Strengthening microbiological surveillance, diagnostic stewardship, and antimicrobial stewardship is essential to optimize empiric therapy and improve pediatric sepsis outcomes.