Abstract
Background
Antibiotic-resistant bloodstream infections are a major public health concern, particularly in children under five years of age. The objective of this study was to determine the prevalence of bloodstream infections and assess the antimicrobial resistance profiles and their associated factors among febrile children under five years of age in Bahir Dar, northwest Ethiopia.Methods
A cross-sectional study was conducted from November to December 2025 among 281 children under five years of age who attended the pediatric clinic of Felege Hiwot Comprehensive Specialized Hospital in Bahir Dar. Sociodemographic and clinical data were collected using a structured questionnaire through face-to-face interviews with the parents or guardians. Approximately 3 mL of venous blood was aseptically collected and cultured using standard microbiological techniques. Bacterial identification was performed based on colony characteristics and biochemical tests. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method. Data were entered into EpiData version 3.1 and analyzed using SPSS version 26. Logistic regression analysis was used to identify factors associated with bloodstream infections, and statistical significance was set at p Results
The prevalence of bloodstream infection was 19.2% (54/281; 95% CI: 14.0%-24.4%). The most common isolate was Klebsiella pneumoniae (31%), followed by Enterobacter cloacae (11%), Escherichia coli (9%), and Acinetobacter baumannii (9) %. Gram-negative bacteria accounted for 80% of the isolates. Antimicrobial susceptibility testing revealed high resistance rates to commonly used antibiotics, particularly ampicillin (87.0%, 40/46), trimethoprim-sulfamethoxazole (86.3%, 44/51), and cefepime 42/54 (77.8). Resistance was also high to ciprofloxacin (68.5%, 37/54), tobramycin (68.6%, 35/51), amoxicillin-clavulanic acid (66.0%, 31/47), gentamicin (63.3%, 31/49), tetracycline (61.1%, 33/54), and chloramphenicol (60.5%, 26/43). In contrast, lower resistance rates were observed for cefotaxime (37.0%, 20/54) and meropenem (20.4%, 11/54). Significant associated factors of blood stream infections included age 7 days (AOR = 2.74; 95% CI: 1.22-6.15), partially immunized children (AOR = 3.21; 95% CI: 1.08-9.51; p = 0.036), and non-immunized children (AOR = 9.87; 95% CI: 3.61-26.9; p Conclusion
The prevalence of bloodstream infections among febrile children under five years of age was high. Younger age, fever duration > 7 days, and partially immunization and non-immunization were significant predictors of bloodstream infection. Strengthening antimicrobial stewardship, improving immunization coverage, and enhancing early diagnosis are essential to reduce the burden of bloodstream infections and combat antimicrobial resistance.