Prevalence and Management of Suspected and Confirmed Bloodstream Infections Among Acute Leukaemia Patients Receiving Chemotherapy at Kenyatta National Hospital, Kenya

Abstract

Patients with acute leukaemia receiving chemotherapy are highly susceptible to infection because of disease-related immune dysfunction, chemotherapy-induced neutropenia, mucosal injury, and frequent use of invasive vascular devices. However, evidence on bloodstream infection and its management in this population in Kenya remains limited. This study aimed to determine the prevalence of suspected and confirmed bloodstream infection and to evaluate antibiotic utilisation and adherence to evidence-based treatment guidelines among patients with acute leukaemia receiving chemotherapy in adult wards at Kenyatta National Hospital. A retrospective cross-sectional study was conducted using medical records of patients aged ≥13 years with acute myeloid or acute lymphoblastic leukaemia who received chemotherapy in adult wards at Kenyatta National Hospital between January 2018 and December 2025. Of 332 eligible records identified after screening, 139 were selected using simple random sampling. Data were abstracted using a structured tool and analysed descriptively with IBM SPSS Statistics version 26. Of 139 patients, 58 (41.7%; 95% confidence interval: 33.4–50.4%, exact Clopper–Pearson method) met the composite definition of bloodstream infection. Of these, 12 (20.7% of cases; 8.6% of all patients) were microbiologically confirmed and 46 (79.3% of cases; 33.1% of all patients) were clinically suspected or documented. Of 15 isolates, 14 (93.3%) were bacterial and 1 (6.7%) was fungal (Candida spp.); Gram-negative organisms accounted for 71.4% of bacterial isolates (10 of 14). Cephalosporins were the most frequently used antibiotic class (53.4%), and two antibiotics per patient was the most common regimen size (41.4%). Among the 58 patients with bloodstream infection, 17 (29.3%) were adherent to all applicable guideline components, 37 (63.8%) were non-adherent to at least one, and 4 (6.9%) were not assessable. Bloodstream infection was common according to the study’s composite clinical and microbiological definition, although microbiological confirmation was limited. Strengthening blood-culture investigation, antimicrobial susceptibility testing, clinical documentation, antimicrobial stewardship, and adherence to evidence-based treatment guidelines may improve infection management in this high-risk population.