Bacteremia and resistant gram-negative pathogens among under-fives in Tanzania

Abstract

BackgroundAntibiotic resistance is one of the most serious public health concerns worldwide and is increasing at an alarming rate, making daily treatment decisions more challenging. This study is aimed at identifying local bacterial isolates and their antimicrobial susceptibility patterns to avoid irrational antibiotic use, especially in settings where unguided management occurs and febrile illnesses are predominant.Material and methodsA hospital-based prospective cross-sectional study was conducted from September 2011 to February 2012. Febrile children were serially recruited and demographic and clinical data were collected using a standardized data collection tool. A blood culture was performed and identification of the isolates was undertaken using in-house biochemical tests. Susceptibility to common antibiotics was investigated using the disc diffusion methods.ResultsOf the 1081 children admitted during the study period, 317 (29.3%) met the inclusion criteria and were recruited, of whom 195 (61.5%) and 122 (38.5%) were male and female respectively. The median age was 18 months with an interquartile range of 9 to 36 months. Of the 317 children, 251 (79.2%) were below or equal to 36 months of age. The prevalence of bacteremia was 6.6%. A higher prevalence of bacteraemia was observed in children below 36 months than in those ≥ 36 months (7.5% vs. 3.0%, p = 0.001). Predictors of bacteraemia were an axillary temperature of >38.5 °C (OR =7, 95% CI = 2.2 - 14.8, p-value = 0.0001), a positive malaria slide (OR =5, 95% CI = 3.0 - 21.2, p-value = 0.0001) and a high neutrophils’ count (OR =21 95% CI = 5.6 - 84, p-value = 0.0001). Escherichia coli and Klebsiella pneumoniae accounted for 7 (33.3%) and 6 (28.6%) of all the isolates respectively. Others gram-negatives bacteria were Citrobacter spp 2 (9.5%), Enterobacter spp 1 (4.25%), Pseudomonas spp 2 (9.5%), Proteus spp 1 (4.25%) and Salmonella spp 1 (4.25%). These isolates were highly resistant to ampicillin (95%), co-trimoxazole (90%), tetracycline (90%), gentamicin (80%), augmentin (80%), chloramphenicol (65%), ceftriaxone (35%), cefotaxime (35%) ciprofloxacin (30%), amikacin (30%), ceftazidime (25%) and norfloxacine (10%).ConclusionMulti-resistant gram-negative bacteria are the commonest cause of bacteremia in under-fives attending the Bugando Medical Centre, Mwanza, Tanzania. A high body temperature, a positive malaria slide and a high absolute neutrophils’ count were all independent risk factors found to predict bacteremia. A higher mortality rate was observed in children with bacteraemia. Continuous epidemiological surveillance should be conducted so that a proper and effective antibiotics management can be instituted, especially in children with a high grade fever, a positive malaria slide and a high neutrophils’ count.

Comparison of antibiotic resistant Escherichia coli obtained from drinking water sources in northern Tanzania: a cross-sectional study

“…These five resistance phenotypes have been reported as relatively prominent for clinical isolates obtained from children (<5 years of age) in Tanzania [25] and this pattern of multidrug resistance has been reported elsewhere in both hospital and environmental settings [23, 26–28]. Presumably, the dissemination of these resistance traits is related to the spread of mobile genetic elements such as plasmids that are widely distributed among enteric bacteria [29].…”

“…Bla TEM-1 is widely distributed by plasmids and encodes a clinically significant, broad spectrum β-lactamase that hydrolyzes many β-lactams in addition to many penicillins. Christopher et al, [25] reported that 100 % of E. coli clinical isolates from children in Tanzania were resistant to ampicillin and these may have harbored bla TEM-1 . The high prevalence could also be due to higher utilization of beta-lactams antibiotic classes in many areas in Tanzania [35].…”

Bacteremia in children: epidemiology, clinical diagnosis and antibiotic treatment

“…Infections due to resistant Gram-negative bacteria are a growing concern worldwide. Published data from Ghana, Tanzania, South Africa and India have reported resistance rates to amoxicillin of 72-95%, co-trimoxazole (90%), gentamicin (13-80%), co-amoxiclav (20-80%), chloramphenicol (40-65%), fluoroquinolones (10-30%) and third-generation cephalosporins (19-25%) [97][98][99].…”

Meta-analysis of proportion estimates of Extended-Spectrum-Beta-Lactamase-producing Enterobacteriaceae in East Africa hospitals

“…Although there might be differences in magnitude depending on region or country, ESBLs used to be considered primarily nosocomial. Currently they can be frequently found in both hospitals and communities, though magnitudes reported in community-based surveys are generally lower [4, 6–8, 11–13]. Several risk factors have been documented to be associated with ESBL acquisition, including: previous hospitalisation, previous use of antibiotics such as third generation cephalosporins, hospital overcrowding, bed sharing when hospitalised, and international travel [3, 14–19].…”