Prevalence and Antimicrobial Resistance of Microbes Causing Bloodstream Infections in Unguja, Zanzibar

Abstract

BackgroundBloodstream infections (BSI) are frequent and cause high case-fatality rates. Urgent antibiotic treatment can save patients’ lives, but antibiotic resistance can render antibiotic therapy futile. This study is the first to collect epidemiological data on BSI from Unguja, Zanzibar.MethodsClinical data and blood for culturing and susceptibility testing of isolated microbes were obtained from 469 consecutively enrolled neonates, children and adults presenting with signs of systemic infections at Mnazi Mmoja Hospital (MMH), Zanzibar.ResultsPathogenic bacteria were recovered from the blood of 14% of the patients (66/469). The most frequently isolated microbes were Klebsiella pneumoniae, Escherichia coli, Acinetobacter spp. and Staphylococcus aureus. Infections were community-acquired in 56 patients (85%) and hospital-acquired in 8 (12%) (data missing for 2 patients). BSI caused by extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae (E. coli, K. pneumoniae) was found in 5 cases, of which 3 were community-acquired and 2 hospital-acquired. Three of these patients died. Six of 7 Salmonella Typhi isolates were multidrug resistant. Streptococcus pneumoniae was found in one patient only.ConclusionsThis is the first report of ESBL-producing bacteria causing BSI from the Zanzibar archipelago. Our finding of community-acquired BSI caused by ESBL-producing bacteria is alarming, as it implies that these difficult-to-treat bacteria have already spread in the society. In the local setting these infections are virtually impossible to cure. The findings call for increased awareness of rational antibiotic use, infection control and surveillance to counteract the problem of emerging antimicrobial resistance.

Low Efficiency of the Commonly Prescribed Drugs against <i>Klebsiella pneumonia</i>, <i>Escherichia coli</i> and <i>Acinetobacter</i> Species as the Causative Agents of Blood Stream Infection in Malabo, Equatorial Guinea

“…This rate of positive samples from this study was lower than figures from previous studies [16]- [19] in Tanzania (13.4%), Central Africa (15.9%), Ethiopia (28%) and Zanzibar (14%). The difference in rates of positive samples can be explained by the differences in blood culture system, location and health situation in the region, capacity of hospital, epidemiological difference of the etiological agents [ [20].…”

Preliminary insights into the occurrence of similar clones of extended‐spectrum beta‐lactamase‐producing bacteria in humans, animals and the environment in Tanzania: A systematic review and meta‐analysis between 2005 and 2016

“…The overall prevalence of ESBL in the three interfaces was found to be 22.62% (95% CI: 21.08–24.16) (Blomberg et al., ; Moremi et al., ; Mshana, Imirzalioglu, et al., ; Mshana et al., , ; Ndugulile, Jureen, Harthug, Urassa, & Langeland, ; Onken, Said, Jorstad, Jenum, & Blomberg, ; Seni et al., ; Tellevik et al., ). The lowest and highest ESBL prevalence were 0.90% (95% CI: 0.46–1.34) and 53.40% (95% CI: 41.96–64.84), respectively (Blomberg et al., ; Moremi et al., ) (Figure ).…”

“…With regard to ESBL‐PE species, E. coli and Klebsiella species were the predominant bacterial species (93.2%) compared to other bacterial species, which accounted for only 6.8% (Blomberg et al., ; Moremi et al., ; Mshana et al., , ; Mshana, Imirzalioglu, et al., ; Ndugulile et al., ; Onken et al., ; Seni et al., ; Tellevik et al., ) (Figure ).…”

“…Two studies described the outcomes among patients with ESBL‐PE attributable infections; all of them indicated that patients suffering from ESBL‐PE infections were more likely to die compared to those suffering from non‐ESBL‐PE infections 71% versus 39% and 60% versus 36%, respectively (Blomberg et al., ; Onken et al., ).…”

Therapeutic Challenges of Multidrug Resistant Acinetobacter baumannii in Eastern Africa: Systematic Review

“…The high (87.3%) MDR proportion with other comorbidities and short handiness to better treatment options may let for a 13 considerable death in Eastern Africa that we may not noticed. A. baumannii infections was known to be nosocomial, but recently there were reports of high prevalence community acquired infections, exemplified by the high prevalence of A. baumannii among head and body lice of Ethiopia (46), and community acquired blood stream infections of Tanzania (27).…”