Bacteremia and resistant gram-negative pathogens among under-fives in Tanzania
Alexandra Christopher
Bacteremia and resistant gram-negative pathogens among under-fives in Tanzania - Mwanza, Tanzania Catholic University of Health and Allied Sciences CUHAS - Bugando 2013
Abstract
Background: Antibiotic 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 methods: A 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.
Results: Of 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%).
Conclusion: Multi-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.
Bacteremia and resistant gram-negative pathogens among under-fives in Tanzania - Mwanza, Tanzania Catholic University of Health and Allied Sciences CUHAS - Bugando 2013
Abstract
Background: Antibiotic 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 methods: A 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.
Results: Of 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%).
Conclusion: Multi-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.