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Background: Bloodstream infection is a common cause of hospitalization, morbidity and death in children. The impact of antimicrobial resistance and HIV infection on outcome is not firmly established.

Extended-spectrum beta-lactamases (ESBLs) were present in high proportions of Escherichia coli (25% [9 of 36]) and Klebsiella pneumoniae isolates (17% [9 of 52]) causing pediatric septicemia at a tertiary hospital in Tanzania. Patients with septicemia due to ESBL-producing organisms had a significantly higher fatality rate than those with non-ESBL isolates (71% versus 39%, P ‫؍‬ 0.039). This is the first report of the CTX-M-15 genotype of ESBLs on the African continent and the first observation of SHV-12 genotype in an isolate of Salmonella enterica serotype Newport. Resistance to beta-lactam antibiotics was demonstrated inEscherichia coli even before penicillin was released for clinical use. In the 1960s, the first plasmid-transferable beta-lactamase was discovered and named TEM-1 after Temoniera, the Greek girl who harbored the E. coli isolate from which the enzyme was obtained. Since the 1980s, a large number of plasmid-transferable extended-spectrum beta-lactamases (ESBLs) capable of inactivating extended-spectrum cephalosporins has been discovered (6). Most of the ESBLs are derived from TEM-1 and SHV-1 (sulfhydryl variable) by mutations. ESBLs have spread widely and have become a major cause of nosocomial infections associated with high mortality rates, particularly in serious infections such as septicemia (12). In Africa, ESBLs have been reported in Egypt (19), Tunisia (4, 5), Morocco (2), Senegal (18,20), Nigeria (1), South Africa (9), and Kenya (11) but not previously from Tanzania. In the present study, we investigated the prevalence and clinical implications of ESBL production in E. coli, Klebsiella pneumoniae, and salmonellae causing septicemia in infants and children admitted to a tertiary teaching hospital in Tanzania. MATERIALS AND METHODSFrom August 2001 to August 2002, blood cultures were obtained from 1,798 children aged 0 to 7 years with a fever of Ն38°C or other signs of severe infections admitted to the Pediatric Department at Muhimbili National Hospital, a tertiary referral hospital in Dar es Salaam, Tanzania. We included in the present study 113 children who had growth in blood culture of one or more isolates of E. coli, Klebsiella spp., or salmonellae.Blood specimens (1 ml from neonates and 5 ml from older children) were inoculated in BACTEC Myco/F lytic blood culturing vials (Becton Dickinson, Franklin Lakes, N.J). Positive blood cultures were subcultured on Columbia II agar base (Oxoid Ltd, Basingstoke, United Kingdom) with 5% human blood, chocolate agar, and MacConkey agar (Difco/BD Diagnostic Systems, Sparks, Mich.). The isolates were identified according to established procedures (7).Klebsiella spp. were identified with the API 20E system (bioMérieux SA, Marcy l'Etoile, France). Susceptibilities against antimicrobial agents were tested by the disk diffusion method according to NCCLS guidelines (15). Isolates of E. coli, Klebsiella spp., and salmonellae with reduced susceptibilities to cefotaxime (zone diameter of Յ27 mm) and/or ceftazidime (zone diameter of Յ22 mm) according to guidel...

Vitamin A increased the risk of HIV-1 transmission. Multivitamin (B, C, and E) supplementation of breastfeeding mothers reduced child mortality and HIV-1 transmission through breastfeeding among immunologically and nutritionally compromised women. The provision of these supplements to HIV-infected lactating women should be considered.