Bacterial infections in Lilongwe, Malawi: aetiology and antibiotic resistance

Abstract

BackgroundLife-threatening infections present major challenges for health systems in Malawi and the developing world because routine microbiologic culture and sensitivity testing are not performed due to lack of capacity. Use of empirical antimicrobial therapy without regular microbiologic surveillance is unable to provide adequate treatment in the face of emerging antimicrobial resistance. This study was conducted to determine antimicrobial susceptibility patterns in order to inform treatment choices and generate hospital-wide baseline data.MethodsCulture and susceptibility testing was performed on various specimens from patients presenting with possible infectious diseases at Kamuzu Central Hospital, Lilongwe, Malawi.ResultsBetween July 2006 and December 2007 3104 specimens from 2458 patients were evaluated, with 60.1% from the adult medical service. Common presentations were sepsis, meningitis, pneumonia and abscess. An etiologic agent was detected in 13% of patients. The most common organisms detected from blood cultures were Staphylococcus aureus, Escherichia coli, Salmonella species and Streptococcus pneumoniae, whereas Streptococcus pneumoniae and Cryptococcus neoformans were most frequently detected from cerebrospinal fluid. Haemophilus influenzae was rarely isolated. Resistance to commonly used antibiotics was observed in up to 80% of the isolates while antibiotics that were not commonly in use maintained susceptibility.ConclusionsThere is widespread resistance to almost all of the antibiotics that are empirically used in Malawi. Antibiotics that have not been widely introduced in Malawi show better laboratory performance. Choices for empirical therapy in Malawi should be revised accordingly. A microbiologic surveillance system should be established and prudent use of antimicrobials promoted to improve patient care.

The changing microbiological and antimicrobial susceptibility profile of cerebrospinal fluid organism isolates in a teaching hospital, Tangerang, Indonesia

“…An earlier study in India has observed that the infection rate due to Cryptococcus neoformans was 2.93% to 3.13%, and it is lower than our finding (4%) [8]. A study conducted in Malawi had significantly higher frequency of C. neoformans (39.1%) and this high prevalence was likely related to prevalence of HIV infection in their patients and which is different in our study [9], where up to twothirds of patients had neurosurgical procedures.…”

“…The development of many drug-resistant organisms, such as carbapenemresistant and methicillin/oxacillin-resistant strains, and extended-spectrum beta-lactamase (ESBL) producing bacteria may reflect the changing trend of pathogens and their antimicrobial susceptibility pattern [9,10]. Therefore, microbiological surveillance is important to identify the common pathogens and their antimicrobial susceptibility patterns in order to select the rational empirical antimicrobial therapy based on regional and national data to reduce the emergence of resistant organisms [8,11,12].…”

Microbial effects of livestock manure fertilization on freshwater aquaculture ponds rearing tilapia (Oreochromis shiranus) and North African catfish (Clarias gariepinus)

“…Actinobacteria were also prevalent in bird manure, water, and fish fecal samples and are generally associated with high antibiotic resistance genes, particularly MFS transporters (Forsberg et al, 2014). Lastly, fluoroquinolone antibiotics have been used to treat Malaria for many decades (Divo, Sartorelli, Patton, & Bia, 1988), but was replaced in 1993 by other drugs (Laufer et al, 2006), although this class of antibiotics is still widely used to treat a variety of gram negative bacterial infections as ciprofloxacin (Makoka et al, 2012). Antibiotics are used broadly in hospital and other rural clinics in Malawi, while agriculture use is not well documented.…”

New epidemiology of Staphylococcus aureus infection in Africa

“…In addition, some studies have suggested a higher proportion of S. aureus in urinary tract infections: 6.3–13.9% of urinary tract infections are caused by S. aureus in Senegal , Ghana , and Nigeria , as compared with 1.06% in Europe and Brazil . In general, S. aureus is a major pathogen in bloodstream infections (9.5–39.0%), skin and soft tissue infections (62.8–90.0%), ear, nose and throat infections (16.7–29.0%), and surgical site infections (20.4–32.0%) .…”