High Rate of Fatal Cases of Pediatric Septicemia Caused by Gram-Negative Bacteria with Extended-Spectrum Beta-Lactamases in Dar es Salaam, Tanzania

Abstract

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...

Antimicrobial resistance of bacteria isolated from patients with bloodstream infections at a tertiary care hospital in the Democratic Republic of the Congo

“…This rate is high when compared with rates in other African countries. [22,[26][27][28] We found a high prevalence of MDR GNB as major causative agents of BSI. Among GNB, Enterobacteriaceae, particularly E. coli, were the most frequently isolated pathogens.…”

“…[22] Accordingly, the implementation of laboratory capacity for specific diagnosis of causative bacterial agents and determination of their antimicrobial susceptibility profile is pivotal in curbing mortality related to BSI. Although blood cultures have been performed at our hospital for many years, they were characterised by a very low yield of positive isolates, with unreliable identification resulting in largely empirical treatment of presumptive BSI.…”

Characterisation of extended-spectrum β-lactamases among Klebsiella pneumoniae isolates causing bacteraemia and urinary tract infection in Mozambique

“…Although ESBLs have been previously reported in sub-Saharan Africa [5][6][7][27][28][29][30], the report of ESBLs in a rural hospital with limited access to third-generation cephalosporins, such as in Manhiça, Mozambique, is relevant, suggesting again the coselection of antibiotic resistance genes. Despite access to thirdgeneration cephalosporins being limited in this community, a high prevalence of b-lactamase genes, such as bla TEM-like and bla OXA-like , has been reported in Shigella and Salmonella isolates in previous studies, reflecting of the high use of ampicillin in the area [23].…”

“…The reported prevalence of ESBLs is high compared with that reported in neighbouring countries such as Tanzania [27] and South Africa [5]. In another sub-Saharan country (Ethiopia), a high level of ESBL-producers (36%; 46% among inpatients and 33% among outpatients) was reported among E. coli strains from different samples (urine, sputum, stool, wound swabs) [28].…”

Detection of High Prevalence of TEM/SHV/CTX-M Genes in ESBL Producing and Multidrug Resistant Klebsiella Pneumoniae and Klebsiella Oxytoca

“…The first reported β-lactamases TEM-1/2 and SHV-1, described since 1960 from E. coli and Klebsiella pneumoniae were usually chromosomal. They are the most medically important species, often isolated from severe infections in hospitalized or ambulatory patients [25][26][27][28][29]. Klebsiella spp.…”