title: A prospective observational study of bacteraemia in adults admitted to an urban Mozambican hospital.
abstract: BACKGROUND
  Bacteraemia is a common cause of fever among patients presenting to hospitals in sub-Saharan Africa. The worldwide rise of antibiotic resistance makes empirical therapy increasingly difficult, especially in resource-limited settings.
  
  
  OBJECTIVE
  To describe the incidence of bacteraemia in febrile adults presenting to Maputo Central Hospital (MCH), an urban referral hospital in the capital of Mozambique, and characterise the causative organisms and antibiotic susceptibilities. We aimed to describe the antibiotic prescribing habits of local doctors, to identify areas for quality improvement.
  
  
  METHODS
  Inclusion criteria were: (i) ≥18 years of age; (ii) axillary temperature ≥38°C or ≤35°C; (iii) admission to MCH medical wards in the past 24 hours; and (iv) no receipt of antibiotics as an inpatient. Blood cultures were drawn from enrolled patients and incubated using the BacT/Alert automated system (bioMérieux, France). Antibiotic susceptibilities were tested using the Kirby-Bauer disc diffusion method.
  
  
  RESULTS
  Of the 841 patients enrolled, 63 (7.5%) had a bloodstream infection. The most common isolates were Staphylococcus aureus, Escherichia coli, and non-typhoidal Salmonella. Antibiotic resistance was common, with 20/59 (33.9%) of all bacterial isolates showing resistance to ceftriaxone, the broadest-spectrum antibiotic commonly available at MCH. Receipt of insufficiently broad empirical antibiotics was associated with poor in-hospital outcomes (odds ratio 8.05; 95% confidence interval 1.62 - 39.91; p=0.04).
  
  
  CONCLUSIONS
  This study highlights several opportunities for quality improvement, including educating doctors to have a higher index of suspicion for bacteraemia, improving local antibiotic guidelines, improving communication between laboratory and doctors, and increasing the supply of some key antibiotics.
authors.affiliation: University of California, San Diego, USA. mpreziosi@ucsd.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Preziosi
authors.forename: Tomas Francisco
authors.initials: TF
authors.lastname: Zimba
authors.forename: Kristen
authors.initials: K
authors.lastname: Lee
authors.forename: Manuel
authors.initials: M
authors.lastname: Tomas
authors.forename: Suraida
authors.initials: S
authors.lastname: Kinlin
authors.forename: Clotilde
authors.initials: C
authors.lastname: Nhatave-Paiva
authors.forename: Rosa
authors.initials: R
authors.lastname: Bene
authors.forename: Tania
authors.initials: T
authors.lastname: Paunde
authors.forename: Helder
authors.initials: H
authors.lastname: Lopes
authors.forename: Stephen
authors.initials: S
authors.lastname: Kalkhoff
authors.forename: Vishnu
authors.initials: V
authors.lastname: Prathap
authors.forename: Kevan
authors.initials: K
authors.lastname: Akrami
authors.forename: Emilia Virginia
authors.initials: EV
authors.lastname: Noormahomed
authors.forename: Robert Turner
authors.initials: RT
authors.lastname: Schooley
authors.forename: Eliah
authors.initials: E
authors.lastname: Aronoff-Spencer
mesh_terms: D000293:Adolescent; D000328:Adult; D016470:Bacteremia / Q000453:epidemiology*; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D015994:Incidence; D007297:Inpatients; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D016017:Odds Ratio; D011446:Prospective Studies; D055815:Young Adult