title: Prevalence and Antimicrobial Resistance of Microbes Causing Bloodstream Infections in Unguja, Zanzibar.
abstract: BACKGROUND
  Bloodstream infections (BSI) are frequent and cause high case-fatality rates. Urgent antibiotic treatment can save patients' lives, but antibiotic resistance can render antibiotic therapy futile. This study is the first to collect epidemiological data on BSI from Unguja, Zanzibar.
  
  
  METHODS
  Clinical data and blood for culturing and susceptibility testing of isolated microbes were obtained from 469 consecutively enrolled neonates, children and adults presenting with signs of systemic infections at Mnazi Mmoja Hospital (MMH), Zanzibar.
  
  
  RESULTS
  Pathogenic bacteria were recovered from the blood of 14% of the patients (66/469). The most frequently isolated microbes were Klebsiella pneumoniae, Escherichia coli, Acinetobacter spp. and Staphylococcus aureus. Infections were community-acquired in 56 patients (85%) and hospital-acquired in 8 (12%) (data missing for 2 patients). BSI caused by extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae (E. coli, K. pneumoniae) was found in 5 cases, of which 3 were community-acquired and 2 hospital-acquired. Three of these patients died. Six of 7 Salmonella Typhi isolates were multidrug resistant. Streptococcus pneumoniae was found in one patient only.
  
  
  CONCLUSIONS
  This is the first report of ESBL-producing bacteria causing BSI from the Zanzibar archipelago. Our finding of community-acquired BSI caused by ESBL-producing bacteria is alarming, as it implies that these difficult-to-treat bacteria have already spread in the society. In the local setting these infections are virtually impossible to cure. The findings call for increased awareness of rational antibiotic use, infection control and surveillance to counteract the problem of emerging antimicrobial resistance.
authors.affiliation: Department of Medical Microbiology, Vestre Viken Health Trust, Drammen, Norway.
authors.forename: Annette
authors.initials: A
authors.lastname: Onken
authors.affiliation: Department of Medicine, Mnazi Mmoja Hospital, Zanzibar, Tanzania.
authors.forename: Abdulrahman K
authors.initials: AK
authors.lastname: Said
authors.affiliation: Department of Medicine, Haukeland University Hospital, Bergen, Norway.
authors.forename: Melissa
authors.initials: M
authors.lastname: Jørstad
authors.affiliation: Department of Medical Microbiology, Vestre Viken Health Trust, Drammen, Norway.
authors.forename: Pål A
authors.initials: PA
authors.lastname: Jenum
authors.affiliation: Department of Medicine, Haukeland University Hospital, Bergen, Norway.|National Center for Tropical Infectious Diseases, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Sciences, University of Bergen, Bergen, Norway.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Blomberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015995:Prevalence; D013636:Tanzania / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents