title: Antimicrobial resistance pattern: a report of microbiological cultures at a tertiary hospital in Tanzania.
abstract: BACKGROUND
  Antimicrobial resistance has been declared by the World Health Organization as a threat to the public health. The aim of this study was to analyze antimicrobial resistance patterns of the common pathogens occurring at the Bugando Medical Centre (BMC), Mwanza, Tanzania to provide data for antimicrobial stewardship programmes.
  
  
  METHODS
  A total of 3330 microbiological culture results scripts representing non-repetitive specimens reported between June 2013 and May 2015 were retrieved and analyzed for pathogens and their susceptibility patterns using STATA-11 software.
  
  
  RESULTS
  Out of 3330 specimens, 439 (13.2%) had positive culture. Staphylococcus aureus (n = 100; 22.8%), Klebsiella pneumoniae (n = 65; 14.8%) and Escherichia coli (n = 41; 9.3%) were the most frequently isolated bacteria. Of 78 Staphylococcus aureus tested, 27 (34.6%) were found to be methicillin resistant Staphylococcus aureus (MRSA). Rates of resistance of Klebsiella pneumoniae and Escherichia coli isolates to third generation cephalosporins were 38.5% (25/65) and 29.3% (12/41) respectively. Staphylococcus aureus and Klesbiella pneumoniae were commonly isolated from bloodstream infections while Escherichia coli and Pseudomonas aeruginosa were the predominant isolates from urinary tract and wounds infections respectively. Of 23 Salmonella species isolated, 22 (95%) were recovered from the blood. Nine of the 23 Salmonella species isolates (39%) were found to be resistant to third generation cephalosporins. The resistance rate of gram-negative bacteria to third generation cephalosporins increased from 26.5% in 2014 to 57.9% in 2015 (p = 0.004) while the rate of MRSA decreased from 41.2% in 2013 to 9.5% in 2015 (p = 0.016). Multidrug-resistant gram-negative isolates were commonly isolated from Intensive Care Units and it was noted that, the majority of invasive infections were due to gram-negative bacteria.
  
  
  CONCLUSIONS
  There is an increase in proportion of gram-negative isolates resistant to third generation cephalosporins. The diversity of potential pathogens resistant to commonly prescribed antibiotics underscores the importance of sustained and standardized antimicrobial resistance surveillance and antibiotic stewardship programmes in developing countries.
authors.affiliation: Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania. nyamburasogone@gmail.com.|Institute of Hygiene and Microbiology, Wuerzburg University, Wuerzburg, Germany. nyamburasogone@gmail.com.
authors.forename: Nyambura
authors.initials: N
authors.lastname: Moremi
authors.affiliation: Institute of Hygiene and Microbiology, Wuerzburg University, Wuerzburg, Germany.
authors.forename: Heike
authors.initials: H
authors.lastname: Claus
authors.affiliation: Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Mshana
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D062665:Epidemiological Monitoring; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000254:growth & development* / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control / Q000706:statistics & numerical data; D007362:Intensive Care Units; D008826:Microbial Sensitivity Tests; D013636:Tanzania; D062606:Tertiary Care Centers
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial resistance; Cephalosporin-resistant gram-negative bacteria; MRSA; Tanzania