title: Bacteremia caused by multidrug-resistant bacteria among hospitalized malnourished children in Mwanza, Tanzania: a cross sectional study.
abstract: BACKGROUND
  Severe malnutrition has been known to increase susceptibility and severity of infections. Bacteremia in malnourished children has been found to increase morbidity and mortality especially if is due to multidrug resistant bacteria. Here, we report the prevalence of bacteremia among children under 5 years of age and the antibiotic susceptibility pattern of the isolates; the information that can be used by clinicians to guide on the empirical antibiotic treatment.
  
  
  RESULTS
  A total of 402 malnourished children were investigated for bacteremia. The median age of enrolled children were 17 (IQR 12-31) months. Severe malnutrition was observed in 19.1% of malnourished underfives. The point prevalence of bacteremia among malnourished children was 56/402 (13.9%; 95% CI 10.3-17.3). The prevalence of bacteremia was significantly higher among severely malnourished children than in children with moderate/mild malnutrition (18.0 vs. 10.7%, P = 0.03). Mortality was significantly associated with bacteremia among severely malnourished children (OR 2.77, 95% CI 1.02-6.98, P = 0.02). Pseudomonas spp. 20/56 (35.7%) were the most frequent isolates while Staphylococcus aureus and Streptococcus pneumoniae were isolated in 8/56 (14.2%) and 5/56 (8.9%) respectively. Rates of resistance for gram negative bacteria were; ampicillin (100%), amoxicillin/clavulanic acid (85.7%), gentamicin (23.8%), ceftriaxone (23.8%), ceftazidime (23.8%) meropenem (4.7%) and ciprofloxacin (2.4%). methicillin resistant S. aureus strains were confirmed in 4/8 (50%) of S. aureus isolates and 60% of S. pneumoniae isolates were resistant to 1 µg oxacillin.
  
  
  CONCLUSIONS
  Bacteremia due to multi drug resistant isolates is common among severely malnourished children under 5 years of age. There is a need to review empirical antibiotic treatment coupled with antibiotic stewardship to prevent mortality and morbidity of severely malnourished children under 5 years of age.
authors.affiliation: Department of Paediatrics and Child Health, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
authors.forename: Maimuna
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania. mmmirambo@gmail.com.
authors.forename: Mariam M
authors.initials: MM
authors.lastname: Mirambo
authors.affiliation: Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
authors.forename: Martha F
authors.initials: MF
authors.lastname: Mushi
authors.affiliation: Department of Paediatrics and Child Health, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
authors.forename: Adolfine
authors.initials: A
authors.lastname: Hokororo
authors.affiliation: Department of Microbiology and Immunology, Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Mshana
mesh_terms: D016470:Bacteremia / Q000150:complications / Q000382:microbiology*; D001419:Bacteria / Q000302:isolation & purification; D015362:Child Nutrition Disorders / Q000150:complications* / Q000453:epidemiology*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D024901:Drug Resistance, Multiple, Bacterial; D006760:Hospitalization; D006801:Humans; D013636:Tanzania / Q000453:epidemiology