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.

Figures

FIG. 1.

AFLP dendrogram of ESBL-producing bacterial isolates as evaluated by Pearson and UPGMA analysis. The diagram also shows the TEM, SHV, and CTX-M genotypes of the isolates and the MICs of ceftazidime, cefotaxime, and cefepime with or without clavulanate by using the ESBL Etest. -, Not detected; ND, no data.

FIG. 2.

Survival time (in days) after admission to the hospital of children with septicemia caused by E. coli, Klebsiella spp., or salmonellae with or without ESBL. Lines: solid, children with septicemia caused by ESBL-producing bacteria; dashed, children with septicemia caused by non-ESBL-producing bacteria.

FIG. 3.

Survival time (in days) after admission to the hospital of children with septicemia caused by E. coli, Klebsiella spp., or salmonellae with or without ESBL. Lines: solid, children with septicemia caused by ESBL-producing bacteria; dashed, children with septicemia caused by bacteria that did not have an ESBL phenotype but were resistant to the given antimicrobial chemotherapy due to other mechanisms.