Extended-spectrum-β-lactamase-producing Gram-negative bacteria are associated with high mortality in children with bloodstream infections in Dar es Salaam, Tanzania

OBJECTIVES: Studies from Tanzania show rising prevalence of extended-spectrum β-lactamase (ESBL) amongst key bacterial pathogens. We aimed to look at the clinical impact of bloodstream infections (BSI) caused by ESBL producing Gram-negative bacteria (GNB). This study was carried out on hospitalised children aged less than five years from four hospitals of the region of Dar es Salaam. METHODS: The study included 135 hospitalized children with BSI due to GNB which were screened for ESBL. Clinical outcome i.e., death or discharge, was known for 130 children of which 12% (n = 15) died We used univariate and multivariate regression analyses to compare the outcome i.e., in-hospital mortality and length of hospital stay of inpatients with BSI caused by ESBL- producing GNB vs. outcome of inpatients with BSI caused by non ESBL producing GNB. RESULTS: Of the 135 children, 69 (51%) and 66 (49%) had BSI due to ESBL and non-ESBL producers respectively. Of the 15 children who died, 73% had BSI due to Klebsiella pneumoniae or Escherichia coli. Mortality among children with infections caused by ESBL and non-ESBL producers were 16% and 6%, respectively. After adjusting for differences between groups regarding age, sex, and consciousness status on admission, infection with ESBL producing bacteria was a significant predictor of mortality, OR = 29; 95% CI (1.5-540). Children infected with ESBL producing GNB had longer duration of hospital stay, OR 3.2, 95% CI (1.3-7.8). Resistance towards antimicrobial agents other than penicillin's and cephalosporins was significantly higher among ESBL producers than non-ESBL producers e.g. gentamicin (60/69, 87%) vs. (6/66, 9.1%), OR = 67; 95% CI (22.3-198.9) and ciprofloxacin (37/69, 54%) vs. (7/66, 10.6%), OR = 8; 95%CI (3.9-24.3). CONCLUSIONS: The rapidly increasing resistance to commonly used and affordable antibiotics increases the risk of death and prolongs hospital stays in neonates in the study setting. These findings highlight the need for strengthened infection prevention and control in community settings and appropriate antibiotic use to reduce the selection and spread of ESBL-GNB in hospitals.