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This study collected blood from 1038 patients of all age groups with fever and/or serious systemic infection admitted at the Mnazi Mmoja hospital in Zanzibar.

The study has thus far identified first cases of ESBL-producing bacteria in the Zanzibar archipelago and warns of alarming prevalence in the region. Local treatments are insufficient for curing the infections, which calls for increased awareness of antibiotic use. (7)

Bacteria Salmonella typhi causes typhoid fever and is common in low- and middle-income countries. Additionally, it can be resistant to multiple drugs (MDR), significantly narrowing therapeutic options. Genetic analysis of the S. typhi isolates showed that 98% were resistant to multiple drugs, and mostly to ciprofloxacin. All MDR isolates belonged to the genotype 4.3.1.1, which carries MDR genes on a composite transposon integrated into the bacterial genome. (2)

This prospective, hospital-based study recruited children under the age of five, presented with fever and admitted in one of four major hospitals in Dar es Salaam, Tanzania (Amana, Temeke and Mwananyamala Regional Hospitals, and Muhimbili National Hospital). In total 2226 children were enrolled in the study.

A case report form was used to collect relevant clinical information on the child. Blood and/or stool specimens were collected for examination of aetiological agents of fever and antimicrobial susceptibility testing.

Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) are a family of antibiotic-resistant bacteria of the gut (such as Escherichia coli, Klebsiella pneumoniae, Enterobacter spp and others). They can cause systemic infections in the blood, but this link had not previously been well established. In this study we reported that faecal prevalance of ESBL-PE was high (56%), and higher in children with BSI. Comparison of ESBL-PE from the gut and the blood showed similar antimicrobial susceptibility profile. Collectively this indicated that colonization of ESBL-PE in the gut was a risk factor for ESBL bloodstream infections. (4)

Bacterial bloodstream infections (BSIs) and malaria are major causes of death in children under 5 years of age hospitalised with fever. We found that 19% of study participants had pathogens detectable in the blood. Furthermore, malaria and in-hospital mortality were less common than previously reported. However, antimicrobial resistance was increased. Although malaria and bacterial infections contributed equally in causing febrile illness, bacterial infections caused higher in-hospital death. (6)

Analysis of the Gram-negative bacteria showed that mortality was higher in children affected with ESBL bacteria compared to non-ESBL producing bacteria. ESBL bacteria in bloodstream could predict mortality, they increased duration of hospitalisation and showed resistance towards more antibiotic types. (1) 

Furthermore, we analysed a Gram-negative bacteria Acinetobacter baumannii which can cause infections in several sites in the body (bloodstream, lungs and urinary tract). We report for the first time a case of A. baumannii which produces enzyme New Delhi metallo-β-lactamase 1, responsible for resistance to a broad range of β-lactam antibiotics. (5)

Resistance of Gram-negative bacteria to antibiotics fluoroquinolones is increasing all over the world. This study showed that 68% of ESBL-PE isolates were resistant to fluoroquinolones thanks to one or more plasmid mediated quinolone resistance (PMQR) genes. (3)

This project is a part of research network with the in Zanzibar and four major hospitals in Dar es Salaam: Amana, Temeke and Mwananyamala Regional Hospitals, and . We cooperate on both the clinical and research level.