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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., Conclusion: 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.

Background: Methicillin resistant Staphylococcus aureus (MRSA) nasal carriage is a potential niche for spread and a risk factor for subsequent infections. Despite the fact that medical students are exposed to patients in the hospital during their training, information on S. aureus and MRSA nasal carriage among medical students in Tanzania remains to be dearth so as to guide appropriate infection control and preventive measures., Methods: A cross-sectional study involving 314 medical students, pre-clinical (n = 166) and clinical (n = 148), at Catholic University of Health and Allied Sciences (CUHAS) was conducted from February to June 2013. Nasal swabs from eligible students were taken and processed using standard operating procedures so as to identify S. aureus, MRSA and their respective antimicrobial susceptibility patterns., Results: The median age (interquartile range) of the study participants was 24 (22-27) years with approximately 69.4% being males. S. aureus accounted for 21.0% (66/314) of which 1.5% (1/66) was MRSA; giving an overall MRSA nasal carriage prevalence of 0.3% (1/314). Staphylococcus aureus carriage among pre-clinical and clinical students were 19.9% (33/166) and 22.3% (33/148) respectively. MRSA carriage was found in one preclinical student with history of working in hospital for years prior to join CUHAS. Staphylococcus aureus carriage was significantly more in older median age group among clinical students compared to preclinical students (p < 0.001). Majority of the isolates were resistant to Ampicillin (87.9%, 58/66) while all were sensitive to Ciprofloxacin and Vancomycin., Conclusion: There is high prevalence of S. aureus carriage among medical students at CUHAS. Fortunately, MRSA was found in only one student. In the light of these findings, focused MRSA surveillance to other potential sources like health care workers, patients and environment should be carried out in this setting.

Background: Infections are common complications occurring in malnourished childrenas a result of impaired immunity. Urinary tract infections (UTI) have been found to be the commonest cause of fever in normal children in developing countries. However, data regarding UTI among malnourished children is limited because in most of time severe and moderately malnourished children are afebrile despite significant bacteriuria., Methods: A total of 402 malnourished underfives were enrolled. Demographic and other clinical characteristics were collected using standardized data collection tool. Urine specimens were cultured and interpreted according to standard operating procedures. Data were analyzed using STATA version 11., Results: Out of 402 malnourished underfives, 229 (56.9 %) were male. The median age in months was 17 (IQR; 12-31). Of 402 malnourished underfives, 83 (20.3 %) had significant bacteriuria of gram negative enteric bacteria. Escherichia coli 35/84 and Klebsiella pneumonia 20/84 were predominant bacteria isolated. More than 37 % of isolates were resistant to third generation cephalosporins with all of them exhibiting extended spectrum beta lactamase (ESBL) phenotype. Rates of resistance to ampicillin, amoxillin/clavulanic acid, gentamicin and ciprofloxacin were 82/84 (98.7 %), 47/55 (85.4 %), 45/84 (57.8 %) and 9/84 (10.8 %) respectively. Decrease in age and increase in lymphocytes count were independent factors on multivariate logistic regression analysis found to predict UTI (p<0.05)., Conclusions: Multi-resistant gram negative enteric bacteria are common cause of UTI among underfives. A significant number of severe and moderate malnourished children with bacteriuria had no fever. Therefore, routine testing for UTI is emphasized in all malnourished underfives so that appropriate treatment can be initiated.

Pseudomonas spp. and Klebsiella pneumoniae are common causes of serious health care associated infections (HCAIs) worldwide. The treatment options for infections caused by multi-drug resistant (MDR) organisms are limited to tigecycline and carbapenems. A total of 172 isolates of multi-drug resistant Pseudomonas. spp and extended-spectrum β- (ESBL) producing Klebsiella pneumoniae isolated from clinical specimens at the Bugando Medical Centre were tested for their in vitro susceptibility to piperacillin-tazobactam 100/10μg using disc diffusion test as recommended by Clinical Laboratory Standard Institute (CLSI). Out of 59 multi-drug resistant Pseudomonas spp, 54 (92.0%) were susceptible to piperacillin-tazobactam while of 113 ESBL producing Klebsiella pneumoniae, 55 (48.7%) were susceptible to piperacillin-tazobactam 100/10μg. Also, 20 (34.0%) of the Pseudomonas spp were both ESBL producers and susceptible to piperacillin-tazobactam 100/10μg. A significant proportion of Pseudomonas spp isolates from clinical specimens in our setting are susceptible to piperacillin/tazobactam. This study shows that piperacillin-tazobactam offer a better option to clinicians for the treatment of health care associated infections due to Pseudomonas spp. and ESBL producing Klebsiella pneumoniae in our setting and other health facilities where these organisms are of significance.