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Objective Understanding microbiota colonizing ocular surfaces is key to expedite antibiotic prophylactic options for ocular surgeries, and therefore, prevent subsequent surgical site infections (SSIs). To fill this critical gap, we aimed at determining the prevalence and antibiotic susceptibility patterns of bacteria colonizing the external ocular surfaces of 224 patients undergoing ocular surgeries at Bugando Medical Centre (BMC) in Mwanza, Tanzania between May and August 2023. Results The study participants had a median age of 62.5 (interquartile range: 39.5–75.0) years. A total of 78.1% (175/224) ocular swabs were culture positive yielding 196 bacterial isolates. Staphylococcus epidermidis [43.4% ( n  = 85)], Staphylococcus aureus [21.9% ( n  = 43)] and Pseudomonas aeruginosa [14.3% ( n  = 28)] were the most common bacteria. There were low proportions of resistance among predominant Gram-positive and Gram-negative bacteria to gentamicin (≤ 25.0%), and similarly, low resistance among Gram negative bacteria was observed against 3rd generation cephalosporins (≤ 25.0%) and piperacillin-tazobactam (0.0%). Variable resistance profiles were notable to the most commonly used antibiotics (ciprofloxacin and tetracycline: 0.0–66.7%). Our findings underscore an urgent need to revisit antibiotic prophylactic guidelines for ocular surgeries in this tertiary hospital, and calls for prospective evaluation of incident SSIs post-ocular surgeries to guide specific management.

Neonatal bloodstream infections (BSI) can lead to sepsis, with high morbidity and mortality, particularly in low-income settings. The high prevalence of third-generation cephalosporin-resistant organisms (3GC-RO) complicates the management of BSI. Whether BSI is linked to carriage of 3GC-RO, or to acquisition from the hospital environment is important for infection prevention and control, but the relationship remains unclear, especially in low-income settings. At a tertiary hospital in Mwanza, Tanzania, we screened neonatal blood and rectal samples from 200 neonates, and 400 (hospital) environmental samples. We used logistic regression to identify risk factors, and Kolmogorov–Smirnov tests and randomisation analyses to compare distributions of species and resistance patterns to assess potential routes of transmission. We found that BSIs caused by 3GC-RO were frequent (of 59 cases of BSI, 55 were caused by 3GC-RO), as was carriage of 3GC-RO, particularly Escherichia coli , Klebsiella pneumoniae , and Acinetobacter species. In the 28 infants with both a carriage and blood isolate, there were more (4 of 28) isolate pairs of the same species and susceptibility profile than expected by chance ( p  < 0.05), but most pairs were discordant (24 of 28). Logistic regression models found no association between BSI and carriage with either 3GC-RO or only 3GC-R K. pneumoniae . These analyses suggest that carriage of 3GC-RO is not a major driver of BSI caused by 3GC-RO in this setting. Comparison with environmental isolates showed very similar distributions of species and resistance patterns in the carriage, BSI, and the environment. These similar distributions, a high frequency of Acinetobacter spp. isolations, the lack of strong association between carriage and BSI, together with the high proportion of 3GC-RO in BSI all suggest that these neonates acquire multidrug-resistant carriage and blood isolates directly from the hospital environment.

ObjectiveTo delineate the prevalence and factors associated with antimicrobial use across six referral hospitals in Tanzania using WHO point prevalence survey (PPS) methodology to inform hospital-specific antimicrobial stewardship programmes.DesignCross-sectional analytical study.SettingSix referral hospitals in Tanzania.ParticipantsPatients irrespective of age and gender (n=948) admitted in the six referral hospital wards before 8:00 hours on each day of the survey were included in December 2019. Using the WHO PPS methodology, data on hospitals, wards, patients, antibiotics, and indications for antibiotics were collected.Outcome measuresWe analysed the prevalence of antibiotic use by referral hospital, ward, indication and patient characteristics as the main outcomes. We also described adherence to the Tanzania Standard Treatment Guidelines (STG) and WHO’s AWaRe categorisation of antibiotics.ResultsApproximately 62.3% of inpatients were prescribed antibiotics, predominantly from the Access group of antibiotics (ceftriaxone, metronidazole or ampicillin–cloxacillin). The overall adherence of antibiotic prescriptions to the Tanzania STG was high (84.0%), with the exception of Sekou Toure Regional Referral Hospital (68.0%) and Maweni Regional Referral Hospital (57.8%). The most common indication for antibiotic prescriptions was community-acquired infections (39.8%). Children less than 2 years of age (OR 1.73, 95% CI 1.02 to 2.92, p=0.039); admission to surgical wards (OR 4.90, 95% CI 2.87 to 8.36, p <0.001); and admission to paediatric wards (OR 3.93, 95% CI 2.16 to 7.15, p <0.001) were associated with increased odds of antibiotic use. Only 2 of 591 patients were prescribed antibiotics based on culture and antimicrobial susceptibility testing results.ConclusionsEmpirical use of antibiotics is common, and the Access group of antibiotics is predominantly prescribed in children less than 2 years and patients admitted to surgical and paediatric wards. Lack of utilisation of antimicrobial susceptibility testing services in these hospitals requires urgent interventions. Routine monitoring of antibiotic use is recommended to be part of antibiotic stewardship programmes in Tanzania.

Background COVID-19 vaccination campaigns have reduced disease severity and fatalities around the globe. Global data shows that 67.7% of the general population are vaccinated, and Tanzania has reported appealing findings of over 70% coverage among individuals over 18 years of age. However, a group-specific assessment of vaccination coverage is needed in sub-Saharan Africa. This study aimed at assessing the COVID-19 vaccination uptake and associated factors among cancer patients owing to their vulnerability. Methods A cross-sectional analytical study design was conducted in September 2022 at Ocean Road Cancer Institute (ORCI) in Dar es Salaam, Tanzania. A multistage sampling approach was employed for quantitative data collection, combining stratified sampling to ensure the representation of cancer types and simple random sampling to select 479 cancer patients, and purposeful sampling was applied for qualitative data collection involving 26 patients. Data were analysed using the statistical software ‘R’ by logistic regression analysis to determine the association between socio-demographic, clinical, and Health Belief Model (HBM) variables against COVID-19 vaccine uptake among cancer patients. Results A total of 402 (79.5%) participants were female with a mean age (± standard deviation) of 48 ± 12.4 years, ranging from 18 to 83 years. Approximately 58.2% (278/479) of the participants in the quantitative research reported to be vaccinated against COVID-19, and among them, 79.5% were females. After controlling for other variables, having secondary school education or higher education (Adjusted odds ratio [aOR] 2.26, 95% CI 1.20–4.27; p  = 0.011), perception of COVID-19 vaccine (aOR 8.86, 95% CI 2.84–32.2; p  < 0.001), and perceived severity of COVID-19 (aOR 0.56, 95% CI 0.36–0.87; p  = 0.010) were significantly associated with vaccine uptake. In the qualitative part, the findings suggest that individuals’ beliefs, perceptions, and external factors play a role in their decision to vaccinate. Conclusions The update of COVID-19 vaccine among cancer patients at ORCI was 58%; with patients’ higher education status, positive perception on the COVID-19 vaccine, and perceived disease severity being significantly associated with increased COVID-19 vaccination uptake. Public health interventions should leverage these identified factors to promote vaccine uptake by tailoring communication efforts to specific characteristics.

Background Extended spectrum beta-lactamase-producing Klebsiella pneumoniae species complex (ESBL-KpSC) presents a significant therapeutic challenge to global public health, making it essential to assess the risks associated with recovered isolates. In this study, we utilized whole-genome sequencing (WGS) to comprehensively analyze ESBL-KpSC isolates from hospitalized orthopedic patients, their caretakers, and the hospital environments at tertiary referral hospitals in Uganda and Tanzania, East Africa. Methods ESBL-KpSC isolates were collected between September 2019 and May 2020. Rectal swabs were obtained from patients shortly after their admission to orthopedic wards for ESBL-KpSC screening. Additional swabs were collected from caretakers, healthcare workers, and the surrounding hospital environments. Confirmed ESBL-KpSC isolates underwent DNA extraction for WGS, and the resulting sequences were analyzed to identify species, sequence type (ST), antimicrobial resistance (AMR) genes, virulence genes, and to calculate antimicrobial resistance and virulence scores. Results We analyzed 24 ESBL-KpSC isolates, 7 (29.2%) from Uganda and 17 (70.8%) from Tanzania. Of these, 14 (58.3%) were identified as Klebsiella pneumoniae , 7 (29.2%) as Klebsiella quasipneumoniae subsp. similipneumoniae , and 3 (12.5%) as Klebsiella variicola subsp. variicola . The 24 ESBL-KpSC genomes were distributed across 19 sequence types (STs), indicating a high diversity of 79.2% (19/24). Among the 19 STs, two genomes were found in each of the following STs: ST17, ST307, ST2478, ST367-2LV, and ST3946-1LV, with the remaining genomes being singletons. Of the 24 ESBL-KpSC genomes, 6 (25.0%) had a virulence score greater than 0, and one isolate was identified as multidrug-resistant hypervirulent K. pneumoniae (MDR-hvKp). The most prevalent ESBL gene was bla CTX−M−15 , present in 95.8% (23/24) of isolates. Other common antimicrobial resistance (AMR) genes included bla TEM−1D (79.2%, 19/24), sul2 (75.0%, 18/24), strB (66.7%, 16/24), qnrS1 (58.3%, 14/24), and sul1 (58.3%, 14/24). Additionally, 14 different plasmid replicon types were identified, with one isolate carrying up to five plasmids. The most common plasmids were IncFIB(K) (87.5%, 21/24) and IncR (40.0%, 10/24). Conclusion We report, for the first time, the presence of the MDR-hvKp ST307 clone from East Africa. One out of four ESBL-KpSC isolates was identified as a virulent strain harboring multiple AMR genes, underscoring the urgent need for routine screening of patients with prolonged hospital stays. Additionally, our findings emphasize the critical importance of robust infection prevention and control measures to mitigate the spread of AMR within hospitals in East Africa.

Background Neonatal sepsis is a significant cause of morbidity and mortality in neonates. Appropriate clinical diagnosis and empirical treatment in a given setting is crucial as pathogens of bacterial sepsis and antibiotic sensitivity pattern can considerably vary in different settings. This study was conducted at Bugando Medical Centre (BMC), Tanzania to determine the prevalence of neonatal sepsis, predictors of positive blood culture, deaths and antimicrobial susceptibility, thus providing essential information to formulate a policy for management of neonatal sepsis. Methods This was a prospective cross sectional study involving 300 neonates admitted at BMC neonatal unit between March and November 2009. Standard data collection form was used to collect all demographic data and clinical characteristics of neonates. Blood culture was done on Brain Heart Infusion broth followed by identification of isolates using conventional methods and testing for their susceptibility to antimicrobial agents using the disc diffusion method. Results Among 770 neonates admitted during the study period; 300 (38.9%) neonates were diagnosed to have neonatal sepsis by WHO criteria. Of 300 neonates with clinical neonatal sepsis 121(40%) and 179(60%) had early and late onset sepsis respectively. Positive blood culture was found in 57 (47.1%) and 92 (51.4%) among neonates with early and late onset neonatal sepsis respectively (p = 0.466). Predictors of positive blood culture in both early and late onset neonatal sepsis were inability to feed, lethargy, cyanosis, meconium stained liquor, premature rupture of the membrane and convulsion. About 49% of gram negatives isolates were resistant to third generation cephalosporins and 28% of Staphylococcus aureus were found to be Methicillin resistant Staphylococcus aureus (MRSA). Deaths occurred in 57 (19%) of neonates. Factors that predicted deaths were positive blood culture (p = 0.0001), gram negative sepsis (p = 0.0001) and infection with ESBL (p = 0.008) or MRSA (p = 0.008) isolates. Conclusion Our findings suggest that lethargy, convulsion, inability to feed, cyanosis, PROM and meconium stained liquor are significantly associated with positive blood culture in both early and late onset disease. Mortality and morbidity on neonatal sepsis is high at our setting and is significantly contributed by positive blood culture with multi-resistant gram negative bacteria.

Background Antimicrobial resistance (AMR) is a global health security threat and is associated with increased morbidity and mortality. One of the key drivers of AMR is the inappropriate use of antibiotics. A key component of improving antibiotic use is conducting antimicrobial use (AMU) surveillance. Methods USAID Medicines Technologies and Pharmaceutical Services Program has supported the implementation of antimicrobial stewardship activities, including setting up systems for AMU surveillance in Tanzania and Uganda. Results from both countries have been previously published. However, additional implementation experience and lessons learned from addressing challenges to AMU surveillance have not been previously published and are the subject of this narrative article. Results The team identified challenges including poor quality data, low digitalization of tools, and inadequate resources including both financial and human resources. To address these gaps, the Program has supported the use of continuous quality improvement approaches addressing gaps in skills, providing tools, and developing guidelines to fill policy gaps in AMU surveillance. Recommendations to fill these gaps, based on the Potter and Brough systematic capacity building model have been proposed. Conclusions Strengthening AMU surveillance through using a capacity-building approach will fill gaps and strengthen efforts for AMR control in both countries.

Background Streptococcus agalactiae , also known as Group B Streptococcus (GBS) is a member of the gastrointestinal tract and vaginal microbiota, and one of the commonest pathogens affecting pregnant women, neonates and infants. Its observed rate of colonization varies globally due to laboratory methods used, socio-cultural, epidemiological and clinical factors. This study therefore, aimed at determining the prevalence of GBS colonization and associated risk factors among HIV-infected and uninfected pregnant women in various health care facility tiers in Tanzania to guide priority screening and management. Methods A cross-sectional analytical study was conducted from February to June 2021 from the antenatal clinics in the primary, secondary and tertiary health care levels in the northwestern part of Tanzania involving 872 pregnant women. Demographic, obstetric and other clinical data were collected using a pre-tested structured questionnaire. Two swabs (vaginal and rectal) were collected and cultured-on blood agar and CHROMagar TM StrepB agar, followed by antimicrobial susceptibility testing. A two-sample test of proportions was used to compare the GBS prevalence in various sub-groups, and logistic regression analysis was deployed to ascertain the association between predictor variables and GBS colonization. Results The overall proportion of S. agalactiae colonization was 24.5% (214/872) [95% CI: 21.7 − 27.5%], and was significantly higher in the HIV infected group [63.1% (70/111)] than in the HIV-negative group [18.9% (144/761)]; OR (95% CI) = 7.33 (4.77–11.29, p-value < 0.001)]. Colonization was more prevalent in the rectal samples compared to vaginal samples [21.1% versus 8.83%, respectively; p-value < 0.001)] and S. agalactiae recovery was higher using CHROMagar TM StrepB agar compared to blood agar [24.4% versus 18.8%, respectively, p-value = 0.004]. There was no association between GBS colonization and health care facility levels or pregnancy trimesters. The S. agalactiae isolates were sensitive to ampicillin (100%), erythromycin (76.3%), clindamycin (84.4%) and vancomycin (98.1%). Conclusions Approximately a quarter of pregnant women are colonized by GBS in Mwanza, Tanzania; and colonization is remarkably higher among HIV-infected women. Ampicillin is recommended for prophylaxis and treatment of GBS. Introduction of routine GBS screening among all HIV-infected pregnant women using ultrasensitive CHROMagar™ Strep B agar is recommended, and molecular characterization of GBS isolates would be of interest to guide future vaccination strategies.

Background Methicillin resistant Staphylococcus aureus (MRSA) strains were once confined to hospitals however, in the last 20 years MRSA infections have emerged in the community in people with no prior exposure to hospitals. Strains causing such infections were novel and referred to as community-associated MRSA (CA-MRSA). The aim of this study was to determine the MRSA carriage rate in children in eastern Uganda, and to investigate coexistence between CA-MRSA and hospital-associated (HA-MRSA). Methods Between February and October 2011, nasopharyngeal samples (one per child) from 742 healthy children under 5 years in rural eastern Uganda were processed for isolation of MRSA, which was identified based on inhibition zone diameter of ≤19 mm on 30 μg cefoxitin disk. SCC mec and spa typing were performed for MRSA isolates. Results A total of 140  S. aureus isolates (18.9%, 140/742) were recovered from the children of which 5.7% (42/742) were MRSA. Almost all (95.2%, 40/42) MRSA isolates were multidrug resistant (MDR). The most prevalent SCC mec elements were types IV (40.5%, 17/42) and I (38.1%, 16/42). The overall frequency of SCC mec types IV and V combined, hence CA-MRSA, was 50% (21/42). Likewise, the overall frequency of SCC mec types I, II and III combined, hence HA-MRSA, was 50% (21/42). Spa types t002, t037, t064, t4353 and t12939 were detected and the most frequent were t064 (19%, 8/42) and t037 (12%, 5/42). Conclusion The MRSA carriage rate in children in eastern Uganda is high (5.7%) and comparable to estimates for Mulago Hospital in Kampala city. Importantly, HA-MRSA (mainly of spa type t037) and CA-MRSA (mainly of spa type t064) coexist in children in the community in eastern Uganda, and due to high proportion of MDR detected, outpatient treatment of MRSA infection in eastern Uganda might be difficult.

The proportions and similarities of extended-spectrum β-lactamase (ESBL) producing K. pneumoniae (ESBL-KP) and E. coli (ESBL-EC) carrying multiple ESBL genes is poorly known at our setting. This study investigated the existence of multiple ESBL genes (blaCTX-M, blaTEM, and blaSHV) among ESBL-KP and ESBL-EC concurrently isolated from clinical, colonization, and contamination samples from neonatology units in Mwanza-Tanzania. Twenty and 55 presumptive ESBL-EC and ESBL-KP, respectively, from a previous study archived at −80 °C were successfully recovered for this study. Isolates were screened and confirmed for production of ESBLs by phenotypic methods followed by multiplex PCR assay to determine ESBL genes. All (100%) and 97.3% of presumptive ESBL isolates were phenotypically confirmed by Clinical and Laboratory Standards Institute (CLSI) and modified double-disc synergy methods, respectively. About 93.3% (70/75) of phenotypically confirmed ESBL isolates had at least one ESBL gene, whereby for 62.9% (44/70), all ESBL genes (blaCTX-M, blaTEM, and blaSHV) were detected. Eight pairs of ESBL bacteria show similar patterns of antibiotics susceptibility and ESBL genes. ESBL-KP and ESBL-EC, concurrently isolated from clinical, colonization and contamination samples, harbored multiple ESBL genes. Further, eight pairs of ESBL isolates had similar patterns of antibiotics susceptibility and ESBL genes, suggesting transmission of and/or sharing of mobile genetic elements (MGEs) among ESBL-KP and ESBL-EC.