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The present study investigates the infection rates of parasites, morbidity, and the living conditions of street children and orphans in Mwanza city, northern Tanzania. A high percentage of orphans and street children in Mwanza city is infected with one or more parasites. A significantly higher rate of infections with S. mansoni in street children as compared with orphans could be observed. The prevalence of S. mansoni determined by POC CCA test was 65.9% for orphans and 94.5% for street children. 19.2% of the orphans tested positive for S. mansoni in Kato Katz. Of the street children, 77.1% showed positive test results in Kato-Katz. Only 1.3% of the orphans stated in the questionnaire that they use the lake to wash, whereas 91.1% of the street children named the lake as at least one of their options for washing. Protozoal infections used as a marker for hygiene were at a comparable level for both groups. Microscopy showed positive results for G. intestinalis in 8.2% and for E. histolytica/dispar in 23% of orphans and 8.1% for G. intestinalis, and 23.8% for E. histolytica/dispar in street children. Through ultrasonography, we observed no signs of severe PPF and only a few mild PPF patterns. Most street children use the lake to wash and often do not have access to adequate sanitation. However, everyone in the study group indicated having access to safe drinking water. Overall, we found the general hygienic conditions for both groups to be inadequate. With the help of simple public health measures, like improve sanitation and regular mass drug administration, the overall situation would likely be considerably improved.
The acquired immunodeficiency syndrome (AIDS) is currently the most infectious disease worldwide. It is caused by the human immunodeficiency virus (HIV). At the moment there are ~33.3 million people infected with HIV. Sub-Saharan Africa, with ~22.5 million people infected accounts for 68% of the global burden. In most African countries antiretroviral therapy (ART) is administered in limited-resource settings with standardised first- and second-line ART regimens. During this study I analysed the therapy-naïve population of Cape Town, South Africa and Mwanza, Tanzania for any resistance associated mutations (RAMs) against protease inhibitors, nucleoside reverse transcriptase inhibitors and non-nucleoside reverse transcriptase inhibitors. My results indicate that HIV-1 subtype C accounts for ~95% of all circulating strains in Cape Town, South Africa. I could show that ~3.6% of the patient derived viruses had RAMs, despite patients being therapy-naïve. In Mwanza, Tanzania the HIV drug resistance (HIVDR) prevalence in the therapy-naïve population was 14.8% and significantly higher in the older population, >25 years. Therefore, the current WHO transmitted HIVDR (tHIVDR) survey that is solely focused on the transmission of HIVDR and that excludes patients over 25 years of age may result in substantial underestimation of the prevalence of HIVDR in the therapy-naïve population. Based on the prevalence rates of tHIVDR in the study populations it is recommended that all HIV-1 positive individuals undergo a genotyping resistance test before starting ART. I also characterized vif sequences from HIV-1 infected patients from Cape Town, South Africa as the Vif protein has been shown to counteract the antiretroviral activity of the cellular APOBEC3G/F cytidine deaminases. There is no selective pressure on the HIV-1 Vif protein from current ART regimens and vif sequences was used as an evolutionary control. As the majority of phenotypic resistance assays are still based on HIV-1 subtype B, I wanted to design an infectious HIV-1 subtype C proviral molecular clone that can be used for in vitro assays based on circulating strains in South Africa. Therefore, I characterized an early primary HIV-1 subtype C isolate from Cape Town, South Africa and created a new infectious subtype C proviral molecular clone (pZAC). The new pZAC virus has a significantly higher transient viral titer after transfection and replication rate than the previously published HIV-1 subtype C virus from Botswana. The optimized proviral molecular clone, pZAC could be used in future cell culture and phenotypic HIV resistance assays regarding HIV-1 subtype C.
The StrongPaed study in the paediatric ward of a referral hospital in Mwanza in the lake region of Tanzania showed the prevalence of S. stercoralis, G. lamblia, E. histolytica and E. dispar as well as of other intestinal parasites with various diagnostic methods.
The prevalence of S. stercoralis was 2-10 % depending on the diagnostic methods used. There were no symptomatic infections but only carriage of the nematode. The positive results differed greatly depending on the performed diagnostic methods. None of the diagnostics showed satisfying results, neither in sensitivity and specificity nor in feasibility for this population in an endemic region in sub-Saharan Africa. PCR and microscopy were limited by the low amount of examined stool samples and by the resulting lack of sensitivity. Stool cultures were limited by time-consuming procedures and mainly by the problem of differentiation from hookworm and the resulting lack of specificity. ELISA was limited by the need of blood samples and also by poor specificity in the ELISA used.
The prevalence of G. lamblia was high, but mostly only carriage and not symptomatic infections was seen. No E. histolytica was detected, but 8.5 % samples were positive for E. dispar. Among the performed diagnostics, the rapid test showed sufficient results. It showed better sensitivity than microscopy and is cheaper and more feasible than PCR. Differentiation between E. histolytica and E. dispar was only possible with qPCR performed in Germany.
More children were positive for intestinal parasites from rural than from urban areas. The profession of the parents working as farmers was a risk factor for intestinal parasitic infections. Hygienic living conditions such as access to tap water and flush toilets at home were preventive for intestinal parasitic infections in children.
Die Progression der HIV Infektion ist vermutlich bedingt von einer unspezifischen generalisierten Immunaktivierung des Patienten (Sousa, Carneiro et al. 2002; Hazenberg, Otto et al. 2003). Somit könnte ein immunsuppressives Medikament wie das Kortisonpräparat Prednisolon die Progression der Erkrankung verlangsamen. Im Rahmen nicht-kontrollierter Studien konnte die Stabilisierung der CD4+ T-Lymphozyten in HIV-Patienten durch den Einsatz von Kortison beobachtet werden (Andrieu, Lu et al. 1995; Lu, Salerno-Goncalves et al. 1995). Dieser Effekt konnte auch mit niedrig dosiertem Prednisolon (5 mg/Tag) nachgewiesen werden (Ulmer, Muller et al. 2005). Jedoch zeigen neuere Ergebnisse, dass der CD4+ T-Lymphozytenwert bei Studien zu Immunmodulatoren kein verlässlicher Surrogatmarker für die Progression ist (Abrams, Levy et al. 2009). In der vorliegenden Arbeit sollte untersucht werden, ob sich zum Einen der stabilisierende Effekt von niedrig dosiertem Prednisolon (5 mg pro Tag) auf CD4+ T-Lymphozyten in einer kontrollierten Studie bestätigt, ob zum Zweiten die CD4+ T-Lymphozytenstabilisierung auf eine Senkung der Immunaktivierung zurückgeführt werden kann und ob zum Dritten die CD4+ TLymphozytenstabilisierung die klinische Krankheitsprogression verlangsamt. Im Rahmen der ProCort-Studie sollte außerdem eine Bestimmung der Prävalenz medikamentenresistenter HIV-Infektionen bei ART unbehandelten Patienten erfolgen. Hierbei wurden die WHO Kriterien überprüft, die als Einschlusskriterien für Patienten in Resistenz-Überwachungsstudien ein Höchstalter von 25 Jahren festgelegt hat. In unserer Untersuchung wurden demgegenüber Proben von Patienten mit höherem Alter und bereits therapierten Partnern analysiert.Methoden: Im Rahmen einer doppelblinden randomisierten klinischen Studie (ProCort1) im Bugando Medical Center (BMC) in Mwanza, Tansania, wurden 326 HIV-Patienten eingeschlossen, die zuvor noch nie mit ART behandelt wurden und einen CD4+ TLymphozytenwert von mindestens 300/μl aufwiesen. In 14 Visiten wurden, während einer zweijährigen Behandlungsdauer entweder mit 5mg Prednisolon täglich oder mit Placebo, die CD4+ T-Lymphozytenwerte und das Auftreten von Progression der HIV-Infektion bestimmt. Primärer Studienendpunkt war die Krankheitsprogression, definiert als ein Unterschreiten von 200 CD4-Zellen/μl oder dem Auftreten AIDS-definierender Erkrankungen. Um die immunologische Wirkungsweise von Prednisolon in HIV-infizierten Patienten zu untersuchen wurden sowohl in den tansanischen Studienpatienten als auch in einer mit 5 mg Prednisolon behandelten deutschen Kohorte die Lymphozytenaktivierungsmarker CD38/HLADR auf CD3/CD8-Zellen, der Monozytenaktivierungsmarker sCD14 und der Entzündungsmarker suPAR bestimmt. Um die Prävalenz der HIV Medikamentenresistenz (HIVDR) in der ProCort Studienpopulation zu ermitteln wurden 88 Proben der ART unbehandelten Patienten sequenziert. Ergebnisse: Die Ergebnisse der ProCort Studie zeigten eine statistisch signifikante Stabilisierung der CD4+ T-Lymphozytenwerte im Vergleich zum Ausgangswert durch Einsatz einer niedrig dosierten Prednisolonbehandlung (5 mg täglich). In der Intent to treat Analyse wurde ein Zugewinn von +20,1 Zellen/μl pro Jahr für den Prednisolonarm (p < 0.0001) im Vergleich zu -54,2 Zellen/μl pro Jahr für den Placeboarm (p < 0.0001) bestimmt. Die CD4+ T-Lymphozytenwerte zum Zeitpunkt der Startvisite waren im Prednisolonarm statistisch signifikant niedriger (Mean 512.14 Zellen/μl ± S.E.M. 13.39) als im Placeboarm (Mean 554.40 ± S.E.M 15.75; p = 0.042). Dies bedeutet eine schlechtere Ausgangslage für die mit Prednisolon behandelten Patienten. Trotzdem entwickelten nur vier Patienten mit Prednisolonbehandlung im Vergleich zu 11 Patienten mit Placebobehandlung AIDS, was eine statistisch signifikante Verringerung der Progressionsrate bedeutet (p=0.0196). In 16 Patienten versus 18 Patienten fielen die CD4+ T-Lymphozytenwerte unter die Werte von 200 Zellen/μl. Die Behandlung mit Prednisolon war nicht mit einer höheren Rate von unerwünschten Ereignissen oder höherer Viruslast assoziiert.
Background
The World Health Organization (WHO) has recommended guidelines for a HIV drug resistance (HIVDR) survey for resource-limited countries. Eligibility criteria for patients include age below 25 years in order to focus on the prevalence of transmitted HIVDR (tHIVDR) in newly-infected individuals. Most of the participating sites across Africa have so far reported tHIVDR prevalences of below 5%. In this study we investigated whether the rate of HIVDR in patients <25 years is representative for HIVDR in the rest of the therapy-naïve population.
Methods and Findings
HIVDR was determined in 88 sequentially enrolled ART-naïve patients from Mwanza, Tanzania (mean age 35.4 years). Twenty patients were aged <25 years and 68 patients were aged 25–63 years. The frequency of HIVDR in the study population was 14.8% (95%; CI 0.072–0.223) and independent of NVP-resistance induced by prevention of mother-to-child transmission programs. Patients >25 years had a significantly higher HIVDR frequency than younger patients (19.1%; 95% CI 0.095–0.28) versus 0%, P = 0.0344). In 2 out of the 16 patients with HIVDR we found traces of antiretrovirals (ARVs) in plasma.
Conclusions
ART-naïve patients aged over 25 years exhibited significantly higher HIVDR than younger patients. Detection of traces of ARVs in individuals with HIVDR suggests that besides transmission, undisclosed misuse of ARVs may constitute a significant factor in the generation of the observed high HIVDR rate. The current WHO tHIVDR survey that is solely focused on the transmission of HIVDR and that excludes patients over 25 years of age may therefore result in substantial underestimation of the prevalence of HIVDR in the therapy-naïve population. Similar studies should be performed also in other areas to test whether the so far reported optimistic picture of low HIVDR prevalence in young individuals is really representative for the rest of the ART-naïve HIV-infected population.
1. Pollination of sexually reproducing plants requires pollen transfer agents, which can be biotic, abiotic or a combination of biotic and abiotic agents. The dominance of one of pollination system in wild plant communities depends on climatic factors and/or degrees of anthropogenic influences, which have effects on pollinator diversity and pollination function. Anthropogenic activities and climate change are also considered as main causes of ongoing invasion of invasive species into wild and managed habitats which can bring up competition for pollinators with possible negative consequences for the reproduction of co-occurring native plant species.
2. The study aimed to determine pollination systems and pollination limitation of invasive and native plant communities in natural savannah between 870 – 1130 m and semi-natural (managed) grassland between 1300 – 1750 m above sea level; effects of flower density and pollinator abundance on seed production of cross-pollinated and self-pollinated plants; and relationships of bee abundance and the proportion of cross- pollinated plants at the southern slope of Mount Kilimanjaro, Tanzania.
3. Pollinator-exclusion, open pollination and supplemental hand-pollination treatments were applied to 27 plant species in savannah and grassland habitats. Flowers were counted in each clusters based upon their species. Pollinators were sampled by using pan traps. Information-theory-based multi-model averaging and generalized linear mixed effects models were used to identify and analyze the effects of flower density, pollinator abundance, pollination treatments and habitat types on seed production. Regression models were used to determine relationships of altitude with bee abundance, and with proportion of cross-pollinated plants.
4. My results show that mean seed numbers of native plants were significantly lower in pollinator-exclusion treatments than in open-pollination treatments, indicating their reliance on pollinators for reproductive success. In contrast, seed numbers of invasive plants were similar in pollinator-exclusion and open-pollination treatments, demonstrating an ability of reproduction without pollinators. Despite of higher levels of self-pollination in invasive plants, supplemental hand-pollination treatments revealed pollen limitation in grassland and marginally in savannah habitats. There were no significant difference in seed numbers between supplemental hand pollination and open pollination treatments of native plant communities in savannah and grassland, which indicates no pollination limitation in the studied ecological system for native communities. Besides, grassland plants produced comparatively more seeds than savannah plants, however seeds in grasslands were lighter than those of the savannah which may be due to nutrient limitation in grassland.
5. I found 12 cross-pollinated and 15 self-pollinated plants along altitudinal gradient after comparing seeds from pollinator-excluded and open-pollinated experiments. I also found that proportions of cross-pollinated plants and bee abundance simultaneously decreased with increasing altitude. All cross-pollinated plants were native and grew in savannah habitats, with an exception of one species.
6. Neither effects of focal flower density nor a significant interaction between focal flower densities and bee abundance for self-pollinated plants were observed. However, there were effects of focal flower densities and interactions of flower density with bee abundance for cross-pollinated plants. Non-focal flower density has no significant effects on seed production of cross-pollinated and self-pollinated plants.
7. The results show that native plants depend more on cross-pollination than invasive plants, despite of most native plants in managed habitat (grassland) rely on self-pollination for reproduction. The tendency of having more cross-pollinated plants in natural savannah which are in low altitude coincides with other finding that the cross-pollinated plants and bee abundance simultaneously decrease with increasing altitude. Therefore, our findings support the hypotheses that self-fertilization of flowering plants increases with increasing altitude, and pollinator limitation is most pronounced in managed or disturbed habitats. Despite of reduction of pollinators in grassland, only invasive plants experience pollen limitation, which may be due to poor integration with available pollinator networks.
8. I also found bee abundance and flower density are not the main pollination factors required by self-pollinated plants during reproduction. However, focal flower density, which influences pollinator diversity, is more applicable to cross-pollinated plants. Climate change and anthropogenic activities in natural habitats are factors that influence pollinator abundance and functioning, which lead to a shift of mating systems in plant communities so as to assure their reproduction.
Background
Bees (Hymenoptera: Apoidea: Anthophila) are the most important group of pollinators with about 20,507 known species worldwide. Despite the critical role of bees in providing pollination services, studies aiming at understanding which species are present across disturbance gradients are scarce. Limited taxononomic information for the existing and unidentified bee species in Tanzania make their conservation haphazard. Here, we present a dataset of bee species records obtained from a survey in nothern Tanzania i.e. Kilimanjaro, Arusha and Manyara regions. Our findings serve as baseline data necessary for understanding the diversity and distribution of bees in the northern parts of the country, which is a critical step in devising robust conservation and monitoring strategies for their populations.
New information
In this paper, we present information on 45 bee species belonging to 20 genera and four families sampled using a combination of sweep-netting and pan trap methods. Most species (27, ~ 60%) belong to the family Halictidae followed by 16 species (35.5%) from the family Apidae. Megachilidae and Andrenidae were the least represented, each with only one species (2.2%). Additional species of Apidae and Megachilidae sampled during this survey are not yet published on Global Biodiversity Information Facility (GBIF), once they will be available on GBIF, they will be published in a subsequent paper. From a total of 953 occurrences, highest numbers were recorded in Kilimanjaro Region (n = 511), followed by Arusha (n = 410) and Manyara (n = 32), but this pattern reflects the sampling efforts of the research project rather than real bias in the distributions of bee species in northern Tanzania.
One of the pronounced global challenges facing ecologists is how to feed the current growing human population while sustaining biodiversity and ecosystem services. To shed light on this, I investigated the impact of human land use on bee diversity and plant-pollinator interactions in Tanzania Savannah ecosystems. The thesis comprises the following chapters:
Chapter I: General Introduction
This chapter provides the background information including the study objectives and hypotheses. It highlights the ecological importance of bees and the main threats facing bee pollinators with a focus on two land-use practices namely livestock grazing and agriculture. It also highlights the diversity and global distribution of bees. It further introduces the tropical savannah ecosystem, its climate, and vegetation characteristics and explains spectacular megafauna species of the system that form centers of wildlife tourism and inadequacy knowledge on pollinators diversity of the system. Finally, this chapter describes the study methodology including, the description of the study area, study design, and data collection.
Chapter II: Positive effects of low livestock grazing intensity on East African bee assemblages mediated by increases in floral resources
The impact of livestock grazing intensity on bee assemblage has been subjected to research over decades. Moreover, most of these studies have been conducted in temperate Europe and America leaving the huge tropical savannah of East Africa less studied. Using sweep netting and pan traps, a total of 183 species (from 2,691 individuals) representing 55 genera and five families were collected from 24 study sites representing three levels of livestock grazing intensity in savannah ecosystem of northern Tanzania. Results have shown that moderate livestock grazing slightly increased bee species richness. However, high livestock grazing intensity led to a strong decline. Besides, results revealed a unimodal distribution pattern of bee species richness and mean annual temperature. It was also found that the effect of livestock grazing and environmental temperature on bee species richness was mediated by a positive effect of moderate grazing on floral resource richness. The study, therefore, reveals that bee communities of the African savannah zone may benefit from low levels of livestock grazing as this favors the growth of flowering plant species. A high level of livestock grazing intensity will cause significant species losses, an effect that may increase with climatic warming.
Chapter III: Agricultural intensification with seasonal fallow land promotes high bee diversity in Afrotropical drylands
This study investigated the impact of local agriculture intensification on bee diversity in the Afro tropical drylands of northern Tanzania. Using sweep netting and pan traps, a total of 219 species (from 3,428 individuals) representing 58 genera and six families were collected from 24 study sites (distributed from 702 to 1708 m. asl) representing three levels of agriculture intensity spanning an extensive gradient of mean annual temperature. Results showed that bee species richness increased with agricultural intensity and with increasing temperature. However, the effects of agriculture intensity and temperature on bee species richness were mediated by the positive effects of agriculture and temperature on floral resource richness used by bee pollinators. Moreover, results showed that variation of bee body sizes increases with agricultural intensification, “that effect”, however, diminished in environments with higher temperatures. This study reveals that bee assemblages in Afrotropical drylands benefit from agriculture intensification in the way it is currently practiced. Further intensification, including year-round irrigated crop monocultures and extensive use of agrochemicals, is likely to exert a negative impact on bee diversity and pollination services, as reported in temperate regions. Moreover, several bee species were restricted to natural savannah habitats. Therefore, to conserve bee communities in Afro tropical drylands and guarantee pollination services, a mixture of savannah and agriculture, with long periods of fallow land should be maintained.
Chapter IV: Impact of land use intensification and local features on plants and pollinators in Sub-Saharan smallholder farms
For the first time in the region, this study explores the impact of land-use intensification on plants and pollinators in Sub-Saharan smallholder farms. The study complemented field surveys of bees with a modern DNA metabarcoding approach to characterize the foraged plants and thus built networks describing plant-pollinator interactions at the individual insect level. This information was coupled with quantitative traits of landscape composition and floral availability surrounding each farm. The study found that pollinator richness decreased with increasing impervious and agricultural cover in the landscape, whereas the flower density at each farm correlated with pollinator richness. The intensification of agricultural land use and urbanization correlated with a higher foraging niche overlap among pollinators due to the convergence of individuals' flower-visiting strategies. Furthermore, within farms, the higher availability of floral resources drove lower niche overlap among individuals, greater abundance of flower visitors shaped higher generalization at the networks level (H2I), possibly due to increased competition. These mechanistic understandings leading to individuals’ foraging niche overlap and generalism at the network level, could imply stability of interactions and the pollination ecosystem service. The integrative survey proved that plant-pollinator systems are largely affected by land use intensification and by local factors in smallholder farms of Sub-Saharan Africa. Thus, policies promoting nature-based solutions, among which the introduction of more pollinator-friendly practices by smallholder farmers, could be effective in mitigating the intensification of both urban and rural landscapes in this region, as well as in similar Sub-Saharan contexts.
Chapter V: A synopsis of the Bee occurrence data of northern Tanzania
This study represents a synopsis of the bee occurrence data of northern Tanzania obtained from a survey in the Kilimanjaro, Arusha, and Manyara regions. Bees were sampled using two standardized methods, sweep netting and colored pan traps. The study summed up 953 species occurrences of 45 species belonging to 20 genera and four families (Halictidae, Apidae, Megachilidae, and andrenidae) A. This study serves as the baseline information in understanding the diversity and distribution of bees in the northern parts of the country. Understanding the richness and distribution of bees is a critical step in devising robust conservation and monitoring strategies for their populations since limited taxonomic information of the existing and unidentified bee species makes their conservation haphazard.
Chapter VI: General discussion
In general, findings obtained in these studies suggest that livestock grazing and agriculture intensification affects bee assemblages and floral resources used by bee pollinators. Results have shown that moderate livestock grazing intensity may be important in preserving bee diversity. However, high level of livestock grazing intensity may result in a strong decline in bee species richness and abundance. Moreover, findings indicate that agriculture intensification with seasonal fallow lands supports high floral resource richness promoting high bee diversity in Afrotropical drylands. Nonetheless, natural savannahs were found to contain unique bee species. Therefore, agriculture intensification with seasonal fallow should go in hand with conserving remnant savannah in the landscapes to increase bee diversity and ensure pollination services. Likewise, findings suggest that increasing urbanization and agriculture cover at the landscape level reduce plant and pollinator biodiversity with negative impacts on their complex interactions with plants. Conversely, local scale availability of floral resources has shown the positive effects in buffering pollinators decline and mitigating all detrimental effects induced by land-use intensification. Moreover, findings suggest that the impact of human land use (livestock grazing and agriculture) do not act in isolation but synergistically interacts with climatic factors such as mean annual temperature, MAT. The impact of MAT on bee species richness in grazing gradient showed to be more detrimental than in agriculture habitats. This could probably be explained by the remaining vegetation cover following anthropogenic disturbance. Meaning that the remaining vegetation cover in the agricultural gradient probably absorbs the solar radiations hence reducing detrimental effect of mean annual temperature on bee species richness. This one is not the case in grazing gradient since the impact of livestock grazing is severe, leaving the bare land with no vegetation cover. Finally, our findings conclude that understanding the interplay of multiple anthropogenic activities and their interaction with MAT as a consequence of ongoing climate change is necessary for mitigating their potential consequences on bee assemblages and the provision of ecosystem services. Morever, future increases in livestock grazing and agriculture intensification (including year-round crop irrigated monocultures and excessive use of agrochemicals) may lead to undesirable consequences such as species loss and impair provision of pollination services.
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
The role of hospital water systems in the development of Pseudomonas aeruginosa (P. aeruginosa) surgical site infections (SSIs) in low-income countries is barely studied. This study characterized P. aeruginosa isolates from patients and water in order to establish possible epidemiological links.
Methods:
Between December 2014 and September 2015, rectal and wound swabs, and water samples were collected in the frame of active surveillance for SSIs in the two Tanzanian hospitals. Typing of P. aeruginosa was done by multi-locus sequence typing.
Results:
Of 930 enrolled patients, 536 were followed up, of whom 78 (14.6%, 95% CI; 11.6–17.5) developed SSIs. P. aeruginosa was found in eight (14%) of 57 investigated wounds. Of the 43 water sampling points, 29 were positive for P. aeruginosa. However, epidemiological links to wound infections were not confirmed. The P. aeruginosa carriage rate on admission was 0.9% (8/930). Of the 363 patients re-screened upon discharge, four (1.1%) possibly acquired P. aeruginosa during hospitalization. Wound infections of the three of the eight P. aeruginosa SSIs were caused by a strain of the same sequence type (ST) as the one from intestinal carriage. Isolates from patients were more resistant to antibiotics than water isolates.
Conclusions:
The P. aeruginosa SSI rate was low. There was no evidence for transmission from tap water. Not all P. aeruginosa SSI were proven to be endogenous, pointing to other routes of transmission.