Antibiotic Susceptibility Patterns of Bacterial Isolates from Routine Clinical Specimens from Referral Hospitals in Tanzania: A Prospective Hospital-Based Observational Study

Figures & data

Figure 1 Map of the Republic of Tanzania showing geographic locations of the four study sites.

Table 1 Demographic Characteristics of Study Participants (N=388)

Demographic Characteristics	Total	Study Sites
		Maweni n=86	Musoma n=85	Ndanda n=158	Sumbawanga n=59
Sex
Male	185 (47.7)	40 (46.5)	44 (51.8)	73 (46.2)	28 (47.5)
Female	203 (52.3)	46 (53.5)	41 (48.2)	85 (53.8)	31 (52.5)
Age
0–4	46 (12.0)	8 (9.3)	11 (13.8)	23 (14.7)	4 (6.8)
5–15	65 (17.0)	22 (25.6)	10 (12.5)	21 (13.4)	12 (20.3)
16–49	191 (50.0)	43 (50.0)	41 (51.3)	77 (49.0)	30 (50.9)
50+	80 (20.9)	13 (15.1)	18 (22.5)	36 (22.9)	13 (22.0)
Median (IQR)	28 (12, 44)	26 (10,40)	28.5 (13.5, 47)	27 (14, 46)	27 (11,45)

Notes: Six participants had age missing; 5 were from Msoma and 1 from Ndanda.

Table 2 Distribution of Identified Bacterial Isolates by Clinical Specimen

Isolate Type	N	Specimen Type
		Blood	Ear Pus	Urethral Pus	Vaginal Pus	Wound Pus	Stool	Urine	CSF
Acinetobacter spp.	1	–	1 (100.0)	–	–	–	–	–	–
Citrobacter spp.	10	–	2(20.0)	1(10.0)	–	3(30.0)	3(30.0)	1(10.0)	–
E. coli	59	–	1(1.7)	1(1.7)	1(1.7)	3 (5.1)	1(1.7)	51(86.4)	1(1.7)
Enterobacter spp.	5	–	3(60.0)	–	–	–	2(40.0)	–	–
K. oxytoca	2	–	–	–	–	–	–	2(100)	–
Klebsiella spp.	20	–	5(25.0)	–	–	4(20.0)	–	11(55.0)	–
N. gonorrhoeae	8	–	–	3(37.5)	3(37.5)	–	–	2(25.0)	–
P. mirabilis	27	–	13 (48.2)	–	–	10 (37.0)	–	4(14.8)	–
P. aeruginosa	41	4(9.8)	27(65.9)	–	–	9(22.0)	–	1(2.4)	–
Proteus spp.	3	–	–	–	–	–	–	3(100.0)	–
P. vulgaris	5	–	–	–	–	4(80.0)	–	1(20.0)	–
Pseudomonas spp.	8	–	1(12.5)	–	–	4(50.0)	–	3(37.5)	–
S. typhi	4	1(25.0)	–	–	–	–	3(75.0)	–	–
Salmonella spp.	11	–	–	–	–	–	11(100)	–	–
Serratia spp.	1	–	1(100.0)	–	–	–	–	–	–
S. sonnei	8	–	–	–	–	–	8(100)	–	–
Shigella spp.	4	–	–	–	–	–	4(100)	–	–
S. aureus	110	13(11.8)	46(41.8)	1(0.9)	–	43(39.1)	2(1.8)	5(4.5)	–
S. saprophyticus	4	–	–	–	–	–	–	4(100)	–
Staphylococci (CoNs)	5	–	2(40.0)	–	–	–	–	3(60.0)	–
Staphylococcus spp.	5	1(20.0)	3(60.0)	–	–	–	–	1(20.0)	–
S. pneumoniae	4	1(25.0)	–	–	–	–	–	–	3(75.0)
S. aeuruginosa	1	–	1(100)	–	–	–	–	–	–
Streptococcus spp.	18	12(66.7)	5(27.8)	–	–	–	–	1(5.6)	–
V. cholerae 01 ogawa	24	–	–	–	–	–	24(100)	–	–
Total	388	32(8.3)	111(28.6)	6 (1.5)	4(1.0)	80(20.6)	58(14.9)	93(24.0)	4(1.0)

Table 3 Distribution of Identified Bacterial Pathogens from Different Clinical Samples

Isolate	Sex		Age*
	Female	Male	0–4	5–15	16–49	50+
Acinetobacter spp.	1(100)	0	0	0	1(100)	0
Citrobacter spp.	3(30.0)	7(70.0)	1(10.0)	0	8(80.0)	1(10)
E. coli	47(79.7)	12(20.3)	4(6.8)	3(5.1)	33(55.9)	19(32.2)
Enterobacter spp.	3(60.0)	2(40.0)	0	0	5(100)	0
K. oxytoca	1(50.0)	1(50.0)	0	0	0	2(100)
Klebsiella spp.	8(40.0)	12(60.0)	0	1(5.6)	10(55.6)	7(38.9)
N. gonorrhoeae	4(50.0)	4(50.0)	0	1(12.5)	6(75.0)	1(12.5)
P. mirabilis	14(51.9)	13(48.2)	2(7.4)	3(11.1)	13(48.2)	9(33.3)
P. aeruginosa	26(63.4)	15(36.6)	6(15.0)	8(20.0)	17(42.5)	9(22.5)
Proteus spp.	1(33.3)	2(66.7)	1(33.3)	0	1(33.3)	1(33.3)
P. vulgaris	3(60.0)	2(40.0)	0	0	3(60.0)	2(40.0)
Pseudomonas spp.	4(50.0)	4(50.0)	2(25.0)	0	4(50.0)	2(25.0)
S. typhi	2(50.0)	2(50.0)	0	2(50.0)	2(50.0)	0
Salmonella spp.	4(36.4)	7(63.6)	0	4(36.4)	6(54.6)	1(9.1)
Serratia spp.	1(100)	0	0	0	1(100)	0
S. sonnei	4(50.0)	4(50.0)	0	0	7(87.5)	1(12.5)
Shigella spp.	1(25.0)	3(75.0)	0(0.0)	0(0.0)	3(1.6)	1(1.3)
S. aureus	50(45.5)	60(54.6)	18(16.8)	22(20.6)	52(48.6)	15(14.0)
S. saprophyticus	3(75.0)	1(25.0)	0	1(25.0)	3(75.0)	0
Staphylococci (CoNs)	2(40.0)	3(60.0)	0	0	3(60.0)	2(40.0)
Staphylococcus spp.	4(80.0)	1(20.0)	2(40.0)	0	3(60.0)	0
S. pneumoniae	1(25.0)	3(75.0)	1(25.0)	3(75.0)	0	0
Streptococcus spp.	7(38.9)	11(61.1)	6(33.3)	9(50.0)	1(5.6)	2(11.1)
V. cholerae 01 Ogawa	9(37.5)	15(62.5)	3(12.5)	8(33.3)	8(33.3)	5(20.8)

Note: *Six participants had missing age response.

Table 4 Drug Susceptibility Pattern of Bacterial Isolates Tested in the Laboratories

Isolate	AMP					OXA			FOX				AMC				ERY				CLI				GEN				CIP
	R(%)			S(%)		R(%)	S(%)		R(%)		S(%)		R(%)		S(%)		R(%)		S(%)		R(%)		S(%)		R(%)		S(%)		R(%)		S(%)
Citrobacter sp.	9 (100)			0		–	–		–		–		5(50.0)		5(50)		–		–		–		–		5(83.3)		1(16.7)		3(33.3)		2(66.7)
E. coli	45(100)			0		–	–		1(100)		0		27(75.0)		9(25)		6 (85.7)		1(14.3)		–		–		33(70.2)		14(29.8)		23(42.6)		31(57.4)
Enterobacter sp.	3(100)			0		–	–		–		–		3(75.0)		1(25)		–		–		–		–		3(100)		0		0		3(100)
K. oxytoca	–			–		–	–		–		–		–		–		–		–		–		–		–		–		0		1(100)
Klebsiella sp.	–			–		–	–		–		–		10(90.9)		1(9.1)		–		–		0		13(100)		11(64.7)		6(35.3)		10(52.6)		9(47.4)
N. gonorrhoeae	–			–		–	–		–		–		–		–		–		–		–		–		–		–		7(87.5)		1(12.5)
P. mirabilis	25(96.2)			1 (3.8)		–	–		–		–		14(60.9)		9(39.1)		–		–		–		–		25(100)		0		6(25.0)		18(75)
P. aeruginosa	21(100)			0		–	–		–		–		16(88.9)		2(11.1)		–		–		–		–		32(86.5)		51(3.5)		6(16.7)		30(83.3)
Proteus sp.	3(100)			0		–	–		–		–		0		2(100)		–		–		–		–		0		3(100)		1(33.3)		2(66.7)
P. vulgaris	–			–		–	–		–		–		4(100)		0		–		–		–		–		–		–		1(20.0)		4(80.0)
Pseudomonas sp.	–			–		–	–		–		–		–		–		–		–		–		–		2(28.6)		5(71.4)		1(12.5)		7(87.5)
S. typhi	–			–		–	–		–		–		–		–		–		–		–		–		–		–		1(25.0)		3(75.0)
Salmonella sp.	11(100)			0		–	–		–		–		–		–		–		–		–		–		–		–		2(18.2)		9(81.8)
Serratia sp.	1(100)			0		–	–		–		–		1(100)		0		–		–		–		–		–		–		0		1(100)
S. sonnei	–			–		–	–		–		–		2(100)		0		–		–		–		–		2(50.0)		2(50.0)		5(83.3)		1(16.7)
Shigella sp.	–			–		–	–		–		–		1(50.0)		1(50.0)		–		–		–		–		–		–		0		4(100)
V. cholerae 01	13(93.9)			1(7.1)		–	–		0		8(100)		–		–		0		11(100)		–		–		0		9(100)		2(15.4)		11(84.6)
S. saprophyticus	–			–		2(66.7)	1(33.3)		1(50.0)		1(50.0		–		–		3(75.0)		1(25.0)		2(100)		0		0		1(100)		1(50.0)		1(50.0)
Staphylococcus sp.	–			–		1(25.0)	3(75)		3(100)		0		–		–		2(100)		0		1(33.3)		2(66.7)		3(100)		0		1(20.0)		4(80.0)
S. pneumoniae	–			–		0	4(100)		–		–		–		–		1(100)		0		0		3(100)		1(100)		0		0		2(100)
Streptococcus sp.	–			–		–	–		–		–		–		–		12(100)		0		2(14.3)		12(85.7)		9(81.8)		2(18.2)		7(46.7)		8(53.3)
S. aureus	–			–		–	–		–		–		–		–		61(76.3)		19(23.7)		23(34.9)		43(65.1)		27(54.0)		23(46.0)		32(40.0)		48(60)
Staphylococci (CoNs)	1(100)			0		–	–		–		–		–		–		4(100)		0		–		–		1(50.0)		1(50.0)		1(50.0)		1(50.0
Isolate		N	CRO					TET				SXT				MEM				NAL				NIT				CHL
			R(%)		S(%)			R(%)		S(%)		R(%)		S(%)		R(%)		S(%)		R(%)		S(%)		R(%)		S(%)		R(%)		S(%)
Gram-negative
Citrobacter sp.		10	-		-			-		-		-		-		1(16.7)		6(83.3)		-		-		-		-		-		-
E. coli		59	5(23.8)		16(76.2)			33(70.2)		14(29.8)		2(66.7)		1(33.3)		3(30.0)		7(70.0)		5 (62.5)		3(37.5)		2(6.1)		31(93.9)		14(50.0)		14(50.0)
Enterobacter sp.		5	1(50.0)		1(50.0)			2(66.7)		1(33.3)		0		1(100)		0		1(100)		Not urine specimen				Not urine specimen				2(50.0)		2(50.0)
K. oxytoca		2	1(50.0)		1(50.0)			-		-		-		-		-		-		-		-		0		2(100)		0		2(100)
Klebsiella sp.		20	5(55.6)		4(44.4)			-		-		-		-		3(15.8)		17(84.2)		-		-		3(30.0)		7(70)		4(44.4)		5(53.6)
N. gonorrhoeae		8	0		6(100)			-		-		-		-		-		-		-		-		-		-		3(100)		0
P. mirabilis		27	9(40.9)		13(59.1)			21(84.0)		4(16.0)		-		-		2(20.0)		8(80.0)		2(50.0)		2(50.0)		2(50.0)		2(50.0)		10(66.7)		5(33.3)
P. aeruginosa		41	13(65.0)		7(35)			20(95.2)		1(4.8)		-		-		18(66.7)		9(33.3)		-		-		2(100)		0		12(66.7)		8(33.3)
Proteus sp.		3	-		-			2(66.7)		1(33.3)		-		-		-		-		-		-		-		-		-		-
P. vulgaris		5	2(50.0)		2(50.0)			2(50.0)		2(50.0)		0		3(100)		-		-		1(100)		0		0		2(100)		-		-
Pseudomonas sp.		8	0		3(100)			-		-		-		-		-		-		0		2(100)		-		-		-		-
S. typhi		4	0		1(100)			1(100)		0		1(50.0)		1(50.0)		-		-		-		-		1(33.3)		2(66.7)		0		4(100)
Salmonella sp.		11	-		-			3(60.0)		2(40)		7(77.8)		3(22.2)		-		-		-		-		0		1(100)		2(28.6)		5(71.4)
Serratia sp.		1	0		1(100)			1(100)		0		-		-		-		-		-		-		-		-		0		1(100)
S. sonnei		8	2(66.7)		1(33.3)			-		-		-		-		0		2(100)		-		-		0		1(100)		2(25.5)		6(75.0)
Shigella sp.		4	-		-			-		-		-		-		-		-		-		-		-		-		0		1(100)
V. cholerae 01		24	0		9(100)			2(9.1)		20(90.9)		8(88.9)		2(22.1)		0		2(100)		9(100)		0		-		-		8(40.0)		12(60.0)
Gram-positive
S. saprophyticus		4	-		-			1(33.3)		2(66.7)		-		-		-		-		-		-		0		1(100)		2(100)		0
Staphylococcus sp.		4	-		-			2(50.0)		2(50.0)		-		-		-		-		-		-		1(100.0)		0		2(66.7)		1(33.3)
S. pneumoniae		4	-		-			0		2(100)		0		3(100)		-		-		-		-		0		1(100)		-		-
S. aureus		119	5(45.4)		6(54.6)			51(63.8)		29(36.2)		-		-		-		-		-		-		3(12.0)		22(92.0)		15(25.0)		45(75)
Staphylococci (CoNs)		5	-		-			4(100)		0		-		-		-		-		-		-		0		4(100)		0		2(100)
Streptococcus sp.		18	8(66.7)		4(33.3)			7(70.0)		3(30.0)		-		-		0		1(100)		-		-		-		-		7(50.0)		7(50.0)

Notes: Three P. aeruginosa isolates were tested for CAZ, 1 (33.3%) isolate was resistant (results not shown in this Table).

Abbreviations: CAZ, ceftazidime; CRO, ceftriaxone; TET, tetracycline; SXT, trimethoprim-sulfamethoxazole; TMP, trimethoprim; MEM, meropenem; NAL, nalidixic acid; NIT, nitrofurantoin; SPT, spectinomycin; CHL, chloramphenicol.