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Pediatric empiric antibiotic use and resistance patterns at a single tertiary care hospital in Tanzania
Anneka M Hooft1,2, Kum Su Sunny Hwang3, Raya Mussa4
1Departments of Emergency Medicine and Paediatrics, University of California, San Francisco, San Francisco, CA, USA. Anneka.hooft@ucsf.edu.
Insights
Pediatric antibiotic use in Tanzania shows ceftriaxone is common, but resistance is high in gram-negative bacteria like E. coli. This highlights the need for updated antimicrobial stewardship programs to combat rising drug resistance.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Clinical Microbiology
Background:
- Pediatric-specific antibiograms are scarce in Tanzanian public hospitals.
- Empiric antibiotic use patterns in pediatric emergency care are under-documented.
- Understanding resistance and prescribing is crucial for pediatric antimicrobial stewardship (AMS).
Purpose of the Study:
- To assess pediatric empiric antibiotic use in the emergency department.
- To analyze microbiology results and resistance patterns in children.
- To establish a baseline for pediatric antimicrobial stewardship at Muhimbili National Hospital (MNH), Tanzania.
Main Methods:
- Retrospective review of electronic medical records for children in the EMD.
- Documentation of empiric antibiotic prescriptions and their indications.
- Analysis of blood and urine cultures to determine resistance patterns and construct a pediatric antibiogram.
Main Results:
- Ceftriaxone was the most frequent antibiotic prescribed (72%), particularly for lower respiratory infections.
- Low susceptibility to ceftriaxone was observed in gram-negative isolates (e.g., 20% in K. pneumoniae, 18% in E. coli).
- Over 90% of Enterobacterales exhibited multidrug resistance (MDR).
Conclusions:
- Ceftriaxone is widely used, aligning with local sepsis guidelines but not national infectious disease guidelines.
- High rates of ceftriaxone resistance in gram-negative organisms necessitate urgent review of prescribing practices.
- Future quality improvement initiatives must integrate antibiotic prescribing data and local epidemiology to refine treatment guidelines.
Background:
Despite growing microbiology capacity in Tanzanian public hospitals, pediatric-specific antibiograms remain rare, and patterns of empiric antibiotic use in emergency care are poorly described compared to high-income settings. Understanding resistance profiles and empiric prescribing practices is essential for developing successful pediatric antimicrobial stewardship (AMS) programs.
Objectives:
To assess baseline pediatric empiric antibiotic use in the emergency medical department (EMD) and microbiology results from children at Muhimbili National Hospital (MNH), a tertiary care center and referral hospital in Dar es Salaam, Tanzania.
Design:
We retrospectively reviewed the electronic medical records of children seen in the EMD over a one-year period to document empiric antibiotic use and indications. Blood and urine cultures were analyzed to construct a pediatric-specific antibiogram and assess resistance patterns.
Results:
Of 2,316 patients prescribed antibiotics, lower respiratory infection (n = 532, 23%), prophylaxis (n = 380, 16%), and upper respiratory infection (n = 277, 12%) were the most common single indications for use. Ceftriaxone was the most frequently used antibiotic (n = 1,658, 72%). Microbiology data revealed low susceptibility of gram-negative isolates to ceftriaxone: 20% (10/49) in K. pneumoniae and 18% (9/51) in E. coli. Over 90% of Enterobacterales met criteria for multidrug resistance (MDR).
Conclusions:
Ceftriaxone was the most common empiric antibiotic, particularly for lower respiratory infections. Antibiotic treatment selection aligned with local sepsis guidelines, emphasizing broad criteria for therapy rather than national, source-directed infectious disease treatment guidelines. Resistance data demonstrated frequent ceftriaxone resistance among gram-negative organisms. Future studies are needed to understand clinicians' use of bacterial cultures and clinical outcomes in children with resistant isolates. Quality improvement initiatives should incorporate regular review of antibiotic prescribing patterns and microbiology data to ensure treatment guidelines reflect local epidemiology.
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