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Trans R Soc Trop Med Hyg. 2019 Dec 10. pii: trz111. doi: 10.1093/trstmh/trz111. [Epub ahead of print]

A prospective study of Escherichia coli bloodstream infection among adolescents and adults in northern Tanzania.

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Division of Infectious Diseases and International Health, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA.
Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC, 27710, USA.
Kilimanjaro Christian Medical Centre, PO Box 3010, Moshi, Tanzania.
Department of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
Centre for International Health, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
Kilimanjaro Christian Medical University College, Tumaini University, PO Box 3010, Moshi, Tanzania.
Mawenzi Regional Referral Hospital, PO Box 3054, Moshi, Tanzania.



Characterization of the epidemiology of Escherichia coli bloodstream infection (BSI) in sub-Saharan Africa is lacking. We studied patients with E. coli BSI in northern Tanzania to describe host risk factors for infection and to describe the antimicrobial susceptibility of isolates.


Within 24 h of admission, patients presenting with a fever at two hospitals in Moshi, Tanzania, were screened and enrolled. Cases were patients with at least one blood culture yielding E. coli and controls were those without E. coli isolated from any blood culture. Logistic regression was used to identify host risk factors for E. coli BSI.


We analyzed data from 33 cases and 1615 controls enrolled from 2007 through 2018. The median (IQR) age of cases was 47 (34-57) y and 24 (72.7%) were female. E. coli BSI was associated with (adjusted OR [aOR], 95% CI) increasing years of age (1.03, 1.01 to 1.05), female gender (2.20, 1.01 to 4.80), abdominal tenderness (2.24, 1.06 to 4.72) and urinary tract infection as a discharge diagnosis (3.71, 1.61 to 8.52). Of 31 isolates with antimicrobial susceptibility results, the prevalence of resistance was ampicillin 29 (93.6%), ceftriaxone three (9.7%), ciprofloxacin five (16.1%), gentamicin seven (22.6%) and trimethoprim-sulfamethoxazole 31 (100.0%).


In Tanzania, host risk factors for E. coli BSI were similar to those reported in high-resource settings and resistance to key antimicrobials was common.


Escherichia coli ; Africa; Tanzania; bacteremia; risk factors


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