Vergleichende epidemiologische Untersuchungen zur bakteriellen Genese von Fieber unklarer Ursache in Ghana

Bacteremia and antimicrobial drug resistance over time, Ghana

by Lisa Groß
Doctoral thesis
Date of Examination:2012-06-04
Date of issue:2012-05-29
Advisor:Prof. Dr. Uwe Groß
Referee:Prof. Dr. Uwe Groß
Referee:Prof. Dr. Dirk Raddatz
Referee:Prof. Dr. Patricia Virsik-Köpp
Persistent Address: http://dx.doi.org/10.53846/goediss-1533

 

 

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Abstract

English

Bacterial distribution and antimicrobial drug resistance were monitored in patients with bacterial bloodstream infections in rural hospitals in Ghana. In 2001–2002 and in 2009, Salmonella enterica serovar Typhi was the most prevalent pathogen. Although most S. enterica serovar Typhi isolates were chloramphenicol resistant, all isolates tested were susceptible to ciprofloxacin. In Africa, fever is usually a synonym for malaria. However, evidence exists that a large proportion of fever of unknown origin (FUO) can be attributed to bacterial bloodstream infections (BBSI). Although Staphylococcus aureus is the predominant cause of BBSI in industrialized countries (1), in African countries such as Ghana or Kenya, gram-negative bacteria are identifi ed most often in BBSI (2,3). Furthermore, because of a lack of epidemiologic data, FUO in Africa is often treated sequentially, fi rst with antimalarial drugs and then, until some years ago, with antimicrobial drugs such as chloramphenicol. This strategy has often been ineffective (4). The Study In 2000 in hospitals in Ghana, we began to establish bacteriologic laboratories, which since then have participated in a biannual quality control program. For this quality control, 3 encoded bacterial species and their resistance to various antimicrobial drugs must be correctly identifi ed. Three of these hospitals took part in comparative epidemiologic studies of FUO during October 2001–April 2002 and again during August–September 2009 with the objective of establishing a rational treatment approach (Figure). The hospitals were located in Eikwe, a coastal village that has a rural population of ≈2,000 residents; Assin Foso, which is on a regional traffi c route and has a rural/urban population of ≈15,000 residents; and Nkawkaw, which is on the national traffi c route that connects Accra with Kumasi and has an urban population of >45,000 residents. This study was approved by the ethical committee of the University Medical Center, Göttingen, Germany, and the participating hospitals in Ghana. The study design, patient selection, and diagnostic approaches were identical in both study periods; FUO was defi ned as fever >38.5
Keywords: fever of unknown origin; Ciprofloxacin; Chloramphenicol; Salmonella Typhi; Ghana
Schlagwörter: Fieber unklarer Ursache; Typhus; Ciprofloxacin; Chloramphenicol; Salmonella Typhi; Ghana
 
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