| dc.description.abstracteng | 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 | de |