ArticleThe Lancet. Microbe2022
Effect of resistance to third-generation cephalosporins on morbidity and mortality from bloodstream infections in Blantyre, Malawi: a prospective cohort study.
Article in The Lancet. Microbe, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 1 of them a synthesis that pooled it.
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Who cites it
36 citing papers in PubMed, 1 synthesis or guideline pooled it, 56 citations in OpenAlex.
- Progress on implementing the WHO-GLASS recommendations on priority pathogen-antibiotic sensitivity testing in Africa: AWellcome open research · 2024Pooled it
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- Antibiofilm Potential and Mechanisms ofMicroorganisms · 2026Article
- Appraising the infection prevention and control practices at two referral hospitals in Malawi: a mixed methods situational analysis.Antimicrobial resistance and infection control · 2026Article
- Epidemiology of ESBL-Producing, Carbapenem-Resistant, and Carbapenemase-Producing Enterobacterales in Southern Africa.Antibiotics (Basel, Switzerland) · 2026Review
- Patterns of antibiotic use among adult patients across seven hospitals in Malawi: opportunities and challenges for antimicrobial stewardship programmes.Journal of pharmaceutical policy and practice · 2026Article
- Co-creating community-driven solutions and policy priorities to address antimicrobial resistance through Responsive Dialogues: A qualitative evaluation from Malawi.PLOS global public health · 2026Article
- Transmission of extended spectrum β-lactamase-producing Escherichia coli and antimicrobial resistance gene flow across One Health compartments in eastern Africa: a whole-genome sequence analysis from a prospective cohort study.The Lancet. Microbe · 2026Article
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- Global burden of Klebsiella pneumoniae infections and antimicrobial resistance in 2019.BMC infectious diseases · 2025Article
- Gut bacterial dysbiosis in pediatric severe malaria associates with post-discharge mortality.Nature communications · 2025Article
- Extended-spectrum-β-lactamase-producing Gram-negative bacteria are associated with high mortality in children with bloodstream infections in Dar es Salaam, Tanzania.BMC infectious diseases · 2025Article
- Freshwater snail faecal metagenomes reveal environmental reservoirs of antimicrobial resistance genes across two continents.Microbial genomics · 2025Article
- Trends and patterns of antimicrobial resistance among common pathogens isolated from adult bloodstream and urinary tract infections in public health facilities in Malawi, 2020-2024.BMC infectious diseases · 2025Article
- High diversity of Escherichia coli causing invasive disease in neonates in Malawi poses challenges for O-antigen based vaccine approach.Communications medicine · 2025Article
- A Comprehensive Review of Molecular Mechanisms Leading to the Emergence of Multidrug Resistance in Bacteria.Indian journal of microbiology · 2025Review
- Aetiologies, neuroradiological features, and risk factors for mortality and long-term neurosequelae of febrile coma in Malawian children: a prospective cohort study.The Lancet. Global health · 2025Article
- Prevalence of Extended-Spectrum β-Lactamase-ProducingAntibiotics (Basel, Switzerland) · 2025Article
- Carbapenem-resistantMicrobiology spectrum · 2025Article
- Palmatine potentiates cefquinome efficacy against multidrug-resistantFrontiers in microbiology · 2025Article
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Authors and funding
15 authors at 8 institutions in 2 countries.
Funding
Abstract
backgroundThe burden of antimicrobial resistance is a major threat to global health; however, prospective clinical outcome data from Africa are scarce. In Malawi, third-generation cephalosporins are the antibiotics of choice in patients admitted to hospital despite a rapid proliferation of resistance to these drugs. We aimed to quantify the effect of resistance to third-generation cephalosporins on mortality and length of hospital stay among patients with bloodstream infections.
methodsWe did a prospective cohort study of patients admitted to Queen Elizabeth Central Hospital in Blantyre, Malawi. Patients of all ages who had positive blood cultures for Enterobacterales were included, with the exception of those from the genus Salmonella, and were followed up for 180 days. We characterised blood culture isolates using whole-genome sequencing and used Cox regression models to estimate the effect of resistance to third-generation cephalosporins on length of hospital stay, in-hospital mortality, and survival.
findingsBetween Jan 31, 2018, and Jan 13, 2020, we recruited 326 patients, from whom 220 (68%) of 326 isolates were resistant to third-generation cephalosporins. The case fatality proportion was 45% (99 of 220) in patients with bloodstream infections that were resistant to third-generation cephalosporins, and 34% (36 of 106) in patients with bloodstream infections that were sensitive to third-generation cephalosporins. Resistance to third-generation cephalosporins was associated with an increased probability of in-hospital mortality (hazard ratio [HR] 1·44, 95% CI 1·02-2·04), longer hospital stays (1·5 days, 1·0-2·0) and decreased probability of discharge alive (HR 0·31, 0·22-0·45). Whole-genome sequencing showed a high diversity of sequence types of both Escherichia coli and Klebsiella pneumoniae. Although isolates associated with death were distributed across clades, we identified three E coli clades (ST410, ST617, and ST648) that were isolated from 14 patients who all died.
interpretationResistance to third-generation cephalosporins is associated with increased mortality and longer hospital stays in patients with bloodstream infections in Malawi. These data show the urgent need for allocation of resources towards antimicrobial resistance mitigation strategies in Africa.
fundingWellcome Trust and Wellcome Asia and Africa Programme.
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