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Open Access Research article

Bacterial infections in Lilongwe, Malawi: aetiology and antibiotic resistance

Mwai H Makoka1*, William C Miller2, Irving F Hoffman2, Rushina Cholera2, Peter H Gilligan2, Debbie Kamwendo3, Gabriel Malunga3, George Joaki3, Francis Martinson3 and Mina C Hosseinipour3

Author Affiliations

1 National AIDS Commission, Lilongwe, Malawi

2 University of North Carolina at Chapel School of Medicine, North Carolina, USA

3 University of North Carolina Project, Kamuzu Central Hospital, Lilongwe, Malawi

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BMC Infectious Diseases 2012, 12:67  doi:10.1186/1471-2334-12-67

Published: 21 March 2012



Life-threatening infections present major challenges for health systems in Malawi and the developing world because routine microbiologic culture and sensitivity testing are not performed due to lack of capacity. Use of empirical antimicrobial therapy without regular microbiologic surveillance is unable to provide adequate treatment in the face of emerging antimicrobial resistance. This study was conducted to determine antimicrobial susceptibility patterns in order to inform treatment choices and generate hospital-wide baseline data.


Culture and susceptibility testing was performed on various specimens from patients presenting with possible infectious diseases at Kamuzu Central Hospital, Lilongwe, Malawi.


Between July 2006 and December 2007 3104 specimens from 2458 patients were evaluated, with 60.1% from the adult medical service. Common presentations were sepsis, meningitis, pneumonia and abscess. An etiologic agent was detected in 13% of patients. The most common organisms detected from blood cultures were Staphylococcus aureus, Escherichia coli, Salmonella species and Streptococcus pneumoniae, whereas Streptococcus pneumoniae and Cryptococcus neoformans were most frequently detected from cerebrospinal fluid. Haemophilus influenzae was rarely isolated. Resistance to commonly used antibiotics was observed in up to 80% of the isolates while antibiotics that were not commonly in use maintained susceptibility.


There is widespread resistance to almost all of the antibiotics that are empirically used in Malawi. Antibiotics that have not been widely introduced in Malawi show better laboratory performance. Choices for empirical therapy in Malawi should be revised accordingly. A microbiologic surveillance system should be established and prudent use of antimicrobials promoted to improve patient care.