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Widespread antimicrobial resistance makes standard first-line empiric treatment regimens ineffective. To explore potential alternatives, we compared antimicrobial resistance patterns in blood culture isolates from two previous cohort studies on children admitted to hospital with fever in Tanzania, with focus on resistance to the semisynthetic aminoglycosides amikacin and plazomicin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Antimicrobial susceptibility testing was conducted using minimum inhibitory concentration (MIC) strips, with results interpreted according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical breakpoints. Resistance rates to current recommended empiric sepsis treatments and potential new regimens with ampicillin combined with amikacin or plazomicin were assessed. Whole genome sequencing was performed on\n                      <jats:italic>Klebsiella<\/jats:italic>\n                      ,\n                      <jats:italic>Escherichia<\/jats:italic>\n                      , and\n                      <jats:italic>Salmonella<\/jats:italic>\n                      isolates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Antimicrobial susceptibility testing was conducted on 449 blood culture isolates from 427 patients, and whole genome sequencing was performed on 216 isolates. Overall resistance rates to gentamicin-ampicillin and ceftriaxone were 46% and 50%, respectively, while resistance to amikacin-ampicillin and plazomicin-ampicillin was 9%. We estimate that by using amikacin-ampicillin instead of gentamicin-ampicillin, we can reduce the risk of ineffective antibiotic treatment by 37 percentage points (95% confidence interval: 32%-42%). Correspondingly, using amikacin-ampicillin instead of ceftriaxone would reduce the risk by 41 percentage points (95% confidence interval: 35%-46%). In\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      and\n                      <jats:italic>Escherichia coli<\/jats:italic>\n                      ceftriaxone resistance primarily resulted from the\n                      <jats:italic>bla<\/jats:italic>\n                      <jats:sub>CTX-M-15<\/jats:sub>\n                      gene, while resistance to gentamicin was mainly due to the aac(3)-II gene. The aac(6\u2032)-Ib-cr gene was found in 33\n                      <jats:italic>Klebsiella<\/jats:italic>\n                      and\n                      <jats:italic>E. coli<\/jats:italic>\n                      isolates, although only three exhibited amikacin MICs above the clinical breakpoint.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This in vitro analysis suggest that amikacin-ampicillin is a promising option as first-line empiric treatment of suspected sepsis in children in Tanzania. The clinical efficacy and safety need to be evaluated in clinical trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12866-026-05024-5","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T12:45:01Z","timestamp":1776170701000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Antimicrobial resistance in paediatric bloodstream infections in Tanzania: a longitudinal comparison of two cohort studies"],"prefix":"10.1186","volume":"26","author":[{"given":"Trygve","family":"Kristiansen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina John","family":"Moyo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Manyahi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul Christoffer","family":"Lindemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iain G.","family":"Johnston","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristine","family":"M\u00f8rch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Langeland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f8rn","family":"Blomberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,14]]},"reference":[{"issue":"10219","key":"5024_CR1","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","volume":"395","author":"KE Rudd","year":"2020","unstructured":"Rudd KE, Johnson SC, Agesa KM, Shackelford KA, Tsoi D, Kievlan DR, et al. 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Study 1 was approved by the College Research & Publications Committee, Muhimbili University College of Health Sciences, (ref. no. MU\/O1\/1022, 31-JUL-2001). Study 2 was approved by the Muhimbili University College of Health Research Ethics Committee, Senate Research and Publications Committee of Muhimbili University of Health and Allied Sciences, National Institute of Medical Research in Tanzania (Reference Study 2 2016\u201312-29\/AEC\/Vol.XII\/06), and from the Regional Committee for Medical and Health Research Ethics (2015\/881\/REK vest) in Western Norway. 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