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We aimed to look at the clinical impact of bloodstream infections (BSI) caused by ESBL producing Gram-negative bacteria (GNB). This study was carried out on hospitalised children aged less than five years from four hospitals of the region of Dar es Salaam.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      The study included 135 hospitalized children with BSI due to GNB which were screened for ESBL. Clinical outcome i.e., death or discharge, was known for 130 children of which 12% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200915) died We used univariate and multivariate regression analyses to compare the outcome i.e., in-hospital mortality and length of hospital stay of inpatients with BSI caused by ESBL- producing GNB vs. outcome of inpatients with BSI caused by non ESBL producing GNB.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 135 children, 69 (51%) and 66 (49%) had BSI due to ESBL and non-ESBL producers respectively. Of the 15 children who died, 73% had BSI due to\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      or\n                      <jats:italic>Escherichia coli<\/jats:italic>\n                      . Mortality among children with infections caused by ESBL and non-ESBL producers were 16% and 6%, respectively. After adjusting for differences between groups regarding age, sex, and consciousness status on admission, infection with ESBL producing bacteria was a significant predictor of mortality, OR\u2009=\u200929; 95% CI (1.5\u2013540). Children infected with ESBL producing GNB had longer duration of hospital stay, OR 3.2, 95% CI (1.3\u20137.8). Resistance towards antimicrobial agents other than penicillin\u2019s and cephalosporins was significantly higher among ESBL producers than non-ESBL producers e.g. gentamicin (60\/69, 87%) vs. (6\/66, 9.1%), OR\u2009=\u200967; 95% CI (22.3-198.9) and ciprofloxacin (37\/69, 54%) vs. (7\/66, 10.6%), OR\u2009=\u20098; 95%CI (3.9\u201324.3).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The rapidly increasing resistance to commonly used and affordable antibiotics increases the risk of death and prolongs hospital stays in neonates in the study setting. These findings highlight the need for strengthened infection prevention and control in community settings and appropriate antibiotic use to reduce the selection and spread of ESBL-GNB in hospitals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-025-11629-4","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T13:24:48Z","timestamp":1761571488000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Extended-spectrum-\u03b2-lactamase-producing Gram-negative bacteria are associated with high mortality in children with bloodstream infections in Dar es Salaam, Tanzania"],"prefix":"10.1186","volume":"25","author":[{"given":"Sabrina J.","family":"Moyo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Manyahi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Said","family":"Aboud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristine","family":"M\u00f8rch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam P.","family":"Roberts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f8rn","family":"Blomberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Langeland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,27]]},"reference":[{"issue":"10369","key":"11629_CR1","doi-asserted-by":"publisher","first-page":"2221","DOI":"10.1016\/S0140-6736(22)02185-7","volume":"400","author":"GBDAR Collaborators","year":"2022","unstructured":"Collaborators GBDAR. 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This study was reviewed and approved by the Research and Ethics Committee of Muhimbili University of Health and Allied Sciences (MUHAS), National Health Research Ethics Committee (NatHREC) of National Institute of Medical Research (NIMR) in Tanzania and from the Regional Committee for Medical (NIMR\/HQ\/R.8a\/Vol 1X\/2722) and Health Research Ethics (REK) in Western Norway (2015\/881\/REK vest). Written informed consent to participate in this study was provided by the participant\u2019s legal guardian\/next of kin.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1416"}}