Developing_an_antimicrobial_strategy_for_sepsis_in_Malawi__DASSIM3_

DASSIM is an observational study of patients with sepsis admitted to Queen Elizabeth Central Hospital, Blantyre, Malawi. These patients receive prolonged courses of broad spectrum antibiotic, largely ceftriaxone. Blood culture surveillance in Blantyre shows an alarming increase in bloodstream infections with locally untreatable ceftriaxone resistant ESBL producing enterobacteriaeciae (ESBL-E) since ceftriaxone was introduced in 2005, but the drivers of this increase are not clear. DASSIM aims to understand the drivers of acquisition and long term carriage of ESBL-E in sepsis survivors by serial stool sampling and selective ESBL-E culture with subsequent whole genome sequencing of isolates to place them in the local and global context