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Bacteremia in febrile Malawian children: clinical and microbiologic features
A L Walsh1, A J Phiri, S M Graham
1Wellcome Trust Research Laboratories, University of Malawi, Blantyre. mwalsh@malawi.net
Insights
Childhood bacteremia is common in Malawi, with high mortality and significant antibiotic resistance. Non-typhi salmonellae and enteric Gram-negative bacilli were the most frequent pathogens identified in hospitalized children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Limited data exist on childhood bacteremia in Malawi.
- This study describes clinical and microbiologic features of bacteremic children in Malawi.
Purpose of the Study:
- To investigate the incidence, etiology, and clinical features of bacteremia in hospitalized children in Malawi.
- To assess antimicrobial resistance patterns of common bacterial pathogens.
Main Methods:
- Prospective collection of clinical and microbiologic data from blood cultures of febrile children admitted to Queen Elizabeth Central Hospital.
- Analysis of 2,123 blood cultures from September 1996 to August 1997.
Main Results:
- Bacterial pathogens were identified in 17.2% of cultures.
- Non-typhi salmonellae (NTS) and enteric Gram-negative bacilli (67.4%) and Streptococcus pneumoniae (16.4%) were the most common isolates.
- High rates of antimicrobial resistance were observed, with 76% of NTS resistant to ampicillin and 71% to trimethoprim-sulfamethoxazole. Overall mortality was 38%, higher in malnourished children.
Conclusions:
- Bacteremia is a frequent and serious condition in hospitalized Malawian children.
- High mortality rates underscore the severity of the problem.
- Prevalent antimicrobial resistance poses a significant challenge for treatment.
Background:
There are no published data for the incidence or etiology of childhood bacteremia in Malawi. We describe the clinical and microbiologic features of children admitted to hospital from whom blood cultures yielded bacterial pathogens.
Methods:
Any neonate or child admitted to the pediatric wards of the Queen Elizabeth Central Hospital had a blood culture taken in the event of fever without obvious clinical explanation. Clinical and microbiologic data were prospectively collected for children with a significant positive culture.
Results:
Between September, 1996, and August, 1997, we processed 2,123 cultures. Of these, 365 (17.2%) grew a pathogen. Non-typhi salmonellae (NTS) and enteric Gram-negative bacilli constituted 67.4% of isolates, and Streptococcus pneumoniae constituted 16.4%. More than two-thirds of NTS episodes coincided with the peak malaria transmission season (January to June); 67% of bacteremic children were malnourished, 28% severely so. Patients with NTS bacteremia were significantly more likely to have coincident malaria and to have splenomegaly and anemia than children with other infecting organisms. The overall mortality was 38% but varied considerably according to age and nutritional status. Prior antibiotic use, coincident malaria or meningitis did not adversely affect outcome. In vitro resistance to the commonly available antibiotics ampicillin and trimethoprim-sulfamethoxazole was found in 76 and 71% of NTS isolates. Screening tests for penicillin resistance suggested a rate of 21% among pneumococci.
Conclusions:
Bacteremia is common in hospitalized Malawian children and has a high mortality. There are high rates of resistance to some of the commonly used antibacterial agents.