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Published on: February 15, 2013
Pneumococcal bacteremia during a decade in children in Soweto, South Africa
A S Karstaedt1, M Khoosal, H H Crewe-Brown
1Department of Medicine, Chris Hani Baragwanath Hospital, Johannesburg, South Africa.
Insights
Pneumococcal bacteremia in children in Soweto doubled over a decade, primarily due to the HIV epidemic. Antimicrobial susceptibility remained stable, highlighting the ongoing impact of HIV on childhood infections.
Area of Science:
- Pediatric Infectious Diseases
- Epidemiology
- Public Health
Background:
- Pneumococcal bacteremia poses a significant threat to children globally.
- Understanding long-term trends and risk factors is crucial for effective public health interventions.
- The human immunodeficiency virus (HIV) epidemic has been linked to increased susceptibility to various infections in children.
Purpose of the Study:
- To track the incidence and characteristics of pneumococcal bacteremia in Soweto children over ten years.
- To evaluate the influence of HIV infection on trends in pneumococcal bacteremia.
- To assess changes in antimicrobial susceptibility of Streptococcus pneumoniae isolates.
Main Methods:
- Retrospective review of case records for children with pneumococcal bacteremia.
- Data collected from Chris Hani Baragwanath Hospital covering two distinct one-year periods, a decade apart (1986/1987 and 1996/1997).
- Analysis of incidence rates, clinical features, HIV serostatus, and antimicrobial susceptibility patterns.
Main Results:
- The incidence of pneumococcal bacteremia in children under five years old doubled from 1986/1987 to 1996/1997.
- HIV seropositivity was high (60%) among tested patients in 1996/1997, with HIV-infected children showing increased malnutrition and recent antibiotic use.
- Penicillin-nonsusceptible isolates were prevalent, but antimicrobial susceptibility did not significantly change over the decade or by HIV serostatus.
Conclusions:
- The incidence of pneumococcal bacteremia in Soweto children significantly increased over the decade, largely driven by the HIV epidemic.
- HIV infection is a major factor contributing to the rise in pneumococcal bacteremia among children in this region.
- Antimicrobial susceptibility of pneumococcal isolates remained consistent, indicating no widespread resistance development during the study period.
Objectives:
To monitor for a decade the incidence and the clinical and microbiologic characteristics of pneumococcal bacteremia in children in Soweto and to assess the influence of HIV infection on any changes.
Methods:
Case records of children with pneumococcal bacteremia at Chris Hani Baragwanath Hospital from July, 1986, to June, 1987 (1986/ 1987), and from July, 1996, to June, 1997 (1996/ 1997), were retrospectively reviewed.
Results:
There were 194 episodes, 62 in 19861 1987 and 132 in 1996/1997. The minimum annual incidence for children younger than 5 years of age increased from 61 per 100000 (179 per 100000 for those <12 months old) in 1986/1987 to 130 per 100000 (349 per 100000 for those <12 months old) in 1996/1997. Sixty-seven (60%) of 111 patients tested in 1996/1997 were HIV-seropositive; none were tested in 1986/1987. The HIV-infected compared with HIV-noninfected were more likely to be malnourished (61% vs. 36%, P = 0.02), less likely to have other underlying disease (12% vs. 50%, P = 0.00001) and more frequently used antibiotics recently (69% vs. 43%, P = 0.008). Penicillin-nonsusceptible isolates were found in 22 (35%) patients in 1986/1987 and 52 (39%) in 1996/1997. There was no significant change in antimicrobial susceptibility during the decade or by HIV serostatus.
Conclusions:
Children in Soweto had a high incidence of pneumococcal bacteremia which doubled during the decade mainly as a result of the impact of the HIV epidemic. There has been no significant change in antimicrobial susceptibility for the decade.
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