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Bacteraemia in severely malnourished children
1Department of Paediatrics, Baragwanath Hospital, Johannesburg, South Africa.
Insights
Severely malnourished children face a significantly higher risk of bloodstream infections (bacteraemia), especially those with kwashiorkor. This increased risk of bacteraemia substantially elevates their mortality rates.
Area of Science:
- Pediatrics
- Infectious Diseases
- Nutritional Science
Background:
- Severe malnutrition, including kwashiorkor and marasmus, is a significant health concern in hospitalized children.
- Malnourished children exhibit a heightened susceptibility to infections, impacting morbidity and mortality.
Purpose of the Study:
- To investigate the incidence and risk of community-acquired and nosocomial bloodstream infections (bacteraemia) in severely malnourished children.
- To compare the risk of bacteraemia between different types of severe malnutrition (kwashiorkor vs. marasmus).
- To determine the impact of bacteraemia on mortality among malnourished children.
Main Methods:
- A 2-year observational study involving 792 hospitalized severely malnourished children.
- Recording of community-acquired and nosocomial bacteraemia rates.
- Calculation of relative risks for bacteraemia and mortality in malnourished versus well-nourished children.
- Identification of common bacterial pathogens, focusing on Gram-negative enteric aerobes.
Main Results:
- Bacteraemia occurred in 9.9% of malnourished children (7.7% community-acquired, 2.2% nosocomial).
- Malnourished children had a 1.6 times higher risk of bacteraemia on admission and 2.0 times higher risk of nosocomial bacteraemia.
- Kwashiorkor cases showed 3.5 times higher bacteraemia rates than marasmus.
- Gram-negative enteric aerobes were more frequent in malnourished children.
- Bacteraemia increased the relative risk of death by 2.5 times in malnourished children.
- Bacteraemia contributed to 36% of deaths in children with kwashiorkor.
Conclusions:
- Severely malnourished children, particularly those with kwashiorkor, are at increased risk for bacteraemia.
- Bacteraemia significantly contributes to the high mortality rates observed in severely malnourished children.
- Effective management of malnutrition and infection prevention are crucial to reduce mortality.
Abstract:
During a 2-year period, 792 severely malnourished children (kwashiorkor, marasmus and marasmic kwashiorkor) were hospitalized (14.8% of all admissions). Community-acquired bacteraemia was recorded in 7.7% and nosocomial bacteraemia in 2.2% of malnourished children. The relative risk for bacteraemia on admission was 1.6 (95% confidence interval [CI] 1.3-1.9) and 2.0 for nosocomial bacteraemia (95% CI 1.4-3.0) in malnourished children as compared with well nourished children. Bacteraemia was 3.5 times more common in children with kwashiorkor than in marasmic children. Gram-negative enteric aerobes were isolated 2.6 times more frequently from malnourished than from well nourished children. The relative risk of death in malnourished children with bacteraemia was 2.5 times that of malnourished children without bacteraemia. Thirty-six per cent of deaths in children with kwashiorkor were related to bacteraemia. This study emphasizes the increased risk of bacteraemia in malnourished children, particularly those with kwashiorkor, and the impact on mortality.