Bacteraemia in severely malnourished children

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.