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Coagulase-negative staphylococcal bacteremia in severely malnourished Jamaican children

C D Christie1, G T Heikens, M H Golden

  • 1Tropical Metabolism Research Unit, University Hospital of the West Indies, Kingston, Jamaica.

The Pediatric Infectious Disease Journal
|December 1, 1992
PubMed

Insights

Severe malnutrition in children impairs immunity, increasing infection risk. This study found a shift towards Gram-positive bacteria causing bacteremia in these vulnerable children, impacting treatment strategies.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Nutrition Science

Background:

  • Severe protein-energy malnutrition (PEM) in children compromises the immune system, heightening susceptibility to infections and altering inflammatory responses.
  • Bacteremia is a significant concern in malnourished children, necessitating a clear understanding of causative agents and epidemiological trends.

Purpose of the Study:

  • To investigate the incidence, causative agents, and outcomes of bacteremia in hospitalized children with severe PEM.
  • To identify epidemiological shifts in bacterial pathogens responsible for bacteremia in this population.

Main Methods:

  • A 5-year prospective study involving 336 children (2-34 months) with severe PEM admitted to a tropical metabolism research unit.
  • Documented bacteremia in 53 children, analyzing 60 episodes and 69 blood isolates, differentiating community-acquired from nosocomial infections.

Main Results:

  • Bacteremia occurred in 16% of severely malnourished children, with community-acquired infections being most common (72%).
  • Gram-positive organisms, particularly coagulase-negative staphylococci (35%) and Staphylococcus aureus (19%), predominated, contrasting with previous reports of Gram-negative dominance.
  • Patients with coagulase-negative staphylococcal bacteremia showed a higher likelihood of pneumonic consolidation. The bacteremia-related case fatality rate was 8%.

Conclusions:

  • A significant shift towards Gram-positive bacteremia has occurred in severely malnourished children, differing from historical trends.
  • Polymicrobial and Gram-negative septicemia were associated with increased mortality, highlighting the need for targeted interventions.

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