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Published on: September 6, 2019
Bacteraemia in severely malnourished children in an HIV-endemic setting
Esther Babirekere-Iriso1, Philippa Musoke, Adeodata Kekitiinwa
1Department of Paediatrics, Mulago Hospital, Kampala, Uganda. ebabirekere@yahoo.com
Insights
Bacteraemia affects 22% of severely malnourished children, with gram-negative bacteria being common. HIV infection was prevalent, but not strongly linked to bacteraemia. Antibiotic resistance is high, with ceftriaxone and ciprofloxacin showing effectiveness.
Area of Science:
- Pediatric Infectious Diseases
- Nutritional Immunology
- Clinical Microbiology
Background:
- HIV infection increases susceptibility to recurrent bacterial infections and bacteraemia in malnourished children.
- Severe malnutrition is a significant risk factor for invasive bacterial infections in pediatric populations.
- Understanding the epidemiology of bacteraemia in this vulnerable group is crucial for effective management.
Purpose of the Study:
- To determine the prevalence, causative organisms, and antibiotic sensitivity patterns of bacteraemia in severely malnourished children.
- To identify factors associated with bacteraemia in this cohort.
- To assess the prevalence of HIV infection among severely malnourished children.
Main Methods:
- A cross-sectional descriptive study was conducted at Mulago Hospital, Kampala.
- 134 children aged 6-59 months with severe malnutrition were recruited.
- Data collection included prevalence of bacteraemia, identification of causative organisms, antibiotic sensitivity testing, and HIV status determination.
Main Results:
- The prevalence of bacteraemia was 22%, predominantly caused by gram-negative enteric bacilli (Salmonella, E. coli).
- Hypoglycaemia was significantly associated with bacteraemia (p=0.007).
- High resistance rates were observed for common antibiotics (cotrimoxazole, ampicillin), while ceftriaxone and ciprofloxacin showed high sensitivity.
Conclusions:
- Nearly a quarter of severely malnourished children admitted had bacteraemia, with gram-negative bacteria as the main culprits.
- While 44% were HIV-infected, HIV was not strongly associated with bacteraemia.
- Ceftriaxone and ciprofloxacin are recommended as first-line antibiotics for empirical treatment due to high sensitivity and resistance to commonly used drugs.
Background:
HIV infection predisposes children with malnutrition to recurrent bacterial infections and a high risk of bacteraemia.
Methods:
A cross-sectional descriptive study to determine the prevalence, causative organisms, antibiotic sensitivity and factors associated with bacteraemia in malnourished children was undertaken at Mulago Hospital, Kampala. The prevalence of HIV infection was also determined. A total of 134 children aged 6-59 months with severe malnutrition were recruited.
Results:
Sixty-one (45.5%) had oedematous malnutrition and 73 (54.5%) had severe wasting. Fifty-nine (44.0%) were HIV-infected. The prevalence of bacteraemia was 22%. The predominant organisms isolated were gram-negative enteric bacilli (77%) with Salmonella species and E. coli contributing 67% of the isolates. Hypoglycaemia was significantly associated with bacteraemia (p=0.007). Most organisms were resistant to cotrimaxazole (93.3%), ampicillin (76.7%), gentamicin (66.7%) and chloramphenicol (60%). All isolates were sensitive to ceftriaxone. Sensitivity to ciprofloxacin was 97%. There was no strong association between HIV infection and bacteraemia. The relative risk of death in malnourished children with bacteraemia was ten times higher than in those without bacteraemia.
Conclusions:
Nearly a quarter (22%) of children admitted with severe malnutrition had bacteraemia and gram-negative organisms were the predominant cause. Forty-four per cent were HIV-infected. Most of the bacteria were sensitive to ceftriaxone and ciprofloxacin and resistant to commonly used antibiotics. In the absence of culture and sensitivity, ciprofloxacin or ceftriaxone should be considered as first-line antibiotics for severely malnourished children.
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