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Published on: November 16, 2016
Prevalence of community-acquired bacteraemia in Guinea-Bissau: an observational study
Joakim Isendahl1,2, Cristovão Manjuba3, Amabelia Rodrigues4
1Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden. joakim.isendahl@ki.se.
Insights
Bloodstream infections are common in African children, even without fever. Diagnostic capacity needs improvement to identify children at risk for invasive bacterial infections.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Microbiology
- Global Health
Background:
- Bloodstream infections (BSI) in African children are understudied, with limited diagnostic capabilities in many facilities.
- Previous research often focused only on febrile or hospitalized children, potentially underestimating the BSI burden.
Purpose of the Study:
- To investigate the prevalence and characteristics of bloodstream infections in children presenting to a pediatric emergency department in Guinea-Bissau.
- To evaluate the effectiveness of clinical parameters in identifying bacteremia in this population.
- To assess the etiological agents and antimicrobial resistance patterns of BSIs.
Main Methods:
- Conducted blood cultures and malaria diagnostics on 372 children with fever or tachycardia at a referral center.
- Performed bacterial species identification, antimicrobial susceptibility testing, and molecular typing.
- Assessed the predictive value of clinical signs for bacteremia.
Main Results:
- The prevalence of bloodstream infection was 12%, with 46% of infected children being non-febrile.
- Clinical parameters showed poor predictive value for bacteremia.
- Staphylococcus aureus was the most common pathogen (54%), followed by non-typhoidal Salmonella and Streptococcus pneumoniae. Antibiotic resistance was generally low, but some extended-spectrum beta-lactamase-producing Klebsiella pneumoniae were identified.
Conclusions:
- Bacteremia is prevalent in African children regardless of fever, highlighting the need for improved diagnostics.
- The high rate of S. aureus warrants further investigation into potential contamination sources.
- Enhanced microbiological diagnostic facilities and risk-identification algorithms are crucial for managing pediatric bloodstream infections in Africa.
Background:
The burden of bloodstream infections is insufficiently studied in children in Africa and many healthcare facilities lack the capacity to identify invasive disease. Often studies have been limited to febrile patients or patients admitted to hospital.
Methods:
Blood cultures and malaria diagnostics was performed on 372 consecutive children presenting with tachycardia and/or fever to a referral paediatric emergency department in Bissau, Guinea-Bissau. Bacterial species detection, antimicrobial susceptibility testing and molecular typing were performed. The capacity of clinical parameters to identify bacteraemia was evaluated.
Results:
The prevalence of bloodstream infection was 12% (46/372) and in 46% (21/46) of the infections the child was non-febrile at presentation to the hospital. The predictive value for bacteraemia was poor for all assessed clinical parameters. Staphylococcus aureus accounted for 54% (26/48) of the isolates followed by non-typhoidal Salmonella, 10% (5/48), Streptococcus pneumoniae, 8% (4/48), and Salmonella Typhi, 6% (3/48). Among S. aureus there was a large diversity of spa types and 38% produced Pantone-Valentine leukocidin. Antibiotic resistance was low, however two out of three Klebsiella pneumoniae isolates produced extended-spectrum beta-lactamases. Malaria was laboratory confirmed in only 5% of the children but 64% (237/372) received a clinical malaria diagnosis.
Conclusions:
Bacteraemia was common irrespective of the presence of fever among children presenting to the hospital. The high prevalence of Staphylococcus aureus may be due to contamination. There is an imminent need to improve microbiological diagnostic facilities and to identify algorithms that can identify children at risk of bloodstream infections in Africa.
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