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Bacteraemia in malnourished rural African children
R P Reed1, F O Wegerhoff, A D Rothberg
1Shongwe Mission Hospital, University of the Witwatersrand, Johannesburg, Republic of South Africa.
Insights
Malnourished children in rural South Africa face a high risk of bloodstream infections (bacteraemia). Prompt antibiotic treatment showed high sensitivity, but bacteraemia significantly increased mortality rates in these vulnerable children.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Malnutrition is a significant health issue in children under five in rural South Africa.
- A high prevalence of malnutrition was observed in children admitted to Shongwe Mission Hospital.
Purpose of the Study:
- To determine the incidence of bloodstream infections (bacteraemia) in malnourished children.
- To identify common causative organisms and assess their antibiotic sensitivity.
- To evaluate the impact of bacteraemia on mortality rates in malnourished children.
Main Methods:
- A 5-month study was conducted at Shongwe Mission Hospital, analyzing 863 children under five.
- Data collected included nutritional status, presence of bacteraemia, and causative microorganisms.
- Antibiotic sensitivity testing was performed on isolated bacteria.
Main Results:
- 37.5% of admitted children were malnourished, with two-thirds severely so.
- Bacteraemia incidence was 9.6% in malnourished children, higher in severely malnourished (11.8%).
- Gram-negative enteric bacilli were predominant; 95.8% of isolates were sensitive to ampicillin and gentamicin.
Conclusions:
- Bacteraemia poses a significant threat to malnourished children, substantially increasing mortality.
- Empirical antibiotic therapy with ampicillin and gentamicin is effective against common pathogens.
- In resource-limited settings, prioritizing surveillance for antibiotic resistance over full bacterial identification is recommended.
Abstract:
During a 5-month study period, 323 of 863 (37.5%) children below 5 years of age admitted to Shongwe Mission Hospital in rural South Africa were malnourished, two-thirds severely so. The incidence of bacteraemia in malnourished children was 9.6%, 11.8% in those severely malnourished and 5.8% in nutritional dwarfs. The predominant organisms retrieved were Gram-negative enteric bacilli (48.5%). Amongst the severely malnourished, who empirically receive intravenous ampicillin and gentamicin, 95.8% of all isolates were sensitive to this antibiotic combination. The case fatality rate of severely malnourished bacteraemic children was 20.8%. In malnutrition categories overall, the case fatality rate for bacteraemic children (22.6%) was significantly greater than in those without bacteraemia (9.3%). In hospitals with limited resources, full identification of bacteria may not be necessary, provided that regular surveillance for emerging resistance is conducted.