Bacteremia in Childhood Life-Threatening Infections in Urban Gambia: EUCLIDS in West Africa
Secka, F; Herberg, J A; Sarr, I; Darboe, S; Sey, G; Saidykhan, M; Wathuo, M; Kaforou, M; Antonio, M; Roca, A; Zaman, S M A; Cebey-López, M; Boeddha, N P; Paulus, S; Kohlfürst, D S; Emonts, M; Zenz, W; Carrol, E D; de Groot, R; Schlapbach, L; Martinon-Torres, F; Bojang, K; Levin, M; van der Flier, M; Anderson, S T
(2019) Open forum infectious diseases, volume 6, issue 9
(Article)
Abstract
Background: The limited availability of microbiology services in sub-Saharan Africa impedes accurate diagnosis of bacterial pathogens and understanding of trends in prevalence and antibiotic sensitivities. We aimed to characterize bacteremia among hospitalized children in The Gambia and to identify factors associated with bacteremia and mortality. Methods: We prospectively studied children
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presenting with suspected severe infection to 2 urban hospitals in The Gambia, between January 2013 and September 2015. Demographic and anthropometric data, clinical features, management, and blood culture results were documented. Urine screens for antibiotic activity were performed in a subset of participants. Results: Of 411 children enrolled (median age, 29 months; interquartile range, 11-82), 79.5% (325 of 409) reported prehospital antibiotic use. Antimicrobial activity by urinary screen for antibiotic activity was detected in 70.8% (n = 80 of 113). Sixty-six bacterial pathogens were identified in 65 (15.8%) participants and Staphylococcus aureus predominated. Gram-positive organisms were more commonly identified than Gram-negative (P <. 01). Antibiotic resistance against first-line antimicrobials (ampicillin and gentamicin) was common among Gram-negative bacteria (39%; range, 25%-100%). Factors significantly associated with bacteremia included the following: gender, hydration status, musculoskeletal examination findings, admission to the Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine hospital, and meeting sepsis criteria. Those associated with increased mortality were presence of a comorbidity, clinical pallor, tachypnea, and altered consciousness. Tachycardia was associated with reduced mortality. Conclusions: The bacteremia rate in children with suspected childhood life-threatening infectious diseases in The Gambia is high. The pattern of pathogen prevalence and antimicrobial resistance has changed over time compared with previous studies illustrating the importance of robust bacterial surveillance programs in resource-limited settings.
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Keywords: Gambia, antibiotic, bacteremia, children, mortality, Oncology, Clinical Neurology
ISSN: 2328-8957
Publisher: Oxford University Press
Note: Funding Information: Financial support. This work was funded by the European Union’s Seventh Framework programme (Grant agreement no. 279185). J. A. H. and M. L. were funded by the NIHR Imperial College Biomedical Research Centre. M. K. acknowledges funding from the Wellcome Trust (Sir Henry Wellcome Fellowship Grant 206508/Z/17/Z). Publisher Copyright: © 2019 The Author(s) 2019. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
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