ehealth digital library

Digital library of
the Tanzania
health
community

Bacteremia and Resistant Gram-Negative Pathogens Among Under-Fives in Tanzania.

Christopher, A., Mshana, S. E., Kidenya, B. R., Hokororo, A. and Morona, D. (2013) Bacteremia and Resistant Gram-Negative Pathogens Among Under-Fives in Tanzania. Italian journal of pediatrics, 39 (1). p. 27. ISSN 1824-7288

[img]
Preview
PDF
Alexandra_Christopher.pdf - Published Version
Available under License Creative Commons Attribution Non-commercial.

Download (678kB)

Abstract

Antibiotic resistance is one of the most serious public health concerns worldwide and is increasing at an alarming rate, making daily treatment decisions more challenging. This study is aimed at identifying local bacterial isolates and their antimicrobial susceptibility patterns to avoid irrational antibiotic use, especially in settings where unguided management occurs and febrile illnesses are predominant. A hospital-based prospective cross-sectional study was conducted from September 2011 to February 2012. Febrile children were serially recruited and demographic and clinical data were collected using a standardized data collection tool. A blood culture was performed and identification of the isolates was undertaken using in-house biochemical tests. Susceptibility to common antibiotics was investigated using the disc diffusion methods. Of the 1081 children admitted during the study period, 317 (29.3%) met the inclusion criteria and were recruited, of whom 195 (61.5%) and 122 (38.5%) were male and female respectively. The median age was 18 months with an interquartile range of 9 to 36 months. Of the 317 children, 251 (79.2%) were below or equal to 36 months of age. The prevalence of bacteremia was 6.6%. A higher prevalence of bacteraemia was observed in children below 36 months than in those >= 36 months (7.5% vs. 3.0%, p = 0.001). Predictors of bacteraemia were an axillary temperature of >38.5 [degree sign]C (OR =7, 95% CI = 2.2 - 14.8, p-value = 0.0001), a positive malaria slide (OR =5, 95% CI = 3.0 - 21.2, p-value = 0.0001) and a high neutrophils' count (OR =21 95% CI = 5.6 - 84, p-value = 0.0001). Escherichia coli and Klebsiella pneumoniae accounted for 7 (33.3%) and 6 (28.6%) of all the isolates respectively. Others gram-negatives bacteria were Citrobacter spp 2 (9.5%), Enterobacter spp 1 (4.25%), Pseudomonas spp 2 (9.5%), Proteus spp 1 (4.25%) and Salmonella spp 1 (4.25%). These isolates were highly resistant to ampicillin (95%), co-trimoxazole (90%), tetracycline (90%), gentamicin (80%), augmentin (80%), chloramphenicol (65%), ceftriaxone (35%), cefotaxime (35%) ciprofloxacin (30%), amikacin (30%), ceftazidime (25%) and norfloxacine (10%). Multi-resistant gram-negative bacteria are the commonest cause of bacteremia in under-fives attending the Bugando Medical Centre, Mwanza, Tanzania. A high body temperature, a positive malaria slide and a high absolute neutrophils' count were all independent risk factors found to predict bacteremia. A higher mortality rate was observed in children with bacteraemia. Continuous epidemiological surveillance should be conducted so that a proper and effective antibiotics management can be instituted, especially in children with a high grade fever, a positive malaria slide and a high neutrophils' count.

Item Type: Article
Keywords: Bacteremia, Multi-Resistant Gram-Negative Bacteria, Antibiotic Resistance, Hospital, Treatment, Tanzania
Subjects: Health Systems > Community Health
Divisions: Catholic University of Health and Allied Sciences (CUHAS)
Depositing User: Mr Joseph Madata
Date Deposited: 13 Aug 2013 08:25
Last Modified: 13 Aug 2013 08:25
URI: http://ihi.eprints.org/id/eprint/1459

Actions (login required)

Edit Item Edit Item

Downloads

Downloads per month over past year

View more statistics