Bacteraemia in malnourished rural African children

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.

Bacteraemia among severely malnourished children infected and uninfected with the human immunodeficiency virus-1 in Kampala, Uganda

“…Gram negative organisms, especially non typhoidal salmonella species , were the predominant cause of bacteraemia in severely malnourished children, supporting early results from Uganda [2] and recent studies from Kenya, Malawi and Ethiopia [8,11-13]. …”

Antibiotics in severely malnourished children: systematic review of efficacy, safety and pharmacokinetics

“…Moreover, high rates of in vitro resistance to ampicillin and gentamicin have been reported in several African countries (Table 1). [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] According to discussions with staff members, institutions for the care of malnourished children vary in the degree to which they follow current recommendations. Many institutions are now giving more potent broad-spectrum antibiotics to hospitalized malnourished children guided largely by local in vitro sensitivity data.…”

“…2,3 Rationale for antibiotics in severely malnourished children Several epidemiological studies have documented a high prevalence of pneumonia, bacteraemia and urinary tract infections in children with malnutrition (Table 1). [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] In this cohort a wide range of both Gram-positive and Gram-negative organisms are Objective To systemically review the evidence in support of World Health Organization guidelines recommending broad-spectrum antibiotics for children with severe acute malnutrition (SAM). Methods CENTRAL, MEDLINE, EMBASE, LILACS, POPLINE, CAB Abstracts and ongoing trials registers were searched.…”

“…[10][11][12][13][14][15] High rates of resistance to second-line antibiotics such as chloramphenicol, gentamicin and cephalosporins have also been reported in selected contexts, [12][13][14][15] while in general, sensitivity to ciprofloxacin remains high (Table 1). [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] In vitro resistance, however, does not necessarily translate into lack of clinical efficacy.…”

Bacterial infections in hospitalised severely malnourished children in Durban, South Africa

“…5 Gram-negative organisms, especially non-typhoidal Salmonella species, were the predominant cause of bacteraemia in severely malnourished children, 6 supporting early results from Uganda and recent studies from Kenya, Malawi and Ethiopia. [7][8][9][10] Although there was no difference in the types of bacterial organisms by human immunodeficiency virus (HIV) status, blood specimens from severely immuno-suppressed children were more likely to grow Salmonella enteriditis. 11 The mechanism for this is not very clear and may include the difficulty in clearing Salmonella infections from infected macrophages and a weak immune system; the human immunodeficiency virus may predispose the host to infection with Salmonella enteriditis and this, in turn, promotes the production of human immunodeficiency virus (HIV) in the macrophages of the gastrointestinal tract mucosal cells, thus completing a vicious cycle.…”