Bacteremia among Children Admitted to a Rural Hospital in Kenya

Berkley, James A.; Lowe, Brett; Mwangi, Isaiah; Williams, Thomas N.; Bauni, Evasius; Mwarumba, Saleem; Ngetsa, Caroline; Slack, Mary P. E.; Njenga, Sally; Hart, C. A.; Maitland, Kathryn; English, Mike; Marsh, Kevin; Scott, John A.

doi:10.1056/nejmoa040275

Cited by 762 publications

(784 citation statements)

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“…However, blood culture lacks sensitivity and early recognition and treatment of blood stream infections has the potential to avert progression to severe disease with high associated mortality [14,28]. While RDTs can improve targeting of anti-malarial drugs there is no comparable test for bacterial disease.…”

Section: Discussionmentioning

confidence: 99%

Treatment guided by rapid diagnostic tests for malaria in Tanzanian children: safety and alternative bacterial diagnoses

Mtove

Hendriksen

Amos

et al. 2011

Malar J

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BackgroundWHO guidelines for the treatment of young children with suspected malaria have recently changed from presumptive treatment to anti-malarial treatment guided by a blood slide or malaria rapid diagnostic test (RDT). However, there is limited evidence of the safety of this policy in routine outpatient settings in Africa.MethodsChildren 3-59 months of age with a non-severe febrile illness and no obvious cause were enrolled over a period of one year in a malaria endemic area of Tanzania. Treatment was determined by the results of a clinical examination and RDT result, and blood culture and serum lactate were also collected. RDT-negative children were followed up over 14 days.ResultsOver the course of one year, 965 children were enrolled; 158 (16.4%) were RDT-positive and treated with artemether-lumefantrine and 807 (83.4%) were RDT-negative and treated with non-anti-malarial medicines. Compared with RDT-positives, RDT-negative children were on average younger with a lower axillary temperature and more likely to have a history of cough or difficulty in breathing. Six (0.6%) children became RDT-positive after enrolment, all of whom were PCR-negative for Plasmodium falciparum DNA at enrolment. In addition, 12 (1.2%) children were admitted to hospital, one with possible malaria, none of whom died. A bacterial pathogen was identified in 9/965 (0.9%) children, eight of whom were RDT-negative and one was RDT-positive, but slide-negative. Excluding three children with Salmonella typhi, all of the children with bacteraemia were ≤12 months of age. Compared to double-read research slide results RDTs had a sensitivity of 97.8% (95%CI 96.9-98.7) and specificity of 96.3% (95%CI 96.3-98.4).ConclusionsUse of RDTs to direct the use of anti-malarial drugs in young children did not result in any missed diagnoses of malaria although new infections soon after a consultation with a negative RDT result may undermine confidence in results. Invasive bacterial disease is uncommon in children with non-severe illness and most cases occurred in infants with a current fever.

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Section: Discussionmentioning

confidence: 99%

Treatment guided by rapid diagnostic tests for malaria in Tanzanian children: safety and alternative bacterial diagnoses

Mtove

Hendriksen

Amos

et al. 2011

Malar J

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“…The KEMRI/Wellcome Trust Research Programme has conducted a continuous systematic surveillance for invasive bacterial infections amongst infants and children since mid-1998 [14]. Routinely, every paediatric admission or re-admission to Kilifi County Hospital (KCH) in Kenya, other than for elective surgery or observation following minor trauma, has a blood culture performed on admission, and again if there is deterioration during their hospital stay or they are subsequently re-admitted.…”

Section: Methodsmentioning

confidence: 99%

“…among malnourished children in Africa, cited by FAO/WHO [1] was from a study conducted at Kilifi County Hospital in Kenya between 1998 and 2002, prior to the introduction of RUFs [14]. Advantage was taken of the long-term continuation of this study, providing systematic surveillance of invasive bacterial disease in sick and malnourished children, to further examine invasive disease due to Cronobacter and Enterobacter spp [14]. Now, extended surveillance over 1998–2013, including 52,081 blood and 13,345 CSF cultures from children, including those with malnutrition is reported.…”

Section: Introductionmentioning

confidence: 99%

Invasive Cronobacter species infection in infants and children admitted to a rural Kenyan hospital with a high prevalence of malnutrition

Piper

Mwarumba

Ngari

et al. 2018

Paediatrics and International Child Health

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For children with acute malnutrition, ready-to-use therapeutic foods (RUTF) are lifesaving treatments. In 2012, detailed testing detected Enterobacteriaceae including Cronobacter species at low levels in RUTF from all UNICEF-approved producers. Cronobacter in milk feeds has previously been associated with severe neonatal infections. Thus, given the susceptibility of severely malnourished children to invasive bacterial infections, concerns arose about the potential for Cronobacter infections from RUTF. This led to widespread production and supply problems in emergency feeding programmes. The KEMRI/Wellcome Trust Research Programme has conducted systematic surveillance for invasive bacterial infections among children admitted to Kilifi County Hospital, Kenya since 1998. 65,426 paediatric blood and cerebrospinal fluid cultures from 52,733 admissions resulted in 3953 with growth of a pathogenic organism. From the 60 Enterobacter and Cronobacter isolates, possible Cronobacter species were initially selected from their original API-20E biochemical profile, which was repeated and then confirmed using ID-32E. Only two isolates were consistent with Cronobacter species, neither case had received RUTF. Serious infection due to Cronobacter species does not have a significant burden in this population. This has important implications for the continued supply, manufacture and monitoring of emergency feeds for malnourished children.

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“…The World Health Organization (WHO) estimates that 1.2 million infants die of invasive pneumococcal disease (IPD) each year, primarily in low and middle-income countries (LMICs) [5,6]. In 2000, S. pneumoniae accounted for 14.5 million episodes of serious disease in children aged \5 years resulting in 826,000 deaths representing 11 % (8-12 %) of all deaths in children aged 1-59 months (excluding deaths in HIV-infected children) [1].…”

Section: Introductionmentioning

confidence: 99%

Current Trends in Streptococcus pneumoniae Infections and Their Treatment

Shetty

Maldonado

2013

Curr Pediatr Rep

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Invasive pneumococcal disease (IPD) is a major cause of pediatric morbidity and mortality in resource-rich and low and middle-income countries (LMICs). Streptococcus pneumoniae can cause a wide spectrum of invasive and non-invasive disease. In resourcerich countries, implementation of 7-valent pneumococcal conjugate vaccine (PCV7) has been a significant public health achievement. Dramatic decrease in pediatric IPD incidence occurred after PCV7 implementation, but emergence of multi-drug-resistant non-vaccine serotypes (especially 19A) remains a concern. The recently introduced 13-valent PCV (PCV13) has the potential to further reduce the burden of IPD due to serotypes not contained in PCV7. Given the diversity of pneumococcal serotypes and the possibility of serotype replacement disease, innovative approaches to development of pneumococcal vaccines are needed. Continued surveillance of pneumococcal serotypes and antimicrobial resistance is crucial to evaluate the impact of PCV13 vaccine. Improved access to PCVs is crucial to reduce morbidity and mortality related to IPD in LMIC.

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Bacteremia among Children Admitted to a Rural Hospital in Kenya

Cited by 762 publications

References 20 publications

Treatment guided by rapid diagnostic tests for malaria in Tanzanian children: safety and alternative bacterial diagnoses

Treatment guided by rapid diagnostic tests for malaria in Tanzanian children: safety and alternative bacterial diagnoses

Invasive Cronobacter species infection in infants and children admitted to a rural Kenyan hospital with a high prevalence of malnutrition

Current Trends in Streptococcus pneumoniae Infections and Their Treatment

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