Bacteremia in Childhood Life-Threatening Infections in Urban Gambia: EUCLIDS in West Africa

Abstract

BackgroundThe 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.MethodsWe prospectively studied children 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.ResultsOf 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.ConclusionsThe 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.

Bacterial Blood Isolates in Children: Conventional vs. Bactec Automated Blood Culture System in a Tertiary Health Centre in Gombe, North East Nigeria

“…The dominance of Gram-negative bacteria in both culture methods in this study is in consonance with reports from Nigeria [21] [35], South Africa [36], Tanzania [37], Ethiopia [38], Rwanda [39], India [40] [41] and Afghanistan [42] but in contrast to studies from Ghana [28] and the Gambia [29], where gram positive pathogens dominated in Children. Different age categories, variation in sampling and sample size, inadequate specimen volume, antibiotic exposure before culture and gaps in laboratory quality management in the Blood culture process may account for this finding [43] [44].…”

“…Staphylococcus aureus was the predominant bacteria isolated by the automated method in children in this study. This is in agreement with similar studies in Nigeria from Abuja [19], Lagos [20], Kano [46], Ibadan [47] [48] Ife [49] Maiduguri [50] using Bactec BD and with reports from Gambia [28] Uganda [51], Ethiopia [36], Ghana [28] [52], Guinea-Bissau [53] Pakistan [16] and Nepal [54]. It has become a leading cause of hospital and community-acquired bacteremia in children and is often used as a marker of invasiveness [55].…”

“…While numerous factors such as prior antibiotic use, blood volume, blood stream infection periodicity, causative organism, bacteria density in the bloodstream, contribute to Blood Culture sensitivity, antibiotics prior to BC sampling decreases the rate of culture positivity by 45% -50% [10] [23] [24]. This study did not report prior antibiotic use before blood culture, but the studies of Brown [25], Uzodinma [20] and obaro [26] in Nigeria, and reports from Ghana [27], Gambia [28] showed high levels of antibiotic use before culture. Over the-counter antibiotic use is very prevalent and this is likely to impact the outcome of any study aimed at the determination of the causes of bacterial infection in children.…”

Baseline Study for Improving Diagnostic Stewardship at Secondary Health Care Facilities in Nigeria

“…Laboratory diagnostics such as antimicrobial susceptibility testing should guide the management of health conditions caused by bacteria such as sepsis. But, limited access to such services impedes accurate diagnosis and results in poorer health outcomes among patients It also hinders availability of quality microbiologic data to inform empiric treatment guidelines, thus highlighting of strengthening AMR surveillance in Sub-Saharan Africa with evidence-based interventions that use participatory approaches (21,22).…”

A Novel Framework for Phenotyping Children With Suspected or Confirmed Infection for Future Biomarker Studies

“…One of the major drawbacks of using bacterial cultures for confirming “definite bacterial” infection is their limited sensitivity ( Table 1 ) ( 18 ). The sensitivity is directly related to the volume sampled, which is a well-known problem for blood cultures in neonates and children ( 19 ), to the prior use of antibiotics, which is very common in some settings ( 20 ), to culture techniques and to the types of pathogens. Other limitations of cultures of sterile sites are the high rates of contaminants, at times as high as the rate of true bacterial pathogens ( 21 ), and whether or not the site of infection can be sampled directly.…”