Blood culture collection technique and pneumococcal surveillance in Malawi during the four year period 2003–2006: an observational study

Mtunthama, Neema; Gordon, Stephen B.; Kusimbwe, Temwa; Zijlstra, Eduard E.; Molyneux, Malcolm E.; French, Neil

doi:10.1186/1471-2334-8-137

Cited by 14 publications

(16 citation statements)

References 22 publications

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“…However, because this was a retrospective study it was not possible to determine time from blood collection to incubation, or the volume of blood collected for culture—both known to impact on culture yield and likelihood of contaminants. [26] Nonetheless, the rate of blood culture contamination (3.8% of blood cultures taken and 31% of positive blood cultures) is lower than other studies in sub-Sahara Africa, [7,27] and suggests poor technique is unlikely to have greatly influenced our results.…”

Section: Discussionmentioning

confidence: 64%

Invasive bacterial infections in Gambians with sickle cell anemia in an era of widespread pneumococcal and hemophilus influenzae type b vaccination

et al. 2016

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There is relatively little data on the etiology of bacterial infections in patients with sickle cell anemia (SCA) in West Africa, and no data from countries that have implemented conjugate vaccines against both Streptococcus pneumoniae and Haemophilus influenzae type b (Hib).We conducted a retrospective analysis of SCA patients admitted to the Medical Research Council Unit, The Gambia, during a 5-year period when there was high coverage of Hib and Pneumococcal conjugate vaccination. We evaluated 161 admissions of 126 patients between April 2010 and April 2015.Pathogenic bacteria were identified in blood cultures from 11 of the 131 admissions that had cultures taken (8.4%, 95% CI 4.5–14.1%). The most frequent isolate was Salmonella Typhimurium (6/11; 54.5%), followed by Staphylococcus aureus (2/11; 18.2%) and other enteric Gram-negative pathogens (2/11; 18.2%) and there was 1 case of H influenzae non-type b bacteremia (1/11; 9.1%). There were no episodes of bacteremia caused by S pneumoniae or Hib.The low prevalence of S pneumoniae and Hib and the predominance of nontyphoidal Salmonella as a cause of bacteremia suggest the need to reconsider optimal antimicrobial prophylaxis and the empirical treatment regimens for patients with SCA.

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Section: Discussionmentioning

confidence: 64%

Invasive bacterial infections in Gambians with sickle cell anemia in an era of widespread pneumococcal and hemophilus influenzae type b vaccination

et al. 2016

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“…Immediate inoculation into blood culture bottles, installation onto the blood culture machine an average of 4–6 hours post-collection, and consistently high blood inoculum volumes ensured that contaminants were kept to a minimum (10%) and increased the likelihood of culturing S. pneumoniae [36]. Our study enrolment period encompassed wet and dry seasons in Malawi so seasonal variation [8] does not explain the absence of S. pneumoniae that we observed.…”

Section: Discussionmentioning

confidence: 90%

High Prevalence of Tuberculosis and Serious Bloodstream Infections in Ambulatory Individuals Presenting for Antiretroviral Therapy in Malawi

et al. 2012

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BackgroundTuberculosis (TB) and serious bloodstream infections (BSI) may contribute to the high early mortality observed among patients qualifying for antiretroviral therapy (ART) with unexplained weight loss, chronic fever or chronic diarrhea.Methods and FindingsA prospective cohort study determined the prevalence of undiagnosed TB or BSI among ambulatory HIV-infected adults with unexplained weight loss and/or chronic fever, or diarrhea in two routine program settings in Malawi. Subjects with positive expectorated sputum smears for AFB were excluded. Investigations Bacterial and mycobacterial blood cultures, cryptococcal antigen test (CrAg), induced sputum (IS) for TB microscopy and solid culture, full blood count and CD4 lymphocyte count. Among 469 subjects, 52 (11%) had microbiological evidence of TB; 50 (11%) had a positive (non-TB) blood culture and/or positive CrAg. Sixty-five additional TB cases were diagnosed on clinical and radiological grounds. Nontyphoidal Salmonellae (NTS) were the most common blood culture pathogens (29 cases; 6% of participants and 52% of bloodstream isolates). Multivariate analysis of baseline clinical and hematological characteristics found significant independent associations between oral candidiasis or lymphadenopathy and TB, marked CD4 lymphopenia and NTS infection, and severe anemia and either infection, but low positive likelihood ratios (<2 for all combinations).ConclusionsWe observed a high prevalence of TB and serious BSI, particularly NTS, in a program cohort of chronically ill HIV-infected outpatients. Baseline clinical and hematological characteristics were inadequate predictors of infection. HIV clinics need better rapid screening tools for TB and BSI. Clinical trials to evaluate empiric TB or NTS treatment are required in similar populations.

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“…The rate of detection of ''true-positive'' cases of bacteremia in children with CAP managed in the outpatient setting is lower than the rate of ''false-positive'' blood cultures reported in studies of childhood CAP (1.0%-8.2%) [74,77,80] and in studies evaluating the role of blood cultures in the emergency department evaluation of young children with fever (1.2%-2.8%) [81][82][83][84]. It is not known to what extent this relationship is attributable to the effect of preculture antibiotics, inadequate blood culture technique, insufficient blood volume for culture, or some combination of these factors [85][86][87]. Blood volumes sampled for bacterial culture in infants and children are less than those in adults.…”

Section: Evidence Summarymentioning

confidence: 99%

The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America

Bradley

Byington

Shah

et al. 2011

Clinical Infectious Diseases

1,386

1,549

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Evidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Site-of-care management, diagnosis, antimicrobial and adjunctive surgical therapy, and prevention are discussed. Areas that warrant future investigations are also highlighted.

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Blood culture collection technique and pneumococcal surveillance in Malawi during the four year period 2003–2006: an observational study

Cited by 14 publications

References 22 publications

Invasive bacterial infections in Gambians with sickle cell anemia in an era of widespread pneumococcal and hemophilus influenzae type b vaccination

Invasive bacterial infections in Gambians with sickle cell anemia in an era of widespread pneumococcal and hemophilus influenzae type b vaccination

High Prevalence of Tuberculosis and Serious Bloodstream Infections in Ambulatory Individuals Presenting for Antiretroviral Therapy in Malawi

The Management of Community-Acquired Pneumonia in Infants and Children Older Than 3 Months of Age: Clinical Practice Guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America

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