Incidence and Characteristics of Bacteremia among Children in Rural Ghana

Abstract

The objective of the study was to describe systemic bacterial infections occurring in acutely ill and hospitalized children in a rural region in Ghana, regarding frequency, incidence, antimicrobial susceptibility patterns and associations with anthropometrical data.Blood cultures were performed in all children below the age of five years, who were admitted to Agogo Presbyterian Hospital (APH), Asante Region, Ghana, between September 2007 and July 2009. Medical history and anthropometrical data were assessed using a standardized questionnaire at admission. Incidences were calculated after considering the coverage population adjusted for village-dependent health-seeking behavior.Among 1,196 hospitalized children, 19.9% (n = 238) were blood culture positive. The four most frequent isolated pathogens were nontyphoidal salmonellae (NTS) (53.3%; n = 129), Staphylococcus aureus (13.2%; n = 32), Streptococcus pneumoniae (9.1%; n = 22) and Salmonella ser. Typhi (7.0%; n = 17). Yearly cumulative incidence of bacteremia was 46.6 cases/1,000 (CI 40.9–52.2). Yearly cumulative incidences per 1,000 of the four most frequent isolates were 25.2 (CI 21.1–29.4) for NTS, 6.3 (CI 4.1–8.4) for S. aureus, 4.3 (CI 2.5–6.1) for S. pneumoniae and 3.3 (CI 1.8–4.9) for Salmonella ser. Typhi. Wasting was positively associated with bacteremia and systemic NTS bloodstream infection. Children older than three months had more often NTS bacteremia than younger children. Ninety-eight percent of NTS and 100% of Salmonella ser. Typhi isolates were susceptible to ciprofloxacin, whereas both tested 100% susceptible to ceftriaxone. Seventy-seven percent of NTS and 65% of Salmonella ser. Typhi isolates were multi-drug resistant (MDR). Systemic bacterial infections in nearly 20% of hospitalized children underline the need for microbiological diagnostics, to guide targeted antimicrobial treatment and prevention of bacteremia. If microbiological diagnostics are lacking, calculated antimicrobial treatment of severely ill children in malaria-endemic areas should be considered.

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

“…The infrequent vancomycin dosing strategy often used among hemodialysis-dependent patients may not maintain an adequate trough level in high-flux, large-poresize artificial kidneys (46)(47)(48), increasing the risk for relapsing SAB. Table 1 summarizes the incidences of SAB from the abovementioned studies and other studies (49)(50)(51)(52)(53)(54)(55).…”

Population-Based Epidemiology and Microbiology of Community-Onset Bloodstream Infections

“…Several other studies have evaluated BSIs at the population level but have had incomplete case ascertainment, have limited analysis to subpopulations, have not specifically defined rates, or have not clearly differentiated between community-and hospital-onset disease (6)(7)(8)(9)(10)(11)(12)(13)(14)(15). It is difficult to precisely define the contemporary (within the last 20 years) overall burden of community-onset BSI, for a number of potential reasons.…”

“…Fourth, and perhaps most importantly, these studies were all reported from high-income Western countries. The burden of community-onset disease may be substantially different elsewhere worldwide (12)(13)(14)(15).…”

“…loodstream infection (BSI) is a major cause of infectious disease morbidity and mortality worldwide (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). Due to a number of determinants, not limited to changing population de-mographics, shifts in health care delivery models, and increasing globalization, the epidemiology of community-onset BSI has been changing in recent decades.…”

Igg Subclasses Targeting the Flagella of Salmonella Enterica Serovar Typhimurium Can Mediate Phagocytosis and Bacterial Killing

“…Increased drug resistance and emergence of new multi-drug resistant S. enterica strains has made iNTS disease difficult to manage [6][7][8]. There is very broad consensus that vaccines against iNTS are urgently needed.…”