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

Lionel Nyamurenje,Moherndran Archary

doi:10.4102/sajid.v33i5.139

Lionel Nyamurenje, Moherndran Archary

Open Access

https://doi.org/10.4102/sajid.v33i5.139

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Abstract

Background: Severe acute malnutrition (SAM) results in alterations of host defence mechanisms, which leads to increased susceptibility to infections. This study describes culture-confirmed bacterial infections in a cohort of HIV-negative severely malnourished children and compares it with a previously described cohort of HIV-positive children.Methods: A retrospective chart review was conducted of all HIV-negative children with SAM admitted to King Edward Hospital, Durban between January 1, 2015 and December 31, 2015. All positive bacterial cultures obtained within 2 days of admission (admission infections) and during 2 to 30 days of admissions (hospital acquired infections) were documented. A cohort of HIV-positive children with SAM was prospectively recruited between July 2012 and February 2015 at the same facility for the MATCH study.Results: A total of 101 patients were eligible for the study, 53% were HIV unexposed; 73% of the total 250 cultures obtained were during admission. Escherichia coli (E. coli) contributed 26% of all positive cultures on admission. Significant differences were noted in laboratory variables between HIV-negative vs. HIV-positive children admitted with SAM. Extended-spectrum betalactamase (ESBL) producers in HIV-positive patients constituted 40% of all Gram-negative isolates vs. 24% in HIV-negative patients.Conclusion: Gram-negative organisms remain an area of concern in both HIV-positive and HIV-negative patients with SAM with resistant organisms more prevalent in HIV-positive patients. Prevention of mother-to-child transmission of HIV reduces prevalence and incidence of HIV, which has been shown to contribute to the burden of bacterial infections in malnourished children.

Highlights

Severe malnutrition is defined as weight for height z-score
Positive cultures were mainly Gramnegative organisms, of which E. coli was the predominant organism, which is different from a study done by Abrha et al in Ethiopia, which showed a predominance of Gram-positive organisms.[15]
Acinetobacter baumanii, which is traditionally a nosocomial organism, was isolated in two sputum specimens collected on admission, showing its prevalence in communities

Summary

Introduction

Severe malnutrition is defined as weight for height z-score 65 cm in length).[1]. The World Health Organization (WHO) defines severe acute malnutrition (SAM) by a very low weight for height (below −3z scores of the median WHO growth standards), by visible severe wasting, or by the presence of nutritional oedema. Marasmus involves inadequate intake of protein and calories, representing the end result of starvation. It occurs in the first year of life due to lack of breast-feeding and use of dilute animal milk. Severe acute malnutrition (SAM) results in alterations of host defence mechanisms, which leads to increased susceptibility to infections. This study describes culture-confirmed bacterial infections in a cohort of HIV-negative severely malnourished children and compares it with a previously described cohort of HIV-positive children. Prevention of mother-to-child transmission of HIV reduces prevalence and incidence of HIV, which has been shown to contribute to the burden of bacterial infections in malnourished children

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