Abstract
BackgroundReports of the etiology of bacteremia in children from Nigeria are sparse and have been confounded by wide spread non-prescription antibiotic use and suboptimal laboratory culture techniques. We aimed to determine causative agents and underlying predisposing conditions of bacteremia in Nigerian children using data arising during the introduction of an automated blood culture system accessed by 7 hospitals and clinics in the Abuja area.MethodsBetween September 2008 and November 2009, we enrolled children with clinically suspected bacteremia at rural and urban clinical facilities in Abuja or within the Federal Capital Territory of Nigeria. Blood was cultured using an automated system with antibiotic removing device. We documented clinical features in all children and tested for prior antibiotic use in a random sample of sera from children from each site.Results969 children aged 2 months-5 years were evaluated. Mean age was 21 ± 15.2 months. All children were not systematically screened but there were 59 (6%) children with established diagnosis of sickle cell disease and 42 (4.3%) with HIV infection. Overall, 212 (20.7%) had a positive blood culture but in only 105 (10.8%) were these considered to be clinically significant. Three agents, Staphylococcus aureus (20.9%), Salmonella typhi (20.9%) and Acinetobacter (12.3%) accounted for over half of the positive cultures. Streptococcus pneumoniae and non-typhi Salmonellae each accounted for 7.6%. Although not the leading cause of bacteremia, Streptococcus pneumoniae was the single leading cause of all deaths that occurred during hospitalization and after hospital discharge.ConclusionS. typhi is a significant cause of vaccine-preventable morbidity while S. pneumoniae may be a leading cause of mortality in this setting. This observation contrasts with reports from most other African countries where non-typhi Salmonellae are predominant in young children. Expanded surveillance is required to confirm the preliminary observations from this pilot study to inform implementation of appropriate public health control measures.
Highlights
Reports of the etiology of bacteremia in children from Nigeria are sparse and have been confounded by wide spread non-prescription antibiotic use and suboptimal laboratory culture techniques
Using data arising from this pilot surveillance, we report the commonly identified causes of community-acquired bacteremia in children aged 2 months-5 years in an urban and semi-urban setting with reference to vaccine-preventable diseases
S. aureus accounted for 20.9% while Acinetobacter and S.pneumoniae accounted for 12.3% and 7.6% respectively
Summary
Reports of the etiology of bacteremia in children from Nigeria are sparse and have been confounded by wide spread non-prescription antibiotic use and suboptimal laboratory culture techniques. We aimed to determine causative agents and underlying predisposing conditions of bacteremia in Nigerian children using data arising during the introduction of an automated blood culture system accessed by 7 hospitals and clinics in the Abuja area. It is well established that invasive bacteria disease is the leading cause of childhood mortality in sub-Saharan Africa and most of these infections are preventable by the use of vaccines which are already licensed and in routine use in most developed countries. Few health facilities in Africa have the microbiologic laboratories with capacity to identify invasive bacterial infection. While S. pneumoniae has been identified as the leading cause of bacteremia or invasive bacteria disease in The Gambia [7], Kenya [6], Mozambique [8], this was not the case in Ghana [9] and Malawi [10] where non-typhi Salmonella (NTS) predominated. Availability of national epidemiologic data will strengthen advocacy for the introduction of relevant vaccines
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