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.
Highlights
High infant morbidity and mortality is still one of the major health issues in sub-Saharan Africa with 4.6 million children dying before the age of five years [1]
While public interest tends to focus on malaria, tuberculosis and HIV, the morbidity and mortality burden of systemic bloodstream infections are still insufficiently investigated
One hundred fifty-five were excluded from the analysis because of missing data on blood cultures, leaving 1,196 hospitalized children
Summary
High infant morbidity and mortality is still one of the major health issues in sub-Saharan Africa with 4.6 million children dying before the age of five years [1]. According to WHO statistics of 2008, malaria accounts for 18% of deaths among children below five years in Ghana, closely followed by pneumonia (13%), diarrhea (12%) and pre-maturity at birth (12%). While public interest tends to focus on malaria, tuberculosis and HIV, the morbidity and mortality burden of systemic bloodstream infections are still insufficiently investigated. Published data from Tanzania reveals clinical overestimation of malaria, whereas invasive bacterial disease was underestimated [3]. Clinical differentiation between severe malaria and invasive bacterial infection is difficult because of the overlap in disease symptoms [4]. A further factor complicating the diagnosis and therapy is selftreatment with antimicrobial drugs prior to professional health care, which may impede the diagnosis and increases the risk of emergence and spread of antibiotic resistance [5]
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