Infections in Children Admitted with Complicated Severe Acute Malnutrition in Niger

Anne-Laure Page,Said Aberrane,Nathalie De Rekeneire,Myrto Schaefer,Ali Djibo,Ann-Carole Janssens,Claire Rieux,Emmanuel Baron,Philippe J Guerin,Hubert Ducou-Le-Pointe,Sani Sayadi,Jean-Claude Manuguerra,Rebecca F Grais

doi:10.1371/journal.pone.0068699

Abstract

BackgroundAlthough malnutrition affects thousands of children throughout the Sahel each year and predisposes them to infections, there is little data on the etiology of infections in these populations. We present a clinical and biological characterization of infections in hospitalized children with complicated severe acute malnutrition (SAM) in Maradi, Niger.MethodsChildren with complicated SAM hospitalized in the intensive care unit of a therapeutic feeding center, with no antibiotics in the previous 7 days, were included. A clinical examination, blood, urine and stool cultures, and chest radiography were performed systematically on admission.ResultsAmong the 311 children included in the study, gastroenteritis was the most frequent clinical diagnosis on admission, followed by respiratory tract infections and malaria. Blood or urine culture was positive in 17% and 16% of cases, respectively, and 36% had abnormal chest radiography. Enterobacteria were sensitive to most antibiotics, except amoxicillin and cotrimoxazole. Twenty-nine (9%) children died, most frequently from sepsis. Clinical signs were poor indicators of infection and initial diagnoses correlated poorly with biologically or radiography-confirmed diagnoses.ConclusionsThese data confirm the high level of infections and poor correlation with clinical signs in children with complicated SAM, and provide antibiotic resistance profiles from an area with limited microbiological data. These results contribute unique data to the ongoing debate on the use and choice of broad-spectrum antibiotics as first-line treatment in children with complicated SAM and reinforce the call for an update of international guidelines on management of complicated SAM based on more recent data.

Highlights

Malnutrition plays a major role in over one-third of all child deaths worldwide [1,2]
In many regions of the world with high rates of childhood mortality and malnutrition, there is little to no diagnostic facility and the most common pathogens infecting malnourished children have barely been characterized in terms of types, prevalence, antibiotic resistance profiles or clinical presentation
Demographic, nutritional status and main diagnosis upon admission in the study population did not differ from the general population admitted to the intensive therapeutic feeding center (ITFC) during the study period (Table S1, Figure 1, Table 1)

Summary

Introduction

Malnutrition plays a major role in over one-third of all child deaths worldwide [1,2]. In many regions of the world with high rates of childhood mortality and malnutrition, there is little to no diagnostic facility and the most common pathogens infecting malnourished children have barely been characterized in terms of types, prevalence, antibiotic resistance profiles or clinical presentation. Case management is empiric, following World Health Organization (WHO) guidelines developed over 10 years ago based on limited data [4,5]. In these guidelines, routine oral cotrimoxazole is recommended for children admitted with uncomplicated severe acute malnutrition (SAM), amoxicillin is often preferred. We present a clinical and biological characterization of infections in hospitalized children with complicated severe acute malnutrition (SAM) in Maradi, Niger

Methods

Results

Conclusion