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Secka F, Herberg JA, Sarr I, Darboe S, Sey G, Saidykhan M, Wathuo M, Kaforou M, Antonio M, Roca A, Zaman SMA, Cebey-López M, Boeddha NP, Paulus S, Kohlfürst DS, Emonts M, Zenz W, Carrol ED, de Groot R, Schlapbach L, Martinon-Torres F, Bojang K, Levin M, van der Flier M, Anderson ST. Bacteremia in Childhood Life-Threatening Infections in Urban Gambia: EUCLIDS in West Africa. Open Forum Infect Dis 2019; 6:ofz332. [PMID: 31660408 PMCID: PMC6798247 DOI: 10.1093/ofid/ofz332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/23/2019] [Indexed: 01/13/2023] Open
Abstract
Background The limited availability of microbiology services in sub-Saharan Africa impedes accurate diagnosis of bacterial pathogens and understanding of trends in prevalence and antibiotic sensitivities. We aimed to characterize bacteremia among hospitalized children in The Gambia and to identify factors associated with bacteremia and mortality. Methods We prospectively studied children presenting with suspected severe infection to 2 urban hospitals in The Gambia, between January 2013 and September 2015. Demographic and anthropometric data, clinical features, management, and blood culture results were documented. Urine screens for antibiotic activity were performed in a subset of participants. Results Of 411 children enrolled (median age, 29 months; interquartile range, 11–82), 79.5% (325 of 409) reported prehospital antibiotic use. Antimicrobial activity by urinary screen for antibiotic activity was detected in 70.8% (n = 80 of 113). Sixty-six bacterial pathogens were identified in 65 (15.8%) participants and Staphylococcus aureus predominated. Gram-positive organisms were more commonly identified than Gram-negative (P < .01). Antibiotic resistance against first-line antimicrobials (ampicillin and gentamicin) was common among Gram-negative bacteria (39%; range, 25%–100%). Factors significantly associated with bacteremia included the following: gender, hydration status, musculoskeletal examination findings, admission to the Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine hospital, and meeting sepsis criteria. Those associated with increased mortality were presence of a comorbidity, clinical pallor, tachypnea, and altered consciousness. Tachycardia was associated with reduced mortality. Conclusions The bacteremia rate in children with suspected childhood life-threatening infectious diseases in The Gambia is high. The pattern of pathogen prevalence and antimicrobial resistance has changed over time compared with previous studies illustrating the importance of robust bacterial surveillance programs in resource-limited settings.
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Affiliation(s)
- F Secka
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
| | - J A Herberg
- Imperial College London, Section of Paediatric Infectious Disease, United Kingdom
| | - I Sarr
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
| | - S Darboe
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
| | - G Sey
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
| | - M Saidykhan
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
| | - M Wathuo
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
| | - M Kaforou
- Imperial College London, Section of Paediatric Infectious Disease, United Kingdom
| | - M Antonio
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
| | - A Roca
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
| | - S M A Zaman
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
| | - M Cebey-López
- Instituto de Investigación Sanitaria de Santiago, Genetics-Vaccines-Infectious Diseases and Paediatrics Research Group, GENVIP, Spain
| | - N P Boeddha
- Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Intensive Care and Department of Paediatric Surgery, The Netherlands
| | - S Paulus
- University of Liverpool Institute of Infection and Global Health, Department of Clinical Infection Microbiology and Immunology, United Kingdom
| | - D S Kohlfürst
- Medical University of Graz, Department of General Paediatrics, Austria
| | - M Emonts
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom.,Paediatric Infectious Diseases and Immunology Department, Newcastle upon Tyne Hospitals Foundation Trust, Great North Children's Hospital, United Kingdom
| | - W Zenz
- Medical University of Graz, Department of General Paediatrics, Austria
| | - E D Carrol
- University of Liverpool Institute of Infection and Global Health, Department of Clinical Infection Microbiology and Immunology, United Kingdom
| | - R de Groot
- Paediatric Infectious Diseases and Immunology, Amalia Children's Hospital, and Expertise Center for Immunodeficiency and Autoinflammation, and Section Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, and Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
| | - L Schlapbach
- University Children's Hospital Zurich and the Children's Research Center, Switzerland
| | - F Martinon-Torres
- Instituto de Investigación Sanitaria de Santiago, Genetics-Vaccines-Infectious Diseases and Paediatrics Research Group, GENVIP, Spain
| | - K Bojang
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
| | - M Levin
- Imperial College London, Section of Paediatric Infectious Disease, United Kingdom
| | - M van der Flier
- Paediatric Infectious Diseases and Immunology, Amalia Children's Hospital, and Expertise Center for Immunodeficiency and Autoinflammation, and Section Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, and Radboud Center for Infectious Diseases, Radboudumc, Nijmegen, the Netherlands
| | - S T Anderson
- Medical Research Council The Gambia at London School of Hygiene & Tropical Medicine, United Kingdom
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