Article

Incidence of clinically significant bacteraemia in children who present to hospital in Kenya: Community-based observational study

Department of Paediatrics, University of Oxford, Oxford, England, United Kingdom
The Lancet (Impact Factor: 45.22). 03/2006; 367(9509):482-8. DOI: 10.1016/S0140-6736(06)68180-4
Source: PubMed

ABSTRACT

Estimates of the burden of invasive bacterial disease in sub-Saharan Africa have previously relied on selected groups of patients, such as inpatients; they are, therefore, probably underestimated, potentially hampering vaccine implementation. Our aim was to assess the incidence of bacteraemia in all children presenting to a hospital in Kenya, irrespective of clinical presentation or decision to admit.
We did a community-based observational study for which we cultured blood from 1093 children who visited a Kenyan hospital outpatient department. We estimated bacteraemia incidence with a Demographic Surveillance System, and investigated the clinical significance of bacteraemia and the capacity of clinical signs to identify cases.
The yearly incidence of bacteraemia per 100,000 children aged younger than 2 years and younger than 5 years was 2440 (95% CI 1307-3573) and 1192 (692-1693), respectively. Incidence of pneumococcal bacteraemia was 597 (416-778) per 100,000 person-years of observation in children younger than age 5 years. Three-quarters of episodes had a clinical focus or required admission, or both; one in six was fatal. After exclusion of children with occult bacteraemia, the incidence of clinically significant bacteraemia per 100,000 children younger than age 2 years or 5 years fell to 1741 (790-2692) and 909 (475-1343), respectively, and the yearly incidence of clinically significant pneumococcal bacteraemia was 436 (132-739) per 100,000 children younger than 5 years old. Clinical signs identified bacteraemia poorly.
Clinically significant bacteraemia in children in Kilifi is twice as common, and pneumococcal bacteraemia four times as common, as previously estimated. Our data support the introduction of pneumococcal vaccine in sub-Saharan Africa.

Download full-text

Full-text

Available from: Mike English, Aug 17, 2015
  • Source
    • "us ( SES ) groups ( Q1 = low SES and Q4 = high SES ) . doi : 10 . 1371 / journal . pone . 0139433 . g003 Urbanicity and Bacteraemia PLOS ONE | DOI : 10 . 1371 / journal . pone . 0139433 September 29 , 2015 8 / 11 We detected bacteraemia in 3 . 1% of febrile OPD children , a frequency similar to that in other OPD studies from sub - Saharan Africa . Brent et al . ( 2006 ) reported a rate of 2% in paedi - atric outpatients in Kenya [ 20 ] and Thriemer et al . ( 2012 ) reported a rate of 4% in outpatients of all ages in Zanzibar [ 21 ] . Yet , case numbers in our study were too small to assess effects at pathogen level apart from NTS . It remains unclear whether NTS was the main pathogen associ - ated wi"
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Systemic bacterial infections are a major cause of paediatric febrile illness in sub-Saharan Africa. Aim of this study was to assess the effects of social and geographical determinants on the risk of bacteraemia in a rural-urban transition zone in Ghana. Methods Children below 15 years of age with fever were recruited at an outpatient department in the suburban belt of Kumasi, Ghana’s second largest city. Blood was taken for bacterial culture and malaria diagnostics. The socio-economic status of participants was calculated using Principle Component Analysis. A scale, based on key urban characteristics, was established to quantify urbanicity for all communities in the hospital catchment area. A case-control analysis was conducted, where children with and without bacteraemia were cases and controls, respectively. Results Bacteraemia was detected in 72 (3.1%) of 2,306 hospital visits. Non-typhoidal Salmonella (NTS; n = 24; 33.3%) and Salmonella typhi (n = 18; 25.0%) were the most common isolates. Logistic regression analysis showed that bacteraemia was negatively associated with urbanicity (odds ratio [OR] = 0.8; 95% confidence interval [CI]: 0.7–1.0) and socio-economic status (OR = 0.8; 95% CI: 0.6–0.9). Both associations were stronger if only NTS infections were used as cases (OR = 0.5; 95% CI: 0.3–0.8 and OR = 0.6; 95% CI: 0.4–1.0, respectively). Conclusions The results of this study highlight the importance of individual as well as community factors as independent risk factors for invasive bacterial infection (IBI) and especially NTS. Epidemiological data support physicians, public health experts and policy makers to identify disease prevention and treatment needs in order to secure public health in the transitional societies of developing countries.
    Full-text · Article · Sep 2015 · PLoS ONE
  • Source
    • "This vaccination programme would thus be expected to impact upon the pneumococcal serotypes implicated in PCAP. Pathogens are difficult to identify in children with pneumonia, with blood culture and serological testing often negative due to minimal presence of bacteremia (Brent et al., 2006; Korppi et al., 2008). This paucity of S. pneumoniae isolation makes examining pneumococcal serotype distribution in PCAP difficult, with no UK, and little worldwide, data. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The 7-valent pneumococcal conjugate vaccine (PCV7) was introduced routinely in the UK from September 2006 and replaced by PCV13 in 2010. In a prospective study from 2009 to 2011 of 160 children aged ≤16 years with radiologically confirmed pneumonia, likely pneumococcal infections were identified in 26%. Detection of pneumococci was improved with polymerase chain reaction compared to culture (21.6% versus 6% of children tested, P = 0.0004). Where serotyping was possible, all (n = 23) were non-PCV7 but PCV13 serotypes; 1 (43.5%), 3 (21.7%), 7A/F, and 19A (17.4% each).
    Full-text · Article · Mar 2013 · Diagnostic microbiology and infectious disease
  • Source
    • "False-negative results are therefore possible if specimen collection is delayed. For serum specimens, no publications could be found that reported the maximum time since last dose that the antibiotic could be detected (although one validation study of plasma reported that antibiotics could be detected up to 8 hours after the last dose [43]). This is probably because most validation assays for serum specimens have focused on monitoring drug toxicity levels and thus report the shortest interval after treatment that the antibiotic can be detected (as short as 60 minutes [44]). "
    [Show abstract] [Hide abstract]
    ABSTRACT: To draw inferences about the putative etiologic agents of severe pneumonia, the Pneumonia Etiology Research for Child Health (PERCH) project must be able to objectively assess antibiotic pretreatment in enrolled participants. This review is focused on the disk diffusion bioassay, a simple laboratory method to assess recent antibiotic treatment. In this method, a sensitive indicator organism is used to detect antimicrobial activity in body fluid specimens that have been inoculated on a filter paper disk and placed on agar growth medium. We reviewed and present several variations on the disk diffusion method as applied to serum or urine, including specimen handling, choice of indicator organism and medium, and incubation steps. Although there are limitations to the disk diffusion method, its low cost, ease of use, and ability to broadly detect antibiotic pretreatment make it an appealing method for epidemiologic studies such as PERCH.
    Preview · Article · Apr 2012 · Clinical Infectious Diseases
Show more