Bacteremia among children admitted to a rural hospital in Kenya
Bacteremia among children admitted to a rural hospital in Kenya
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DOI：
10.1056/nejmoa040275
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发表时间：
2005-01-06
影响因子：
158.5
通讯作者：
Scott, JAG
中科院分区：
文献类型：
--
作者：
Berkley, JA;Lowe, BS;Scott, JAG
背景：关于撒哈拉以南非洲儿童侵袭性细菌感染的流行病学数据很少。我们研究了每一个急性儿科入院肯尼亚农村地区医院检查的患病率，发病率，类型和社区获得性bacteremia.METHODS结果：1998年8月至2002年7月，我们培养的血液从19,339住院患者入院，并计算bacteremia的发病率的基础上的人口由hospital.RESULTS：在总共1783名婴儿谁是60天以下的年龄，228有菌血症（12.8%），因为866 14,787名儿童谁是60天或以上的年龄（5.9%）。在60天以下的婴儿中，大肠杆菌和B组链球菌在广泛的分离株中占主导地位（分别为14%和11%）。在60天或以上的婴儿中，肺炎链球菌、非伤寒沙门氏菌、流感嗜血杆菌和E。大肠埃希菌占70%以上。社区获得性菌血症的最低年发病率估计为1岁以下婴儿每10万儿童1457例，2岁以下儿童1080例，5岁以下儿童505例。在所有住院死亡病例中，26%为社区获得性菌血症儿童。在308例菌血症儿童死亡中，103例（33.4%）发生在入院当天，217例（70.5%）发生在两天内。结论：社区获得性菌血症是撒哈拉以南地区农村医院儿童死亡的主要原因，这一发现突出了预防和克服广泛使用现有细菌性疾病疫苗的政治和经济障碍的必要性。
BACKGROUND:There are few epidemiologic data on invasive bacterial infections among children in sub-Saharan Africa. We studied every acute pediatric admission to a rural district hospital in Kenya to examine the prevalence, incidence, types, and outcome of community-acquired bacteremia.METHODS:Between August 1998 and July 2002, we cultured blood on admission from 19,339 inpatients and calculated the incidence of bacteremia on the basis of the population served by the hospital.RESULTS:Of a total of 1783 infants who were under 60 days old, 228 had bacteremia (12.8 percent), as did 866 of 14,787 children who were 60 or more days of age (5.9 percent). Among infants who were under 60 days old, Escherichia coli and group B streptococci predominated among a broad range of isolates (14 percent and 11 percent, respectively). Among infants who were 60 or more days of age, Streptococcus pneumoniae, nontyphoidal salmonella species, Haemophilus influenzae, and E. coli accounted for more than 70 percent of isolates. The minimal annual incidence of community-acquired bacteremia was estimated at 1457 cases per 100,000 children among infants under a year old, 1080 among children under 2 years, and 505 among children under 5 years. Of all in-hospital deaths, 26 percent were in children with community-acquired bacteremia. Of 308 deaths in children with bacteremia, 103 (33.4 percent) occurred on the day of admission and 217 (70.5 percent) within two days.CONCLUSIONS:Community-acquired bacteremia is a major cause of death among children at a rural sub-Saharan district hospital, a finding that highlights the need for prevention and for overcoming the political and financial barriers to widespread use of existing vaccines for bacterial diseases.