Incidence and Characteristics of Bacteremia among Children in Rural Ghana
Incidence and Characteristics of Bacteremia among Children in Rural Ghana
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DOI：
10.1371/journal.pone.0044063
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发表时间：
2012-09-10
期刊：
影响因子：
3.7
通讯作者：
Schwarz, Norbert Georg
中科院分区：
文献类型：
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作者：
Nielsen, Maja Verena;Sarpong, Nimako;Schwarz, Norbert Georg
这项研究的目的是描述加纳农村地区急性疾病和住院儿童中发生的系统性细菌感染的频率、发病率、药物敏感性模式以及与人体测量学数据的关系。对2007年9月至2009年7月间在加纳阿桑特地区Agogo长老会医院(APH)住院的所有5岁以下儿童进行血液培养。入院时使用标准化问卷评估病史和人体测量学数据。发病率是在考虑了针对村依赖健康寻求行为进行调整的覆盖人群后计算的。在1196名住院儿童中，血培养阳性238例，占19.9%。最常见的4种病原菌是非伤寒沙门氏菌(53.3%；n=129)、金黄色葡萄球菌(13.2%；n=32)、肺炎链球菌(9.1%；n=22)和沙门氏菌。伤寒杆菌(7.0%；n=17)。菌血症年累计发病率为46.6例/1000(CI 40.9~52.2)。在四种最常见的菌株中，年累积发病率分别为25.2(CI 21.1-29.4)、6.3(CI 4.1-8.4)、4.3(CI 2.5-6.1)和3.3(CI 1.8-4.9)。泰菲。消瘦与菌血症和全身NTS血流感染呈正相关。大于3个月的儿童比年龄更小的儿童更容易出现NTS菌血症。NTS和沙门氏菌的感染率分别为98%和100%。伤寒分离株对环丙沙星敏感，而两株伤寒杆菌对头孢曲松均100%敏感。77%的NTS和65%的沙门氏菌。伤寒杆菌耐多药(MDR)。近20%住院儿童的全身性细菌感染突出了微生物诊断的必要性，以指导有针对性的抗菌治疗和预防菌血症。如果缺乏微生物学诊断，应考虑对疟疾流行地区的重病儿童进行计算的抗微生物治疗。
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.