Bacteraemia among severely malnourished children infected and uninfected with the human immunodeficiency virus-1 in Kampala, Uganda.
Bacteraemia among severely malnourished children infected and uninfected with the human immunodeficiency virus-1 in Kampala, Uganda.
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乌干达坎帕拉的人类免疫缺陷病毒1感染和未感染的严重营养不良儿童中的菌血症。
DOI：
10.1186/1471-2334-6-160
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发表时间：
2006-11-07
影响因子：
3.7
通讯作者：
Tumwine, James K.
中科院分区：
文献类型：
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作者：
Bachou, Hanifa;Tylleskar, Thorkild;Kaddu-Mulindwa, Deogratias H.;Tumwine, James K.
确定严重营养不良儿童菌血症的严重程度，并根据HIV感染状况描述细菌类型和抗菌药物敏感性。从76份血液标本中回收了分离株。使用商业抗生素盘进行抗生素敏感性试验，并记录人口统计学和临床结果。在450名儿童中，63%为男性;中位年龄为17.0个月（四分位数间距，IQR 12-24），57%有水肿。411例检测的HIV阳性中有151例（36.7%）; 445例血液标本中有76例（17.1%）生长细菌分离株; 58%为革兰氏阴性- S。鼠伤寒沙门氏菌（27.6%）和沙门氏菌（27.6%）。尿道炎（11.8%）。葡萄球菌金黄色葡萄球菌（26.3%）和链球菌（26.3%）。革兰阳性菌主要为肺炎克雷伯菌（13.2%）。除了口腔鹅口疮（OR 2.3 CI 1.0-5.1）和低白蛋白血症（OR 3.5 CI 1.0-12.1）外，不同HIV状态、年龄< 24个月、男性或水肿的菌血症风险无差异。来自严重免疫抑制儿童（CD4% <15%）的分离株更可能生长沙门氏菌（OR 5.4; CI 1.6 - 17.4）。对环丙沙星、头孢曲松、庆大霉素敏感率≥ 80%，对氯霉素、氨苄西林、复方新诺明敏感率< 50%，对复方新诺明敏感率<25%。怀疑菌血症的敏感性为95.9%，特异性为99.2%。在菌血症儿童中，HIV阳性儿童的死亡率较高（43.5%vs 20.5%）; OR 3.0（95%CI 1.0，8.6）。每6名严重营养不良的儿童中就有1名患有菌血症，死亡率很高，特别是在艾滋病毒抗体阳性的儿童中。鉴于对常见抗生素的高度耐药性，需要进行临床试验，以确定管理严重营养不良儿童菌血症的最佳抗生素组合。
To establish the magnitude of bacteraemia in severely malnourished children, and describe the types of bacteria and antimicrobial sensitivity by HIV status. Isolates were recovered from 76 blood specimens. Antibiotic susceptibility tests were performed using commercial antibiotic disks and demographic and clinical findings were recorded. Of the 450 children 63% were male; median age 17.0 months (inter quartile range, IQR 12–24) and 57% had oedema. 151 (36.7 %) of 411 tested HIV-positive; 76 (17.1%) of 445 blood specimens grew bacterial isolates; 58% were Gram negative – S. typhimurium (27.6%) and S. enteriditis (11.8%). Staph. aureus (26.3%) and Strep. pneumoniae (13.2%) were the main Gram positive organisms. There was no difference in the risk of bacteraemia by HIV status, age < 24 months, male sex, or oedema, except for oral thrush (OR 2.3 CI 1.0–5.1) and hypoalbuminaemia (OR 3.5 CI 1.0–12.1). Isolates from severely immuno-suppressed children (CD4% <15%) were more likely to grow Salmonella enteriditis (OR 5.4; CI 1.6 – 17.4). The isolates were susceptible (≥ 80%) to ciprofloxacin, ceftriaxone and gentamicin; with low susceptibility to chlorampenicol, ampicillin (< 50%) and co-trimoxazole (<25%). Suspicion of bacteraemia had 95.9% sensitivity and 99.2% specificity. Among bacteraemic children, mortality was higher (43.5% vs 20.5%) in the HIV-positive; OR 3.0 (95%CI 1.0, 8.6). Bacteraemia affects 1 in every 6 severely malnourished children and carries high mortality especially among the HIV-positive. Given the high level of resistance to common antibiotics, there is need for clinical trials to determine the best combinations of antibiotics for management of bacteraemia in severely malnourished children.
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DOI：
10.1016/s1201-9712(01)90067-0
发表时间：
2001-01-01
期刊：
International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases
影响因子：
--
作者：
Bahwere, P;Levy, J;De Mol, P
通讯作者：
De Mol, P
影响因子：
--
作者：
Reed, RP;Wegerhoff, FO;Rothberg, AD
通讯作者：
Rothberg, AD
影响因子：
3
作者：
Kariuki, S;Revathi, G;Hart, CA
通讯作者：
Hart, CA
影响因子：
2
作者：
Nimri, LF;Rawashdeh, M;Meqdam, MM
通讯作者：
Meqdam, MM
影响因子：
158.5
作者：
Berkley, JA;Lowe, BS;Scott, JAG
通讯作者：
Scott, JAG