Coagulase-negative staphylococcal bacteremia in severely malnourished Jamaican children.
Immunosuppression increases the susceptibility to infection and changes the inflammatory response in children with severe protein-energy malnutrition. In this 5-year prospective study bacteremia was documented in 16% of 336 severely malnourished children, 2 to 34 months of age, who were hospitalized consecutively in the Tropical Metabolism Research Unit, Kingston, Jamaica. The 53 children had 60 episodes of nosocomial and community-acquired bacteremia with 69 blood isolates. Community-acquired bacteremia accounted for 72% (43 of 60) of bacteremic episodes. Thirty-five percent (24 of 69) of the strains were coagulase-negative staphylococci, 19% (13 of 69) were Staphylococcus aureus and 11% (8 of 69) were Streptococcus Group D. Seventeen episodes of coagulase-negative staphylococcal bacteremia were acquired in the community and 7 were nosocomial. These patients were more likely to have pneumonic consolidation than children with all other bacteremias combined (P < 0.02, Fisher's exact test). The bacteremia-related case fatality rate was 8% (5 of 60). Polymicrobial and Gram-negative septicemia were independent positive predictive factors for mortality when compared with single-agent and Gram-positive sepsis (P < 0.02). This 71% (49 of 69) prevalence of Gram-positive organisms suggests a change in the epidemiology from the predominant Gram-negative etiologies (76%) described in previous reports.
Christie
C D
CD
Tropical Metabolism Research Unit, University Hospital of the West Indies, Kingston, Jamaica.
Heikens
G T
GT
Golden
M H
MH
D016470:Bacteremia / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology*; D002675:Child, Preschool; D003030:Coagulase; D005260:Female; D006801:Humans; D007223:Infant; D007563:Jamaica / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000150:complications* / Q000453:epidemiology; D013203:Staphylococcal Infections / Q000150:complications*
D003030:Coagulase