Bacteraemia among severely malnourished children infected and uninfected with the human immunodeficiency virus-1 in Kampala, Uganda.
BACKGROUND
To establish the magnitude of bacteraemia in severely malnourished children, and describe the types of bacteria and antimicrobial sensitivity by HIV status.


METHODS
Isolates were recovered from 76 blood specimens. Antibiotic susceptibility tests were performed using commercial antibiotic disks and demographic and clinical findings were recorded.


RESULTS
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 (> or = 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).


CONCLUSIONS
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.
Bachou
Hanifa
H
Department of Paediatrics and Child Health Makerere University Medical School P O Box 7072, Kampala Uganda. hanifa.bachou@student.uib.no
Tylleskär
Thorkild
T
Kaddu-Mulindwa
Deogratias H
DH
Tumwine
James K
JK
D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D015362:Child Nutrition Disorders / Q000150:complications* / Q000401:mortality; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000401:mortality / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D014454:Uganda
D000900:Anti-Bacterial Agents