title: Bacteraemia among severely malnourished children infected and uninfected with the human immunodeficiency virus-1 in Kampala, Uganda.
abstract: 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.
authors.affiliation: Department of Paediatrics and Child Health Makerere University Medical School P O Box 7072, Kampala Uganda. hanifa.bachou@student.uib.no
authors.forename: Hanifa
authors.initials: H
authors.lastname: Bachou
authors.forename: Thorkild
authors.initials: T
authors.lastname: Tylleskär
authors.forename: Deogratias H
authors.initials: DH
authors.lastname: Kaddu-Mulindwa
authors.forename: James K
authors.initials: JK
authors.lastname: Tumwine
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents