title: A population-based study of hospital admission incidence rate and bacterial aetiology of acute lower respiratory infections in children aged less than five years in Bangladesh.
abstract: The research was carried out to study the rate of population-based hospital admissions due to acute lower respiratory infections (ALRIs) and bacterial aetiology of ALRIs in children aged less than five years in Bangladesh. A cohort of children aged less than five years in a rural surveillance population in Matlab, Bangladesh, was studied for two years. Cases were children admitted to the Matlab Hospital of ICDDR,B with a diagnosis of severe ALRIs. Bacterial aetiology was determined by blood culture. Antimicrobial resistance patterns of Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae (Spn) isolates were determined using the disc-diffusion method. In total, 18,983 children aged less than five years contributed to 24,902 child-years of observation (CYO). The incidence of ALRI-related hospital admissions was 50.2 per 1,000 CYO. The incidences of ALRI were 67% higher in males than in females and were higher in children aged less than two years than in older children. About 34% of the cases received antibiotics prior to hospitalization. Of 840 blood samples cultured, 39.4% grew a bacterial isolate; 11.3% were potential respiratory pathogens, and the rest were considered contaminants. The predominant isolates were Staphylococcus aureus (4.5%). Hib (0.4%) and Spn (0.8%) were rarely isolated; however, resistance of both these pathogens to trimethoprim-sulphamethoxazole was common. The rate of ALRI-related hospitalizations was high. The high rate of contamination, coupled with high background antibiotic use, might have contributed to an underestimation of the burden of Hib and Spn. Future studies should use more sensitive methods and more systematically look for resistance patterns of other pathogens in addition to Hib and Spn.
authors.affiliation: Johns Hopkins University Bloomberg School of Public Heath, 615 N. Wolfe St., Baltimore, MD 21205, USA. abaqui@jhsph.edu
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
authors.forename: Mahbubur
authors.initials: M
authors.lastname: Rahman
authors.forename: K
authors.initials: K
authors.lastname: Zaman
authors.forename: Shams
authors.initials: S
authors.lastname: El Arifeen
authors.forename: Hafizur Rahman
authors.initials: HR
authors.lastname: Chowdhury
authors.forename: Nazma
authors.initials: N
authors.lastname: Begum
authors.forename: Gaurav
authors.initials: G
authors.lastname: Bhattacharya
authors.forename: Rashid A
authors.initials: RA
authors.lastname: Chotani
authors.forename: Mohammad
authors.initials: M
authors.lastname: Yunus
authors.forename: Mathuram
authors.initials: M
authors.lastname: Santosham
authors.forename: Robert E
authors.initials: RE
authors.lastname: Black
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D001459:Bangladesh / Q000453:epidemiology; D002675:Child, Preschool; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial; D005260:Female; D006193:Haemophilus influenzae / Q000187:drug effects / Q000302:isolation & purification; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000382:microbiology*; D012621:Seasons; D012737:Sex Factors; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification