Community-acquired bacteremia among children admitted to a rural hospital in Mozambique.
BACKGROUND
Although community-acquired bacteremia is an important cause of childhood mortality in Africa, recognition of disease burden and potential impact of bacterial vaccines is limited.


METHODS
Blood cultures for bacterial pathogens were conducted systematically among children <15 years of age admitted to Manhiça District Hospital, from 2001 to 2006.


RESULTS
Blood-stream infections were identified in 8% (1550/19,896) of pediatric hospital admissions. Nontyphoidal Salmonella (NTS) and Pneumococcus were the most prevalent pathogens isolated (26% and 25% of 1550 cases, respectively). Until 28 days of life, Staphylococcus aureus (39%) and group B Streptococcus (20%) predominated. Incidence of community-acquired bacteremia per 100,000 child-years was 1730/10 in children <1 year old, 782/10 in 1-4 year oldd, and 49/10 in children 5 years and older. Case-fatality of bacteremia was 12%. Community-acquired bacteremia associated mortality accounted for 21% (162/788) of hospital deaths. Resistance to antibiotics commonly used in Mozambique was high among invasive isolates of Haemophilus influenzae, Escherichia coli, and NTS.


CONCLUSIONS
Community-acquired bacteremia is an important cause of pediatric hospital admission and death in rural African hospitals. The high burden of disease, mortality, and pattern of antibiotic resistance associated with bacteremia underscore the need for prevention in Sub-Saharan Africa.
Sigaúque
Betuel
B
Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique. betuel.sigauque@manhica.net
Roca
Anna
A
Mandomando
Inácio
I
Morais
Luís
L
Quintó
Llorenç
L
Sacarlal
Jahit
J
Macete
Eusébio
E
Nhamposa
Tacilta
T
Machevo
Sónia
S
Aide
Pedro
P
Bassat
Quique
Q
Bardají
Azucena
A
Nhalungo
Delino
D
Soriano-Gabarró
Montse
M
Flannery
Brendan
B
Menendez
Clara
C
Levine
Myron M
MM
Alonso
Pedro L
PL
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000150:complications / Q000453:epidemiology*; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D002648:Child; D015362:Child Nutrition Disorders / Q000150:complications / Q000453:epidemiology; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000150:complications / Q000453:epidemiology; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D012424:Rural Population
D000900:Anti-Bacterial Agents