title: Community acquired bacteremia in young children from central Nigeria--a pilot study.
abstract: BACKGROUND
  Reports of the etiology of bacteremia in children from Nigeria are sparse and have been confounded by wide spread non-prescription antibiotic use and suboptimal laboratory culture techniques. We aimed to determine causative agents and underlying predisposing conditions of bacteremia in Nigerian children using data arising during the introduction of an automated blood culture system accessed by 7 hospitals and clinics in the Abuja area.
  
  
  METHODS
  Between September 2008 and November 2009, we enrolled children with clinically suspected bacteremia at rural and urban clinical facilities in Abuja or within the Federal Capital Territory of Nigeria. Blood was cultured using an automated system with antibiotic removing device. We documented clinical features in all children and tested for prior antibiotic use in a random sample of sera from children from each site.
  
  
  RESULTS
  969 children aged 2 months-5 years were evaluated. Mean age was 21±15.2 months. All children were not systematically screened but there were 59 (6%) children with established diagnosis of sickle cell disease and 42 (4.3%) with HIV infection. Overall, 212 (20.7%) had a positive blood culture but in only 105 (10.8%) were these considered to be clinically significant. Three agents, Staphylococcus aureus (20.9%), Salmonella typhi (20.9%) and Acinetobacter (12.3%) accounted for over half of the positive cultures. Streptococcus pneumoniae and non-typhi Salmonellae each accounted for 7.6%. Although not the leading cause of bacteremia, Streptococcus pneumoniae was the single leading cause of all deaths that occurred during hospitalization and after hospital discharge.
  
  
  CONCLUSIONS
  S. typhi is a significant cause of vaccine-preventable morbidity while S. pneumoniae may be a leading cause of mortality in this setting. This observation contrasts with reports from most other African countries where non-typhi Salmonellae are predominant in young children. Expanded surveillance is required to confirm the preliminary observations from this pilot study to inform implementation of appropriate public health control measures.
authors: Michigan State University, East Lansing, MI 48824, USA. Stephen.obaro@hc.msu.edu
authors: Stephen
authors: S
authors: Obaro
authors: Lovett
authors: L
authors: Lawson
authors: Uduak
authors: U
authors: Essen
authors: Khalid
authors: K
authors: Ibrahim
authors: Kevin
authors: K
authors: Brooks
authors: Adekunle
authors: A
authors: Otuneye
authors: Denis
authors: D
authors: Shetima
authors: Patience
authors: P
authors: Ahmed
authors: Theresa
authors: T
authors: Ajose
authors: Michael
authors: M
authors: Olugbile
authors: David
authors: D
authors: Idiong
authors: Damola
authors: D
authors: Ogundeji
authors: Comfort
authors: C
authors: Ochigbo
authors: Grace
authors: G
authors: Olanipekun
authors: Walid
authors: W
authors: Khalife
authors: Richard
authors: R
authors: Adegbola
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