title: Prevalence of community-acquired bacteraemia in Guinea-Bissau: an observational study.
abstract: BACKGROUND
  The burden of bloodstream infections is insufficiently studied in children in Africa and many healthcare facilities lack the capacity to identify invasive disease. Often studies have been limited to febrile patients or patients admitted to hospital.
  
  
  METHODS
  Blood cultures and malaria diagnostics was performed on 372 consecutive children presenting with tachycardia and/or fever to a referral paediatric emergency department in Bissau, Guinea-Bissau. Bacterial species detection, antimicrobial susceptibility testing and molecular typing were performed. The capacity of clinical parameters to identify bacteraemia was evaluated.
  
  
  RESULTS
  The prevalence of bloodstream infection was 12% (46/372) and in 46% (21/46) of the infections the child was non-febrile at presentation to the hospital. The predictive value for bacteraemia was poor for all assessed clinical parameters. Staphylococcus aureus accounted for 54% (26/48) of the isolates followed by non-typhoidal Salmonella, 10% (5/48), Streptococcus pneumoniae, 8% (4/48), and Salmonella Typhi, 6% (3/48). Among S. aureus there was a large diversity of spa types and 38% produced Pantone-Valentine leukocidin. Antibiotic resistance was low, however two out of three Klebsiella pneumoniae isolates produced extended-spectrum beta-lactamases. Malaria was laboratory confirmed in only 5% of the children but 64% (237/372) received a clinical malaria diagnosis.
  
  
  CONCLUSIONS
  Bacteraemia was common irrespective of the presence of fever among children presenting to the hospital. The high prevalence of Staphylococcus aureus may be due to contamination. There is an imminent need to improve microbiological diagnostic facilities and to identify algorithms that can identify children at risk of bloodstream infections in Africa.
authors.affiliation: Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden. joakim.isendahl@ki.se.|Department of Medicine Solna, Unit of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden. joakim.isendahl@ki.se.
authors.forename: Joakim
authors.initials: J
authors.lastname: Isendahl
authors.affiliation: Department of Paediatrics, Hospital Nacional Simão Mendes, Bissau, Guinea-Bissau. cristo_manjuba2000@yahoo.com.br.
authors.forename: Cristovão
authors.initials: C
authors.lastname: Manjuba
authors.affiliation: Bandim Health Project, Bissau, Guinea-Bissau. amabelia.rodrigues@bandim.org.
authors.forename: Amabelia
authors.initials: A
authors.lastname: Rodrigues
authors.affiliation: Department of Medicine Solna, Unit of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden. weiping.xu@ki.se.
authors.forename: Weiping
authors.initials: W
authors.lastname: Xu
authors.affiliation: Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden. birgitta.henriques@ki.se.|Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden. birgitta.henriques@ki.se.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Henriques-Normark
authors.affiliation: Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden. christian.giske@karolinska.se.|Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden. christian.giske@karolinska.se.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Giske
authors.affiliation: Department of Medicine Solna, Unit of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden. pontus.naucler@ki.se.|Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden. pontus.naucler@ki.se.
authors.forename: Pontus
authors.initials: P
authors.lastname: Nauclér
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D006169:Guinea-Bissau / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008288:Malaria / Q000453:epidemiology*; D008297:Male; D017720:Molecular Epidemiology; D011008:Pneumococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D015995:Prevalence; D012485:Salmonella typhi / Q000187:drug effects / Q000302:isolation & purification / Q000502:physiology; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification / Q000502:physiology; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000302:isolation & purification / Q000502:physiology; D014435:Typhoid Fever / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents