title: Bloodstream bacterial infection among outpatient children with acute febrile illness in north-eastern Tanzania.
abstract: BACKGROUND
  Fever is a common clinical symptom in children attending hospital outpatient clinics in rural Tanzania, yet there is still a paucity of data on the burden of bloodstream bacterial infection among these patients.
  
  
  METHODS
  The present study was conducted at Korogwe District Hospital in north-eastern Tanzania. Patients aged between 2 and 59 months with a history of fever or measured axillary temperature ≥37.5°C attending the outpatient clinic were screened for enrolment into the study. Blood culturing was performed using the BACTEC 9050® system. A biochemical analytical profile index and serological tests were used for identification and confirmation of bacterial isolates. In-vitro antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method. The identification of Plasmodium falciparum malaria was performed by microscopy with Giemsa stained blood films.
  
  
  RESULTS
  A total of 808 blood cultures were collected between January and October 2013. Bacterial growth was observed in 62/808 (7.7%) of the cultured samples. Pathogenic bacteria were identified in 26/808 (3.2%) cultures and the remaining 36/62 (58.1%) were classified as contaminants. Salmonella typhi was the predominant bacterial isolate detected in 17/26 (65.4%) patients of which 16/17 (94.1%) were from patients above 12 months of age. Streptococcus pneumoniae was the second leading bacterial isolate detected in 4/26 (15.4%) patients. A high proportion of S. typhi 11/17 (64.7%) was isolated during the rainy season. S. typhi isolates were susceptible to ciprofloxacin (n = 17/17, 100%) and ceftriaxone (n = 13/17, 76.5%) but resistant to chloramphenicol (n = 15/17, 88.2%). P. falciparum malaria was identified in 69/808 (8.5%) patients, none of whom had bacterial infection.
  
  
  CONCLUSIONS
  Bloodstream bacterial infection was not found to be a common cause of fever in outpatient children; and S. typhi was the predominant isolate. This study highlights the need for rational use of antimicrobial prescription in febrile paediatric outpatients presenting at healthcare facilities in rural Tanzania.
authors.affiliation: Korogwe Research Laboratory, Tanga Centre, National Institute for Medical Research, P. O. Box 5004, Tanga, Tanzania. cbdmahende@yahoo.co.uk.|Department of Medical Entomology and Parasitology, School of Public Health, Muhimbili University of Health and Allied Sciences, P. O. Box 65001, Dar es Salaam, Tanzania. cbdmahende@yahoo.co.uk.
authors.forename: Coline
authors.initials: C
authors.lastname: Mahende
authors.affiliation: Department of Medical Entomology and Parasitology, School of Public Health, Muhimbili University of Health and Allied Sciences, P. O. Box 65001, Dar es Salaam, Tanzania. bngasala70@yahoo.co.uk.
authors.forename: Billy
authors.initials: B
authors.lastname: Ngasala
authors.affiliation: Korogwe Research Laboratory, Tanga Centre, National Institute for Medical Research, P. O. Box 5004, Tanga, Tanzania. jpalusingu@yahoo.co.uk.|Department of International Health, Microbiology and Immunology, University of Copenhagen, Copenhagen, Denmark. jpalusingu@yahoo.co.uk.
authors.forename: John
authors.initials: J
authors.lastname: Lusingu
authors.affiliation: Korogwe Research Laboratory, Tanga Centre, National Institute for Medical Research, P. O. Box 5004, Tanga, Tanzania. albutichi@gmail.com.
authors.forename: Allvan
authors.initials: A
authors.lastname: Butichi
authors.affiliation: Korogwe Research Laboratory, Tanga Centre, National Institute for Medical Research, P. O. Box 5004, Tanga, Tanzania. plushino@yahoo.com.
authors.forename: Paminus
authors.initials: P
authors.lastname: Lushino
authors.affiliation: Korogwe Research Laboratory, Tanga Centre, National Institute for Medical Research, P. O. Box 5004, Tanga, Tanzania. marthalemnge@yahoo.com.
authors.forename: Martha
authors.initials: M
authors.lastname: Lemnge
authors.affiliation: Korogwe Research Laboratory, Tanga Centre, National Institute for Medical Research, P. O. Box 5004, Tanga, Tanzania. b.mmbando@yahoo.com.
authors.forename: Bruno
authors.initials: B
authors.lastname: Mmbando
authors.affiliation: Department of Medical Entomology and Parasitology, School of Public Health, Muhimbili University of Health and Allied Sciences, P. O. Box 65001, Dar es Salaam, Tanzania. zulpremji688@gmail.com.
authors.forename: Zul
authors.initials: Z
authors.lastname: Premji
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D002443:Ceftriaxone / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D002701:Chloramphenicol / Q000494:pharmacology; D002939:Ciprofloxacin / Q000494:pharmacology; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016778:Malaria, Falciparum / Q000175:diagnosis / Q000453:epidemiology* / Q000469:parasitology; D008297:Male; D008826:Microbial Sensitivity Tests; D008853:Microscopy; D010045:Outpatients; D010963:Plasmodium falciparum / Q000254:growth & development / Q000302:isolation & purification; D011018:Pneumonia, Pneumococcal / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D012424:Rural Population; D012485:Salmonella typhi / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D013296:Streptococcus pneumoniae / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D013636:Tanzania / Q000453:epidemiology; D014435:Typhoid Fever / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D002701:Chloramphenicol; D002443:Ceftriaxone