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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Antimicrobial resistance predicts death in Tanzanian children with bloodstream infections: A prospective cohort study
BMC Infectious Diseases, Volume 7, Article 43, Year 2007
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Description
Background: Bloodstream infection is a common cause of hospitalization, morbidity and death in children. The impact of antimicrobial resistance and HIV infection on outcome is not firmly established. Methods: We assessed the incidence of bloodstream infection and risk factors for fatal outcome in a prospective cohort study of 1828 consecutive admissions of children aged zero to seven years with signs of systemic infection. Blood was obtained for culture, malaria microscopy, HIV antibody test and, when necessary, HIV PCR. We recorded data on clinical features, underlying diseases, antimicrobial drug use and patients' outcome. Results: The incidence of laboratory-confirmed bloodstream infection was 13.9% (255/1828) of admissions, despite two thirds of the study population having received antimicrobial therapy prior to blood culture. The most frequent isolates were klebsiella, salmonellae, Escherichia coli, enterococci and Staphylococcus aureus. Furthermore, 21.6% had malaria and 16.8% HIV infection. One third (34.9%) of the children with laboratory-confirmed bloodstream infection died. The mortality rate from Gram-negative bloodstream infection (43.5%) was more than double that of malaria (20.2%) and Gram-positive bloodstream infection (16.7%). Significant risk factors for death by logistic regression modeling were inappropriate treatment due to antimicrobial resistance, HIV infection, other underlying infectious diseases, malnutrition and bloodstream infection caused by Enterobacteriaceae, other Gram-negatives and candida. Conclusion: Bloodstream infection was less common than malaria, but caused more deaths. The frequent use of antimicrobials prior to blood culture may have hampered the detection of organisms susceptible to commonly used antimicrobials, including pneumococci, and thus the study probably underestimates the incidence of bloodstream infection. The finding that antimicrobial resistance, HIV-infection and malnutrition predict fatal outcome calls for renewed efforts to curb the further emergence of resistance, improve HIV care and nutrition for children. © 2007 Blomberg et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Blomberg, Bjørn
Norway, Bergen
Haukeland Universitetssjukehus
Norway, Bergen
Universitetet I Bergen
Manji, Karim Premji
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Urassa, Willy K.
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Tamim, Bushir S.
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Mwakagile, Davis S.M.
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Jureen, Roland
Norway, Bergen
Haukeland Universitetssjukehus
Singapore, Singapore City
Alexandra Hospital, Singapore
Msangi, Viola
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Tellevik, Marit Gjerde
Norway, Bergen
Haukeland Universitetssjukehus
Norway, Bergen
Universitetet I Bergen
Holberg-Petersen, Mona
Norway, Oslo
Ulleval University Hospital
Norway, Oslo
Medisinske Fakultet
Harthug, Stig
Norway, Bergen
Haukeland Universitetssjukehus
Norway, Bergen
Universitetet I Bergen
Maselle, Samuel Y.M.
Tanzania, Dar es Salaam
Muhimbili University of Health and Allied Sciences
Langeland, Nina
Norway, Bergen
Haukeland Universitetssjukehus
Norway, Bergen
Universitetet I Bergen
Statistics
Citations: 17
Authors: 12
Affiliations: 6
Identifiers
Doi:
10.1186/1471-2334-7-46
e-ISSN:
14712334
Research Areas
Food Security
Infectious Diseases
Maternal And Child Health
Study Design
Cross Sectional Study
Cohort Study
Study Approach
Quantitative