The prevalence of bacteraemia in the severely malnourished children aged 2 to 59 months at Mbagathi district hospital Nairobi.

Abstract

Introduction: Severe malnutrition is a common cause of preventable morbidity and mortality among children aged 5 years in developing countries. The prevalence of bacteraemia, urinary tract infection, diarrhea and pneumonia among children with severe malnutrition is high. These, coupled with an atypical clinical presentation of sepsis, justify the routine use of empirical antibiotic treatment in the initial phase of inpatient management of SAM children1 2 .The choice of antibiotics should be guided by locally prevalent pathogens and their antibiotic susceptibility patterns. Objectives: The broad objective of this study was to determine the prevalence of bacteraemia in SAM children at Mbagathi District Hospital and its association with the history and physical examination characteristics of the enrolled children. The primary objectives of the study were: • To determine the blood bacterial isolates in SAM children in Mbagathi District Hospital. • To determine the sensitivities of the bacterial isolates to the WHO recommended antibiotics among SAM children in Mbagathi District Hospital. The secondary objective was: • To determine the association of clinical history and examination findings in the bacteraemic and non bacteraemic SAM children. Design: The study was a hospital based cross-sectional survey conducted at Mbagathi District Hospital over a period of 3 months. Subjects and setting: A probability sampling was used to recruit 2 to 59 months’ old children with SAM in the out-patient pediatric filter clinic and the wards at Mbagathi District Hospital. Main outcome measures: Blood bacterial isolates by blood culture and their antibiotic sensitivities to WHO recommended antibiotics by disc diffusion method. Sample size: Using Fishers formula for prevalence studies gave a sample size of 88 children. Study procedure: Socio- demographic characteristics, clinical history, physical examination findings and anthropometric measurements of the study subjects were taken. In subjects who met inclusion criteria, 3mls of venous blood was aseptically drawn and taken within two hours to KEMRI laboratory for culture and sensitivity testing. Data management: Data obtained was coded and entered in a preformed Excel data sheet and analyzed using social sciences statistical package version 18 Results: A total of 90 children seen at Mbagathi District Hospital with severe acute malnutrition were included in this study. The mean age of patients with SAM was 16 months, (SD=8.0) and the age range was 5 to48 months. The presenting features were as follows: Acute diarrhea 40(44.4%), chronic diarrhea 6(6.7%), vomiting everything 31(34.4%), acute cough 19(21.1%), chronic cough 3(3.3%), ability to drink 59(65.6%) fever 56 (62.2%). The total number of enrolled children was 90. 88(97.7%) were severely malnourished, with weight for height < -3SD the median, and 2(2.2%) were very severely malnourished with a WHO Z score weight for height < -4SD the median. The overall prevalence of bacteraemia was 30 %( 27) with S. aureus accounting for 21.1 %( 19); S. typhi 4.4 %( 4); S. epidermidis 3.3 %( 3) and E. fecalis 1.1 % (1). There was no difference in the occurrence of bacteraemia between the male and female gender, (p=0.679) and the various age ranges of the severely malnourished children studied (p=0.853). With regard to bacteraemia and clinical history, children with diarrhea and vomiting were more likely to have bacteraemia with p=0.008 and p=0.05 respectively. The physical examination characteristic associated with bacteraemia was the presence of skin lesions with p=0.008 .In the multivariate analysis the independent risk factors for bacteraemia were acute diarrhea (OR = 5.63; 95% CI 1.3-24.45), oedema (OR = 5.92; 95% CI 1.81-19.37) and skin lesions (OR = 5.08; 95% CI 1.54-16.69). The antibiotic sensitivity profile of the bacterial isolate was as follows; ampicillin and cotrimoxazole showed resistance (resistance to ampicillin ranged from 94.7% to 100% while to cotrimoxazole it was between 63.2% and 100%). Most of the isolates were sensitive to amoxicillin (77.7%), gentamycin, (74%) and chloramphenical (81.4%). Conclusion The prevalence of bacteremia in SAM children in Mbagathi District Hospital was 30%.It was associated with diarrhea, oedema and skin lesions. The isolates were generally sensitive to amoxicillin, gentamycin, and chloramphenical. They showed varying resistance to ampicillin and cotrimoxazole.