Background
The limited availability of microbiology services in sub-Saharan Africa impedes accurate diagno-sis of bacterial pathogens and understanding of trends in prevalence and antibiotic sensitivities. We aimed to characterize bacteremia amongst hospitalized children in The Gambia and to identi-fy factors associated with bacteremia and mortality.
Methods
We prospectively studied children presenting with suspected severe infection to two urban hos-pitals in The Gambia, between January 2013 and September 2015. Demographic and anthropo-metric data, clinical features, management and blood culture results were documented. Urine screens for antibiotic activity were performed in a subset of participants.
Results
Of 411 children enrolled (median age 29 months; IQR: 11-82), 79.5% (325/409) reported pre-hospital antibiotic use. Antimicrobial activity by urinary screen for antibiotic activity was detected in 70.8% (n=80/113). 66 bacterial pathogens were identified in 65 (15.8%) participants and Staphylococcus aureus predominated. Gram positive organisms were more commonly identified than Gram-negative (p<0.01). Antibiotic resistance against first-line antimicrobials (ampicillin and gentamicin) was common among Gram-negative bacteria (39%; range 25-100%). Factors signif-icantly associated with bacteremia included: gender, hydration status, musculoskeletal examina-tion findings, admission to the MRCG-LSHTM hospital, and meeting sepsis criteria. Those asso-ciated with increased mortality were presence of a comorbidity, clinical pallor, tachypnoea and altered consciousness. Tachycardia was associated with reduced mortality.
Conclusions
The bacteremia rate in children with suspected childhood life-threatening infectious diseases in The Gambia is high. The pattern of pathogen prevalence and antimicrobial resistance has changed over time compared to previous studies illustrating the importance of robust bacterial surveillance programs in resource-limited settings.