Noorani N, Macharia W M, Oyatsi D, Revathi G
Kenyatta National Hospital, Nairobi, Kenya.
East Afr Med J. 2005 Jul;82(7):343-8.
To identify bacterial isolates and determine antibiotic sensitivity pattern in children with severe Protein Energy Malnutrition (PEM) presenting at the Paediatric Filter Clinic (PFC) of Kenyatta National Hospital (KNH).
Hospital based cross-sectional survey.
Paediatric Filter Clinic of Kenyatta National Hospital (KNH), a tertiary level teaching institution for the University of Nairobi, Kenya.
Children between two and sixty months presenting at the hospital outpatient filter clinic with severe malnutrition.
Ninety-one children, forty six female and forty five males, were recruited for the study. Of these, sixty had Marasmus, twenty Kwashiorkor and eleven Marasmic-Kwashiorkor. HIV serology was positive in 43% of study subjects. There were 30 bacterial isolates from 26 subjects. Ten bacterial isolates were gram positive and twenty gram negative. Isolation rates did not vary by HIV serological status. Twenty one out of the 30 isolates were from blood culture. About 1/3 of the gram positive isolates were coagulase negative staphylococci, largely resistant to commonly used antibiotics such as Erythromycin, Ampicillin, Cotrimoxazole, Chloramphenicol and even Oxacillin. More than half demonstrated resistance to commonly used oral antibiotics while 80% of all gram positive and negative isolates were sensitive to Ciprofloxacin. Aminoglycosides, Gentamicin and Amikacin, and third generation Cephalosporins, Ceftriaxone and Ceftazidime, were found to be effective against most gram-negative isolates.
Nearly a third (28.9%) of children admitted with severe malnutrition at KNH have concomitant severe bacterial infections; primarily manifesting as bacteraemia. Gram-negative agents are responsible for most severe bacterial infections in children admitted at the KNH, regardless of their HIV serological status. Whenever possible, blood culture should be included in the initial septic screening of severely malnourished children at KNH. In the absence of culture and sensitivity information, ciprofloxacin should be considered among the first line options in the empirical treatment of severe bacterial infections among these children. Clinical trials to further evaluate in-vivo effectiveness of various single or combination antibiotics are recommended.
鉴定肯尼亚肯雅塔国家医院（KNH）儿科筛查门诊（PFC）中患有重度蛋白质能量营养不良（PEM）儿童的细菌分离株，并确定其抗生素敏感性模式。
基于医院的横断面调查。
肯尼亚内罗毕大学的三级教学机构肯雅塔国家医院儿科筛查门诊（KNH）。
在医院门诊筛查门诊就诊的2至60个月大的重度营养不良儿童。
91名儿童被纳入研究，其中46名女性，45名男性。其中，60名患有消瘦型营养不良，20名患有夸希奥科病，11名患有混合型营养不良。43%的研究对象HIV血清学检测呈阳性。26名受试者共分离出30株细菌。10株细菌为革兰氏阳性菌，20株为革兰氏阴性菌。分离率不受HIV血清学状态的影响。30株分离株中有21株来自血培养。约1/3的革兰氏阳性分离株为凝固酶阴性葡萄球菌，对红霉素、氨苄西林、复方新诺明、氯霉素甚至苯唑西林等常用抗生素大多耐药。超过一半的菌株对常用口服抗生素耐药，而所有革兰氏阳性和阴性分离株中80%对环丙沙星敏感。氨基糖苷类药物庆大霉素和阿米卡星以及第三代头孢菌素头孢曲松和头孢他啶对大多数革兰氏阴性分离株有效。
在KNH住院的重度营养不良儿童中，近三分之一（28.9%）伴有严重细菌感染；主要表现为菌血症。革兰氏阴性菌是KNH住院儿童中大多数严重细菌感染的病原体，无论其HIV血清学状态如何。只要有可能，KNH对重度营养不良儿童进行初始败血症筛查时应包括血培养。在缺乏培养和药敏信息的情况下，环丙沙星应被视为这些儿童严重细菌感染经验性治疗的一线选择之一。建议进行临床试验以进一步评估各种单一或联合抗生素的体内有效性。
