Bachou Hanifa, Tylleskär Thorkild, Kaddu-Mulindwa Deogratias H, Tumwine James K
Department of Paediatrics and Child Health Makerere University Medical School P O Box 7072, Kampala Uganda.
BMC Infect Dis. 2006 Nov 7;6:160. doi: 10.1186/1471-2334-6-160.
To establish the magnitude of bacteraemia in severely malnourished children, and describe the types of bacteria and antimicrobial sensitivity by HIV status.
Isolates were recovered from 76 blood specimens. Antibiotic susceptibility tests were performed using commercial antibiotic disks and demographic and clinical findings were recorded.
Of the 450 children 63% were male; median age 17.0 months (inter quartile range, IQR 12-24) and 57% had oedema. 151 (36.7 %) of 411 tested HIV-positive; 76 (17.1%) of 445 blood specimens grew bacterial isolates; 58% were Gram negative - S. typhimurium (27.6%) and S. enteriditis (11.8%). Staph. aureus (26.3%) and Strep. pneumoniae (13.2%) were the main Gram positive organisms. There was no difference in the risk of bacteraemia by HIV status, age < 24 months, male sex, or oedema, except for oral thrush (OR 2.3 CI 1.0-5.1) and hypoalbuminaemia (OR 3.5 CI 1.0-12.1). Isolates from severely immuno-suppressed children (CD4% <15%) were more likely to grow Salmonella enteriditis (OR 5.4; CI 1.6 - 17.4). The isolates were susceptible (> or = 80%) to ciprofloxacin, ceftriaxone and gentamicin; with low susceptibility to chlorampenicol, ampicillin (< 50%) and co-trimoxazole (<25%). Suspicion of bacteraemia had 95.9% sensitivity and 99.2% specificity. Among bacteraemic children, mortality was higher (43.5% vs 20.5%) in the HIV-positive; OR 3.0 (95%CI 1.0, 8.6).
Bacteraemia affects 1 in every 6 severely malnourished children and carries high mortality especially among the HIV-positive. Given the high level of resistance to common antibiotics, there is need for clinical trials to determine the best combinations of antibiotics for management of bacteraemia in severely malnourished children.
确定重度营养不良儿童菌血症的发生率，并按艾滋病毒感染状况描述细菌类型及抗菌药敏情况。
从76份血标本中分离出菌株。使用商用抗生素药敏纸片进行抗生素敏感性试验，并记录人口统计学和临床资料。
450名儿童中，63%为男性；中位年龄17.0个月（四分位间距，IQR 12 - 24），57%有水肿。411名接受检测的儿童中151名（36.7%）艾滋病毒呈阳性；445份血标本中有76份（17.1%）培养出细菌菌株；58%为革兰氏阴性菌——鼠伤寒沙门氏菌（27.6%）和肠炎沙门氏菌（11.8%）。金黄色葡萄球菌（26.3%）和肺炎链球菌（13.2%）是主要的革兰氏阳性菌。除鹅口疮（比值比2.3，可信区间1.0 - 5.1）和低白蛋白血症（比值比3.5，可信区间1.0 - 12.1）外，菌血症风险在艾滋病毒感染状况、年龄<24个月、男性或水肿方面无差异。来自严重免疫抑制儿童（CD4%<15%）的菌株更易培养出肠炎沙门氏菌（比值比5.4；可信区间1.6 - 17.4）。分离菌株对环丙沙星、头孢曲松和庆大霉素敏感（≥80%）；对氯霉素、氨苄西林（<50%）和复方新诺明（<25%）敏感性低。菌血症疑似诊断的敏感性为95.9%，特异性为99.2%。在菌血症儿童中，艾滋病毒阳性者死亡率更高（43.5%对20.5%）；比值比3.0（95%可信区间1.0，8.6）。
菌血症影响每6名重度营养不良儿童中的1名，且死亡率高，尤其是艾滋病毒阳性者。鉴于对常用抗生素的耐药性水平高，需要进行临床试验以确定治疗重度营养不良儿童菌血症的最佳抗生素组合。
