Michigan State University, East Lansing, MI 48824, USA.
BMC Infect Dis. 2011 May 19;11:137. doi: 10.1186/1471-2334-11-137.
Reports of the etiology of bacteremia in children from Nigeria are sparse and have been confounded by wide spread non-prescription antibiotic use and suboptimal laboratory culture techniques. We aimed to determine causative agents and underlying predisposing conditions of bacteremia in Nigerian children using data arising during the introduction of an automated blood culture system accessed by 7 hospitals and clinics in the Abuja area.
Between September 2008 and November 2009, we enrolled children with clinically suspected bacteremia at rural and urban clinical facilities in Abuja or within the Federal Capital Territory of Nigeria. Blood was cultured using an automated system with antibiotic removing device. We documented clinical features in all children and tested for prior antibiotic use in a random sample of sera from children from each site.
969 children aged 2 months-5 years were evaluated. Mean age was 21±15.2 months. All children were not systematically screened but there were 59 (6%) children with established diagnosis of sickle cell disease and 42 (4.3%) with HIV infection. Overall, 212 (20.7%) had a positive blood culture but in only 105 (10.8%) were these considered to be clinically significant. Three agents, Staphylococcus aureus (20.9%), Salmonella typhi (20.9%) and Acinetobacter (12.3%) accounted for over half of the positive cultures. Streptococcus pneumoniae and non-typhi Salmonellae each accounted for 7.6%. Although not the leading cause of bacteremia, Streptococcus pneumoniae was the single leading cause of all deaths that occurred during hospitalization and after hospital discharge.
S. typhi is a significant cause of vaccine-preventable morbidity while S. pneumoniae may be a leading cause of mortality in this setting. This observation contrasts with reports from most other African countries where non-typhi Salmonellae are predominant in young children. Expanded surveillance is required to confirm the preliminary observations from this pilot study to inform implementation of appropriate public health control measures.
尼日利亚儿童菌血症病因的报告很少，且由于广泛的非处方抗生素使用和实验室培养技术不佳而变得复杂。我们旨在使用在阿布贾地区的 7 家医院和诊所使用的自动血液培养系统引入期间产生的数据，确定尼日利亚儿童菌血症的病原体和潜在的诱发因素。
2008 年 9 月至 2009 年 11 月，我们在阿布贾农村和城市临床医疗机构或尼日利亚联邦首都特区内招募了患有临床疑似菌血症的儿童。使用带抗生素去除装置的自动系统培养血液。我们记录了所有儿童的临床特征，并在每个地点的儿童随机血清样本中测试了先前抗生素的使用情况。
共评估了 969 名 2 个月至 5 岁的儿童。平均年龄为 21±15.2 个月。并非所有儿童都进行了系统筛查，但有 59 名（6%）儿童患有镰状细胞病，42 名（4.3%）患有 HIV 感染。总体而言，有 212 名（20.7%）儿童的血培养呈阳性，但只有 105 名（10.8%）被认为具有临床意义。三种病原体，金黄色葡萄球菌（20.9%）、伤寒沙门氏菌（20.9%）和不动杆菌（12.3%）占阳性培养物的一半以上。肺炎链球菌和非伤寒沙门氏菌各占 7.6%。尽管不是菌血症的主要原因，但肺炎链球菌是住院期间和出院后所有死亡的单一主要原因。
伤寒沙门氏菌是一种可通过疫苗预防的发病率的重要原因，而肺炎链球菌可能是该环境中死亡的主要原因。这一观察结果与大多数其他非洲国家的报告形成对比，在这些国家，非伤寒沙门氏菌在幼儿中占主导地位。需要扩大监测以确认这项初步观察结果，为实施适当的公共卫生控制措施提供信息。
