Christopher Alexandra, Mshana Stephen E, Kidenya Benson R, Hokororo Aldofineh, Morona Domenica
Ital J Pediatr. 2013 May 8;39:27. doi: 10.1186/1824-7288-39-27.
Antibiotic resistance is one of the most serious public health concerns worldwide and is increasing at an alarming rate, making daily treatment decisions more challenging. This study is aimed at identifying local bacterial isolates and their antimicrobial susceptibility patterns to avoid irrational antibiotic use, especially in settings where unguided management occurs and febrile illnesses are predominant.
A hospital-based prospective cross-sectional study was conducted from September 2011 to February 2012. Febrile children were serially recruited and demographic and clinical data were collected using a standardized data collection tool. A blood culture was performed and identification of the isolates was undertaken using in-house biochemical tests. Susceptibility to common antibiotics was investigated using the disc diffusion methods.
Of the 1081 children admitted during the study period, 317 (29.3%) met the inclusion criteria and were recruited, of whom 195 (61.5%) and 122 (38.5%) were male and female respectively. The median age was 18 months with an interquartile range of 9 to 36 months. Of the 317 children, 251 (79.2%) were below or equal to 36 months of age. The prevalence of bacteremia was 6.6%. A higher prevalence of bacteraemia was observed in children below 36 months than in those ≥ 36 months (7.5% vs. 3.0%, p = 0.001). Predictors of bacteraemia were an axillary temperature of >38.5 °C (OR =7, 95% CI = 2.2 - 14.8, p-value = 0.0001), a positive malaria slide (OR =5, 95% CI = 3.0 - 21.2, p-value = 0.0001) and a high neutrophils' count (OR =21 95% CI = 5.6 - 84, p-value = 0.0001). Escherichia coli and Klebsiella pneumoniae accounted for 7 (33.3%) and 6 (28.6%) of all the isolates respectively. Others gram-negatives bacteria were Citrobacter spp 2 (9.5%), Enterobacter spp 1 (4.25%), Pseudomonas spp 2 (9.5%), Proteus spp 1 (4.25%) and Salmonella spp 1 (4.25%). These isolates were highly resistant to ampicillin (95%), co-trimoxazole (90%), tetracycline (90%), gentamicin (80%), augmentin (80%), chloramphenicol (65%), ceftriaxone (35%), cefotaxime (35%) ciprofloxacin (30%), amikacin (30%), ceftazidime (25%) and norfloxacine (10%).
Multi-resistant gram-negative bacteria are the commonest cause of bacteremia in under-fives attending the Bugando Medical Centre, Mwanza, Tanzania. A high body temperature, a positive malaria slide and a high absolute neutrophils' count were all independent risk factors found to predict bacteremia. A higher mortality rate was observed in children with bacteraemia. Continuous epidemiological surveillance should be conducted so that a proper and effective antibiotics management can be instituted, especially in children with a high grade fever, a positive malaria slide and a high neutrophils' count.
抗生素耐药性是全球最严重的公共卫生问题之一，且正以惊人的速度增长，这使得日常治疗决策更具挑战性。本研究旨在确定当地细菌分离株及其抗菌药敏模式，以避免不合理使用抗生素，尤其是在缺乏指导的管理环境中且发热性疾病占主导的情况下。
2011年9月至2012年2月进行了一项基于医院的前瞻性横断面研究。对发热儿童进行连续招募，并使用标准化数据收集工具收集人口统计学和临床数据。进行血培养，并使用内部生化试验对分离株进行鉴定。采用纸片扩散法研究对常用抗生素的敏感性。
在研究期间收治的1081名儿童中，317名（29.3%）符合纳入标准并被招募，其中男性195名（61.5%），女性122名（38.5%）。中位年龄为18个月，四分位间距为9至36个月。在317名儿童中，251名（79.2%）年龄小于或等于36个月。菌血症患病率为6.6%。36个月以下儿童的菌血症患病率高于36个月及以上儿童（7.5%对3.0%，p = 0.001）。菌血症的预测因素为腋温>38.5°C（比值比=7，95%置信区间=2.2 - 14.8，p值=0.0001）、疟疾涂片阳性（比值比=5，95%置信区间=3.0 - 21.2，p值=0.0001）和中性粒细胞计数高（比值比=21，95%置信区间=5.6 - 84，p值=0.0001）。大肠埃希菌和肺炎克雷伯菌分别占所有分离株的7株（33.3%）和6株（28.6%）。其他革兰氏阴性菌为柠檬酸杆菌属2株（9.5%）、肠杆菌属1株（4.25%）、假单胞菌属2株（9.5%）、变形杆菌属1株（4.25%）和沙门菌属1株（4.25%）。这些分离株对氨苄西林（95%）、复方新诺明（90%）、四环素（90%）、庆大霉素（80%）、阿莫西林/克拉维酸（80%）、氯霉素（65%）、头孢曲松（35%）、头孢噻肟（35%）、环丙沙星（30%）、阿米卡星（30%）、头孢他啶（25%）和诺氟沙星（10%）高度耐药。
多重耐药革兰氏阴性菌是坦桑尼亚姆万扎布甘多医疗中心五岁以下儿童菌血症最常见的原因。高热、疟疾涂片阳性和绝对中性粒细胞计数高均为预测菌血症的独立危险因素。菌血症患儿的死亡率较高。应持续进行流行病学监测，以便制定适当有效的抗生素管理措施，尤其是对高热、疟疾涂片阳性和中性粒细胞计数高的儿童。
