Moyo Sabrina J, Manyahi Joel, Blomberg Bjørn, Tellevik Marit Gjerde, Masoud Nahya Salim, Aboud Said, Manji Karim, Roberts Adam P, Hanevik Kurt, Mørch Kristine, Langeland Nina
Department of Clinical Science, University of Bergen, Bergen, Norway.
Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Front Microbiol. 2020 Sep 10;11:2118. doi: 10.3389/fmicb.2020.02118. eCollection 2020.
Febrile illness is the commonest cause of hospitalization in children <5 years in sub-Saharan Africa, and bacterial bloodstream infections and malaria are major causes of death.
From March 2017 to July 2018, we enrolled 2,226 children aged 0-5 years hospitalized due to fever in four major public hospitals of Dar es Salaam, namely, Amana, Temeke, and Mwananyamala Regional Hospitals and Muhimbili National Hospital. We recorded social demographic and clinical data, and we performed blood-culture and HIV-antibody testing. We used qPCR to quantify parasitaemia and Matrix-Assisted Laser Desorption/Ionization-Time of Flight (MALDI-TOF) to identify bacterial isolates. Disk diffusion method was used for antimicrobial susceptibility testing.
Nineteen percent of the children (426/2,226) had pathogens detected from blood. Eleven percent (236/2,226) of the children had bacteraemia/fungaemia and 10% (204/2,063) had malaria. Ten children had concomitant malaria and bacteraemia. Gram-negative bacteria (64%) were more frequent than Gram-positive (32%) and fungi (4%). Over 50% of Gram-negative bacteria were extended-spectrum beta-lactamase (ESBL) producers and multidrug resistant. Methicillin resistant (MRSA) was found in 11/42 (26.2%). The most severe form of clinical malaria was associated with high parasitaemia (>four million genomes/μL) of in plasma. Overall, in-hospital death was 4% (89/2,146), and it was higher in children with bacteraemia (8%, 18/227) than malaria (2%, 4/194, = 0.007). Risk factors for death were bacteraemia ( = 0.03), unconsciousness at admission ( < 0.001), and admission at a tertiary hospital ( = 0.003).
Compared to previous studies in this region, our study showed a reduction in malaria prevalence, a decrease in in-hospital mortality, and an increase in antimicrobial resistance (AMR) including ESBLs and multidrug resistance. An increase of AMR highlights the importance of continued strengthening of diagnostic capability and antimicrobial stewardship programs. We also found malaria and bacteraemia contributed equally in causing febrile illness, but bacteraemia caused higher in-hospital death. The most severe form of clinical malaria was associated with parasitaemia.
在撒哈拉以南非洲地区，发热性疾病是5岁以下儿童住院最常见的原因，细菌性血流感染和疟疾是主要的死亡原因。
2017年3月至2018年7月，我们在达累斯萨拉姆的四家主要公立医院，即阿曼纳医院、特梅克医院、姆瓦纳亚马拉地区医院和穆希姆比利国家医院，招募了2226名因发热住院的0至5岁儿童。我们记录了社会人口统计学和临床数据，并进行了血培养和HIV抗体检测。我们使用定量聚合酶链反应（qPCR）来定量疟原虫血症，并使用基质辅助激光解吸/电离飞行时间质谱（MALDI-TOF）来鉴定细菌分离株。采用纸片扩散法进行药敏试验。
19%的儿童（426/2226）血液中检测到病原体。11%（236/2226）的儿童患有菌血症/真菌血症，10%（204/2063）的儿童患有疟疾。10名儿童同时患有疟疾和菌血症。革兰氏阴性菌（64%）比革兰氏阳性菌（32%）和真菌（4%）更常见。超过50%的革兰氏阴性菌是超广谱β-内酰胺酶（ESBL）产生菌且具有多重耐药性。在42例中的11例（26.2%）发现了耐甲氧西林金黄色葡萄球菌（MRSA）。临床疟疾最严重的形式与血浆中高疟原虫血症（>400万个基因组/微升）有关。总体而言，住院死亡率为4%（89/2146），菌血症患儿的死亡率（8%，18/227）高于疟疾患儿（2%，4/194，P = 0.007）。死亡的危险因素是菌血症（P = 0.03）、入院时昏迷（P < 0.001）以及在三级医院入院（P = 0.003）。
与该地区以前的研究相比，我们的研究显示疟疾患病率有所降低，住院死亡率有所下降，包括ESBLs和多重耐药性在内的抗菌药物耐药性（AMR）有所增加。AMR的增加凸显了持续加强诊断能力和抗菌药物管理计划的重要性。我们还发现疟疾和菌血症在引起发热性疾病方面的作用相当，但菌血症导致的住院死亡率更高。临床疟疾最严重的形式与疟原虫血症有关。
