Bacteremia among Children Admitted to a Rural Hospital in Kenya
James A. Berkley, M.D., Brett S. Lowe, M.Phil., Isaiah Mwangi, M.B., B.Ch., Thomas Williams, Ph.D., Evasius Bauni, M.Sc., Saleem Mwarumba, H.N.D., Caroline Ngetsa, H.N.D., Mary P.E. Slack, F.R.C.Path., Sally Njenga, H.N.D., C. Anthony Hart, F.R.C.Path., Kathryn Maitland, Ph.D., Mike English, M.D., Kevin Marsh, F.R.C.P., and J. Anthony G. Scott, M.R.C.P.
Background There are few epidemiologic data on invasive bacterialinfections among children in sub-Saharan Africa. We studiedevery acute pediatric admission to a rural district hospitalin Kenya to examine the prevalence, incidence, types, and outcomeof community-acquired bacteremia.
Methods Between August 1998 and July 2002, we cultured bloodon admission from 19,339 inpatients and calculated the incidenceof bacteremia on the basis of the population served by the hospital.
Results Of a total of 1783 infants who were under 60 days old,228 had bacteremia (12.8 percent), as did 866 of 14,787 childrenwho were 60 or more days of age (5.9 percent). Among infantswho were under 60 days old, Escherichia coli and group B streptococcipredominated among a broad range of isolates (14 percent and11 percent, respectively). Among infants who were 60 or moredays of age, Streptococcus pneumoniae, nontyphoidal salmonellaspecies, Haemophilus influenzae, and E. coli accounted for morethan 70 percent of isolates. The minimal annual incidence ofcommunity-acquired bacteremia was estimated at 1457 cases per100,000 children among infants under a year old, 1080 amongchildren under 2 years, and 505 among children under 5 years.Of all in-hospital deaths, 26 percent were in children withcommunity-acquired bacteremia. Of 308 deaths in children withbacteremia, 103 (33.4 percent) occurred on the day of admissionand 217 (70.5 percent) within two days.
Conclusions Community-acquired bacteremia is a major cause ofdeath among children at a rural sub-Saharan district hospital,a finding that highlights the need for prevention and for overcomingthe political and financial barriers to widespread use of existingvaccines for bacterial diseases.
Source Information
From the Centre for Geographic Medicine Research (Coast), Kilifi, Kenya (J.A.B., B.S.L., I.M., T.W., E.B., S.M., C.N., S.N., K. Maitland, M.E., K. Marsh, J.A.G.S.); the Centre for Clinical Vaccinology and Tropical Medicine (J.A.B., B.S.L., K. Marsh, J.A.G.S.) and the Department of Paediatrics (M.E.), University of Oxford, Oxford, United Kingdom; the Health Protection Agency Haemophilus Reference Unit, John Radcliffe Hospital, Oxford, United Kingdom (M.P.E.S.); the Department of Microbiology, University of Liverpool, Liverpool, United Kingdom (C.A.H.); and the Department of Paediatrics and Wellcome Trust Centre for Clinical Tropical Medicine, Imperial College, London (K. Maitland).
Address reprint requests to Dr. Berkley at P.O. Box 230, Kilifi, Kenya, or at jberkley{at}kilifi.mimcom.net.
Bacteremia among Kenyan Children
Levy S. B., Zimmermann O., de Ciman R., Gross U., Berkley J. A., Lowe B. S., Scott J. A. G.
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N Engl J Med 2005;
352:1379-1381, Mar 31, 2005.
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