Abstract:

Background: In malaria endemic areas, the correct diagnosis of children with fever is difficult since blood stream infection and malaria are practically indistinguishable by clinical features alone. Therefore it was the aim of this study to identify bacteria isolates and their antimicrobial susceptibility patterns to avoid irrational antibiotic use.

Material and Methods: Hospital based prospective cross sectional study was done from September 2011 to February 2012 to determine the bacterial isolates and the susceptibility pattern among children with fever. Febrile children were serially recruited, demographic and clinical data were collected using standardized data collection tool. Blood culture was performed and identification of the isolates done using in house biochemical tests and susceptibility to common antibiotics done using the disc diffusion testing.

Results: A total of 317 children were recruited of whom 195 (61.5%) and 122 (38.5%) were male and female respectively. The median age was 18 months with interquartile range of 9 to 36. Of 317 children, 251 (79.2%) children were below or equal to 36 months of age. Prevalence of bacteremia was 6.6%. Predictors of bacteremia were axillary temperature > 38.5°C (OR = 7, 95% CI=2.2 – 14.8, p-value=0.001), positive malaria slide (OR = 5, 95% CI = 3.0 – 21.2, p-value=0.0001 and high neutrophils count (OR = 21 95% CI = 5.6-84, p-value=0.0001). Female children had more bacteremia than male though the difference was not statistically significance (OR = 0.9, 95%CI 0.3-2.4 and P-value=0.9). The common bacteria isolated from the blood were gram-negative, Escherichia coli (33.3%) and Klesiella pneumoniae (28.6%) Others included Citrobacter, Enterobacter spp, Pseudomonas aeruginosa and Proteus. These isolates were resistant to ampicillin (95%), cotrimoxazole (90%), tetracycline (90%), gentamicin (80%), augmentin (80%), chloramphenicol (65%), ciprofloxacin (30%), amikacin (30%), ceftazidine (25%) and norfloxacine (10%). The only gram-positive isolate was Staphylococcal aureus which were resistant to all antibiotics except for amikacin, imepenem, norfloxacine and ceftazidine. Of the total blood cultures (3.2%) were considered to be contaminant.

Conclusion and Recommendations: Gram-negative bacteria are the commonest cause of bacteremia in infants and children attending Bugando Medical Centre. Escherichia coli and Klebsiella pneumonia are leading causes of bacteremia which are multiple resistant to the first line antibiotics including ampicillin, gentamicin and contrimoxazole as recommended by IMCI; High body temperature; malaria and high absolute neutrophil count were the most predictors of bacteremia. The risk of death if the child is infected with gram-negative bacteria is six times than if the child has gram-positive infection. More studies are encouraged in order to come up come up with strong recommendation on the management of bacteremia at hospital.