Prevalence and atiology of bacteraemia in severely malnourished children attending Mulago Hospital

Abstract

BACKGROUND: Severe malnutrition is a major cause of childhood morbidity and mortality especially in developing counties. Severe malnutrition affects 7% of Uganda children below 5 years. During a 3 months study period, 226 of 3675 (6.15%) children admitted to Mulago Hospital were severely malnourished. Bacteraemia is common in malnutrition and often carries a grave prognosis if appropriate antibiotic treatment is not instituted early. METHODS: A study of the prevalence and aetiology of bacteraemia was carried out between September and November 2001 in acute care unit and Mwanamugimu ward of Mulago Hospital, Kampala. In this cross sectional descriptive study, 134 children aged 6-59 months with severe malnutrition were recruited to determine the prevalence, causative organisms, antibiotic sensitivity and associated factors of bacteraemia. Data was analysed using the SPSS program. RESULTS: One hundred and thirty four malnourished children were studied. The mean age was 17.7 months. Sixty one (45.5%) of the children had oedematous malnutrition while 73 (54.5%) had severe wasting. The prevalence of bacteraemia was 22%. The predominant organisms isolated were gram-negative enteric bacilli (77%) with salmonella species and E. coli contributing 67% of the isolates. Hypoglycaemia was significantly associated with bacteraemia (p=0.007%). Most gram negative organisms were resistant to ampicillin (85%), chloramphenicol (67%) and gentamicin (63%). All isolates were sensitive to ceftriaxone. Most of the organisms were sensitive to ciprofloxacin with 97% sensitivity of isolates. The relative risk of death in malnourished children with bacteraemia was 10 times higher than those without bacteraemia. CONCLUSIONS: This study emphasizes the increased risk of bacteraemia in malnourished children and its impact on mortality. The frequency of bacteraemia was high enough to justify all children presenting with severe malnutrition being started on antibiotic treatment to cover both gram-negative and gram-positive organisms. Due to the high mortality and associated resistance of organisms to the commonly used antibiotics (anpicillin and gentamicin), there needs to be a change in the routine antibiotic treatment of malnourished children attending Mulago Hospital.