Translocation of rectal flora and its role in pathogenesis of septicemia in children with severe acute malnutrition

Abstract

Introduction: Childhood under-nutrition alters gut mucosal permeability and architecture, causing movement of organisms from GIT into circulation. Most studies carried have detailed bacteremia with malnutrition but none have described that originating from gut microbial translocation. Objectives: The aim of this study was to identify and characterize organisms carried in the rectum for children with severe acute malnutrition, to compare rectal organisms and blood isolates for children with SAM who develop Septicemia Methods: In this prospective study, 99 rectal swabs and 99 venous blood samples were collected from 99 children with SAM. Bacteria were isolated from rectal samples and screened for resistance to commonly used antibacterial agents(CLSI 2014). Bacterial DNA was detected in blood by Real time PCR targeting 16S rRNA . The children were followed for one week for evidence of sepsis. Results: All children were carriers of MDR bacteria. They include E coli(63.6%) 63/99; K Pneumoniae (22.2%) 22/99; Citrobacter (6.1%) 6/99; Proteus (2%)8/99; Morganella (3%) 3/99; Acinetobacter (1%)1/99. Resistance to antibiotics was as follows 3rd generation 83.8% (83/99),cefepime80.8%(80/99),carbapenem15.2%(15/99).Ampicillin98%(97/99), chloramphenicol 96%(95/99). Gentamicin 63.6%(63/99), Amikacin 29.3% (29/99), cotrimoxazole 90.9% (90/99), Piperacillin 97% (96/99), Piperacillin-Trazobactum 53.5% (53/99). 75%(75/99)of the partcipants were carriers of ESBLs, while 14%(14/99) were AmpC and 17.2%(17/99) were carbapenemases carriers. 3%(3/99) blood samples had positive PCR for 16S rRNA gene . Conclusions: Our findings showed a high prevalence of MDR gram negative bacteria, including carbapenem resistant enterobacteriaece in the gut of children with SAM and the possibility of their translocation into blood. We need to review treatment guidelines for SAM. Treatment guidelines need to be reviewed to promote investigation to guide treatment. of sepsis. Measures both in the community and at hospital need to be put in place to curb the spread of MDR bacteria.