Burden, spectrum and outcome of community-acquired infections among paediatric ward admissions to Tygerberg Hospital

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dc.contributor.advisorBekker, Adrieen_ZA
dc.contributor.advisorDramowski, Angelaen_ZA
dc.contributor.authorMapala, Lydiaen_ZA
dc.contributor.otherStellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.en_ZA
dc.date.accessioned2020-11-16T12:22:48Zen_ZA
dc.date.accessioned2021-02-01T07:55:28Zen_ZA
dc.date.available2020-11-16T12:22:48Zen_ZA
dc.date.available2021-02-01T07:55:28Zen_ZA
dc.date.issued2020-12en_ZA
dc.descriptionThesis (MMed)--Stellenbosch University, 2020.en_ZA
dc.description.abstractENGLISH ABSTRACT: Introduction: Community acquired infections (CAIs), both bacterial and viral in origin, are the most common reason for hospitalization in general paediatric wards. Data from South Africa on the burden, pathogen spectrum, antimicrobial therapy and outcome of paediatric CAIs is limited. Methods: We conducted secondary analysis of data from a prospective cohort of consecutive paediatric admissions to a general ward at Tygerberg Hospital (May - November 2015). Demographics, admission history, laboratory investigations, antimicrobial prescription and hospital outcome data were collected. Results: Of 451 admissions, 364 (81%) were for CAI episodes. Median age and weight of patients with CAI was 4.8 months (IQR 1.5-17.5) and 5.4 kg (IQR 3.6-9.0) respectively. Male gender predominated (210/364; 58%), and HIV-infection prevalence was 6.0% (22/364). Sources of referral were: home (139/364, 38%), other hospitals (113/364, 31%) and clinics (112/364, 31%). Pre-hospital antibiotics (commonly ceftriaxone) were given to 152/364 (42%) of patients. The most prevalent CAI types (n=364) were: respiratory tract infections (197; 54%), gastroenteritis (51; 14%), bloodstream/serious bacterial infections (33; 9%), meningitis (17; 5%) and urinary tract infections (8; 2%). Of 274 blood cultures submitted, 5% yielded a pathogen and 8% were contaminated. Of 140 cerebrospinal fluid samples sent, only 2% yielded a pathogen. Of investigations for respiratory infection, respiratory syncytial virus (RSV), adenovirus (AV) and parainfluenza virus predominated from shell vial culture, whereas RSV, cytomegalovirus and rhinovirus were most frequently identified on polymerase chain reaction testing. Most frequent CAI antibiotic treatment regimens included: ampicillin alone (53%); ampicillin plus gentamicin (25%) and ampicillin plus cefotaxime (20%). Unfavourable outcomes were uncommon (1% died; 4% required re-admission within 30 days of discharge). The majority of antibiotic prescriptions for CAI (323/364; 89%) were compliant with the Essential Drug List (EDL) guidelines. The overall estimated cost of CAI episode management was R 8.2 million or R22,527 per CAI admission episode. Conclusion: CAI's are the most frequent reason for hospitalization and a major driver of antimicrobial use and hospital costs in general paediatric wards. Improved diagnostic stewardship should be implemented in South African paediatric wards to reduce culture contamination, improve pathogen yield, minimize use of unnecessary investigations and reduce inappropriate antimicrobial prescriptions. Despite a high burden and hospital cost of CAI admissions, paediatric clinical outcomes were generally favourable.en_ZA
dc.description.abstract"Geen opsomming biskikbaar"en_ZA
dc.description.versionMastersen_ZA
dc.embargo.terms2021-12-31en_ZA
dc.format.extent32 pagesen_ZA
dc.identifier.urihttp://hdl.handle.net/10019.1/109445en_ZA
dc.language.isoen_ZAen_ZA
dc.publisherStellenbosch : Stellenbosch Universityen_ZA
dc.rights.holderStellenbosch Universityen_ZA
dc.subjectCommunity-acquired infectionsen_ZA
dc.subjectPediatriciansen_ZA
dc.subjectPaediatric ward admissionsen_ZA
dc.subjectPediatricsen_ZA
dc.subjectLaboratory investigationsen_ZA
dc.subjectAnti-infective agentsen_ZA
dc.subjectAnti-infective agentsen_ZA
dc.subjectUCTDen_ZA
dc.titleBurden, spectrum and outcome of community-acquired infections among paediatric ward admissions to Tygerberg Hospitalen_ZA
dc.typeThesisen_ZA
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