Trends in paediatric bloodstream infections at a South African referral hospital
Date
2015-04
Journal Title
Journal ISSN
Volume Title
Publisher
BioMed Central
Abstract
Background: The epidemiology of paediatric bloodstream infection (BSI) in Sub-Saharan Africa is poorly documented
with limited data on hospital-acquired sepsis, impact of HIV infection, BSI trends and antimicrobial resistance.
Methods: We retrospectively reviewed paediatric BSI (0–14 years) at Tygerberg Children’s Hospital between 1 January
2008 and 31 December 2013 (excluding neonatal wards). Laboratory and hospital data were used to determine BSI
rates, blood culture contamination, pathogen profile, patient demographics, antimicrobial resistance and factors
associated with mortality. Fluconazole resistant Candida species, methicillin-resistant Staphylococcus aureus
(MRSA), multi-drug resistant Acinetobacter baumannii and extended-spectrum beta-lactamase (ESBL) producing
Enterobacteriaceae were classified as antimicrobial resistant pathogens.
Results: Of 17001 blood cultures over 6 years, 935 cultures isolated 979 pathogens (5.5% yield; 95% CI 5.3-5.7%).
Contamination rates were high (6.6%, 95% CI 6.4-6.8%), increasing over time (p = 0.003). Discrete BSI episodes were
identified (n = 864) with median patient age of 7.5 months, male predominance (57%) and 13% HIV prevalence. BSI
rates declined significantly over time (4.6–3.1, overall rate 3.5 per 1000 patient days; 95% CI 3.3–3.7; Chi square for trend
p = 0.02). Gram negative pathogens predominated (60% vs 33% Gram positives and 7% fungal); Klebsiella pneumoniae
(154; 17%), Staphylococcus aureus (131; 14%) and Escherichia coli (97; 11%) were most prevalent. Crude BSI mortality was
20% (176/864); HIV infection, fungal, Gram negative and hospital-acquired sepsis were significantly associated with
mortality on multivariate analysis. Hospital-acquired BSI was common (404/864; 47%). Overall antimicrobial resistance
rates were high (70% in hospital vs 25% in community-acquired infections; p < 0.0001); hospital-acquired infection,
infancy, HIV-infection and Gram negative sepsis were associated with resistance. S. pneumoniae BSI declined significantly
over time (58/465 [12.5%] to 33/399 [8.3%]; p =0.04).
Conclusion: Although BSI rates declined over time, children with BSI had high mortality and pathogens exhibited
substantial antimicrobial resistance in both community and hospital-acquired infections. Blood culture sampling
technique and local options for empiric antimicrobial therapy require re-evaluation.
Description
CITATION: Dramowski, A., Cotton, M.F., Rabie, H. & Whitelaw, A. 2015. Trends in paediatric bloodstream infections at a South African referral hospital. BMC Pediatrics, 15(33), doi:10.1186/s12887-015-0354-3.
The original publication is available at http://bmcpediatr.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund.
The original publication is available at http://bmcpediatr.biomedcentral.com
Publication of this article was funded by the Stellenbosch University Open Access Fund.
Keywords
Tygerberg Children’s Hospital, Nosocomial infections -- South Africa -- Cape Town, Community-acquired infection -- South Africa -- Cape Town, Infection in children -- South Africa -- Cape Town
Citation
Dramowski, A., Cotton, M.F., Rabie, H. & Whitelaw, A. 2015. Trends in paediatric bloodstream infections at a South African referral hospital. BMC Pediatrics, 15(33), doi:10.1186/s12887-015-0354-3.