Abstract:
Background: Fever is a common clinical symptom in children attending hospital outpatient clinics in rural Tanzania,
yet there is still a paucity of data on the burden of bloodstream bacterial infection among these patients.
Methods: The present study was conducted at Korogwe District Hospital in north-eastern Tanzania. Patients aged
between 2 and 59 months with a history of fever or measured axillary temperature ≥37.5°C attending the outpatient
clinic were screened for enrolment into the study. Blood culturing was performed using the BACTEC 9050® system.
A biochemical analytical profile index and serological tests were used for identification and confirmation of bacterial
isolates. In-vitro antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method. The
identification of Plasmodium falciparum malaria was performed by microscopy with Giemsa stained blood films.
Results: A total of 808 blood cultures were collected between January and October 2013. Bacterial growth was
observed in 62/808 (7.7%) of the cultured samples. Pathogenic bacteria were identified in 26/808 (3.2%) cultures and
the remaining 36/62 (58.1%) were classified as contaminants. Salmonella typhi was the predominant bacterial isolate
detected in 17/26 (65.4%) patients of which 16/17 (94.1%) were from patients above 12 months of age. Streptococcus
pneumoniae was the second leading bacterial isolate detected in 4/26 (15.4%) patients. A high proportion of S.
typhi 11/17 (64.7%) was isolated during the rainy season. S. typhi isolates were susceptible to ciprofloxacin (n = 17/17,
100%) and ceftriaxone (n = 13/17, 76.5%) but resistant to chloramphenicol (n = 15/17, 88.2%). P. falciparum malaria
was identified in 69/808 (8.5%) patients, none of whom had bacterial infection.
Conclusion: Bloodstream bacterial infection was not found to be a common cause of fever in outpatient children;
and S. typhi was the predominant isolate. This study highlights the need for rational use of antimicrobial prescription
in febrile paediatric outpatients presenting at healthcare facilities in rural Tanzania.
