Spectrum of blood bacterial isolates from severely malnoulished children aged 2 to 59 months at Muhimbili National Hospital,Dar es Salaam, Tanzania.

Abstract

Background In Tanzania, over 50% of under five deaths are attributed to malnutrition. At Muhimbili national hospital severe acute Malnutrition has the highest case fatality rate (32%) compared to other paediatrics conditions. However septicemia as a cause of death in these patients is not well known. Routine empirical uses of antibiotics for the treatment of bacterial infections in the first phase of inpatient management of SAM as recommended by WHO is implemented. Changes of aetiologies and susceptibility to antibiotics might have occurred over time. Therefore it is important to have regular updates on the sensitivity pattern of the commonly used antimicrobials. This information is useful in the proper management of bacterial septicaemia in severe acute malnutrition. . Broad objective: To determine the spectrum and antimicrobial sensitivity pattern of blood bacteria isolates from severely malnourished children aged 2 to 59 months admitted at Muhimbili National hospital. Methodology: This was a cross sectional hospital based study. One hundred thirty eight (138) children aged 2 to 59 months who met the inclusion criteria were recruited in the study between September 2011 to March 2012. Children were consecutively enrolled in the study after their parents or guardians had given a written consent. Demographic and clinical findings were recorded. Bacterial Isolates were recovered from cultured blood specimens. Antibiotic susceptibility tests were performed using commercial antibiotic disks by the Kirby- Bauer disc diffusion method. Data analysis was done using SSPS program for windows version 16 Software.Results: Bacteremia among severely malnourished patients admitted at Muhimbili National Hospital was 29%. Staphylococcus aureus was the commonest gram positive aerobe (47.5%), followed by Coagulase negative Staphylococcus (32.5%) and group D streptococcus (12.5%). The Gram – negative aerobes Klebsiella and Escherichia coli species constituted 5% and 2.5% of all isolates respectively. Majority of patients (68.1%) had taken antibiotics prior to blood sample collection All the blood isolates demonstrated an overall low susceptibility to Ampicillin (15%), Ceftriaxone,(50%),Gentamicin(55%), and Chloramphenicol(58%), but were most susceptible to amikacin (90%) and Kanamycin (92%). Only 58% of the blood bacterial isolates were susceptible to the antibiotics as recommended by the WHO empirical regimens. Forty eight children (34.8%) were HIV positive. Children with HIV infections grew more bacterial isolates compared to those without HIV infections (p = 0.05). Moreover, children with HIV infections grew the group D streptococcus (GDS) aerobes more than those who were HIV negative (p = 0.05). There was no significant difference in susceptibility to antibiotics between the HIV positive and HIV negative groups. Twenty six (18.8%) children died and 7 (17.5%) of them had bacteremia. CONCLUSIONS: The prevalence and pattern of blood bacterial isolates in severely malnourished children is the same since it was last reported by Isaac et al in 1990.Bacterial isolates were similar among HIV positive and HIV negative children. However, patients with HIV infection were most likely to have bacteremia than those without.The blood bacterial isolates were highly susceptible to Kanamycin (92%) and Amikacin (90%). There was high level of bacterial resistance to Chloramphenicol (58%), Gentamicin (55%), Ceftriaxone (50%), Ampicillin (15%), and Cloxacillin (10%), and compared to the previous studies done in the same setting. There was no difference in the susceptibility to antibiotics by HIV infection status.