Low Bacteremia Prevalence Among Febrile Children in Areas of Differing Malaria Transmission in Rural Kenya: A Cross-Sectional Study.

Autor: Onchiri FM; Department of Epidemiology.; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi., Pavlinac PB; Department of Epidemiology., Singa BO; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi., Naulikha JM; Department of Pediatrics.; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi., Odundo EA; Walter Reed Project, United States Army Medical Research Unit, Kericho, Kenya., Farquhar C; Department of Epidemiology.; Department of Global Health.; Department of Medicine, University of Washington, Seattle., Richardson BA; Department of Biostatistics.; Fred Hutchinson Cancer Research Center, Vaccine and Infectious Disease Division, Seattle, Washington., John-Stewart G; Department of Epidemiology.; Department of Pediatrics.; Department of Global Health.; Department of Medicine, University of Washington, Seattle., Walson JL; Department of Epidemiology.; Department of Pediatrics.; Department of Global Health.; Department of Medicine, University of Washington, Seattle.
Jazyk: angličtina
Zdroj: Journal of the Pediatric Infectious Diseases Society [J Pediatric Infect Dis Soc] 2016 Dec; Vol. 5 (4), pp. 385-394. Date of Electronic Publication: 2015 Jul 28.
DOI: 10.1093/jpids/piv043
Abstrakt: Background: With malaria declining, other causes of fever may account for a substantial portion of severe childhood illness in sub-Saharan Africa. We determined prevalence, etiologies, and correlates of bacteremia among children in Western Kenya.
Methods: In a cross-sectional study, febrile children aged 6 months to 15 years presenting to Kisii (low malaria endemicity) and Homabay (high malaria endemicity) Hospitals were enrolled and screened for malaria, human immunodeficiency virus (HIV) infection and bacteremia. Correlates of bacteremia were evaluated using logistic regression.
Results: Among 1476 children enrolled, 48 (3.3%) had bacteremia (23 of 734, 3.1% in Kisii and 25 of 734, 3.4% in Homabay). Salmonella spp (19 typhi and 21 nontyphoidal salmonella) accounted for 83% (40 of 48) of isolates. The distribution of Salmonella spp was similar between sites. Bacteremia was associated with incomplete vaccination (adjusted odds ratio [aOR] = 2.1; 95% confidence interval [CI], 1.1-4.1), before treatment with antimalarials (aOR = 2.7; 95% CI, 1.4-4.1), having sought care elsewhere (aOR = 2.2; 95% CI, 1.2-4.0) and lower education of caregiver (aOR = 2.5; 95% CI, 1.1-4.8). Nontyphoidal salmonella bacteremia was associated with HIV (aOR = 6.8; 95% CI, 1.1-35.1) and anemia (hemoglobin <8 g/dL) (aOR = 5.2; 95% CI, 1.4-18.9).
Conclusions: Bacteremia was relatively uncommon, but children with HIV, anemia, incomplete vaccination, and/or persistent fever despite malaria treatment may have higher risk and may benefit from targeted bacterial culture and/or empiric antibiotic therapy.
(© The Author 2015. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)
Databáze: MEDLINE
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