Antimicrobial treatment practices among Ugandan children with suspicion of central nervous system infection
| Autor: | Deborah Nanjebe, Yolanda Mueller, Fabienne Nackers, Elizabeth Kemigisha, Richard A. Murphy, Rémi N. Charrel, Dan Nyehangane, Juliet Mwanga-Amumpaire, Yap Boum, Said Aberrane, Anne-Laure Page, Céline Langendorf |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
Bacterial Diseases Central Nervous System Antibiotics lcsh:Medicine Nervous System Central Nervous System Infections 0302 clinical medicine Anti-Infective Agents Infectious Diseases of the Nervous System Epidemiology Case fatality rate Medicine and Health Sciences Uganda 030212 general & internal medicine lcsh:Science Child Anti-Bacterial Agents/therapeutic use Anti-Infective Agents/therapeutic use Ceftriaxone/therapeutic use Central Nervous System Infections/drug therapy Central Nervous System Infections/epidemiology Child Preschool Coinfection/drug therapy Coinfection/epidemiology Coinfection/microbiology Drug Resistance Bacterial/genetics Escherichia coli/drug effects Escherichia coli/pathogenicity Escherichia coli Infections/drug therapy Escherichia coli Infections/epidemiology Escherichia coli Infections/microbiology Female Humans Infant Malaria/drug therapy Malaria/epidemiology Malaria/microbiology Uganda/epidemiology beta-Lactamases/genetics Escherichia coli Infections Multidisciplinary Coinfection Antimicrobials Ceftriaxone Drugs Antimicrobial Anti-Bacterial Agents Diagnosis of malaria Infectious Diseases Neurology Anatomy Research Article medicine.drug medicine.medical_specialty medicine.drug_class Inflammatory Diseases 030231 tropical medicine Microbiology beta-Lactamases Antimalarials 03 medical and health sciences Antibiotic resistance Microbial Control Bacterial Meningitis Internal medicine Drug Resistance Bacterial Escherichia coli Parasitic Diseases medicine Meningitis Pharmacology business.industry lcsh:R Biology and Life Sciences Tropical Diseases medicine.disease Malaria Antibiotic Resistance lcsh:Q Antimicrobial Resistance business |
| Zdroj: | PLoS ONE PloS one, vol. 13, no. 10, pp. e0205316 PLoS ONE, Vol 13, Iss 10, p e0205316 (2018) |
| ISSN: | 1932-6203 |
| DOI: | 10.1371/journal.pone.0205316 |
| Popis: | Acute central nervous system (CNS) infections in children in sub-Saharan Africa are often fatal. Potential contributors include late presentation, limited diagnostic capacity and inadequate treatment. A more nuanced understanding of treatment practices with a goal of optimizing such practices is critical to prevent avoidable case fatality. We describe empiric antimicrobial treatment, antibiotic resistance and treatment adequacy in a prospective cohort of 459 children aged two months to 12 years hospitalised for suspected acute CNS infections in Mbarara, Uganda, from 2009 to 2012. Among these 459 children, 155 had a laboratory-confirmed diagnosis of malaria (case-fatality rate [CFR] 14%), 58 had bacterial infections (CFR 24%) and 6 children had mixed malaria and bacterial infections (CFR 17%). Overall case fatality was 18.1% (n = 83). Of 219 children with laboratory-confirmed malaria and/or bacterial infections, 182 (83.1%) received an adequate antimalarial and/or antibiotic on the day of admission and 211 (96.3%) within 48 hours of admission. The proportion of those receiving adequate treatment was similar among survivors and non-survivors. All bacterial isolates were sensitive to ceftriaxone except one Escherichia coli isolate with extended-spectrum beta-lactamase (ESBL). The observed high mortality was not a result of inadequate initial antimicrobial treatment at the hospital. The epidemiology of CNS infection in this setting justifies empirical use of a third-generation cephalosporin, however antibiotic resistance should be monitored closely. |
| Databáze: | OpenAIRE |
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