Background: The epidemiology of paediatric bloodstream infection (BSI) in Sub-Saharan Africa is poorly documented\nwith limited data on hospital-acquired sepsis, impact of HIV infection, BSI trends and antimicrobial resistance.\nMethods: We retrospectively reviewed paediatric BSI (0ââ?¬â??14 years) at Tygerberg Childrenââ?¬â?¢s Hospital between 1 January\n2008 and 31 December 2013 (excluding neonatal wards). Laboratory and hospital data were used to determine BSI\nrates, blood culture contamination, pathogen profile, patient demographics, antimicrobial resistance and factors\nassociated with mortality. Fluconazole resistant Candida species, methicillin-resistant Staphylococcus aureus\n(MRSA), multi-drug resistant Acinetobacter baumannii and extended-spectrum beta-lactamase (ESBL) producing\nEnterobacteriaceae were classified as antimicrobial resistant pathogens.\nResults: Of 17001 blood cultures over 6 years, 935 cultures isolated 979 pathogens (5.5% yield; 95% CI 5.3-5.7%).\nContamination rates were high (6.6%, 95% CI 6.4-6.8%), increasing over time (p = 0.003). Discrete BSI episodes were\nidentified (n = 864) with median patient age of 7.5 months, male predominance (57%) and 13% HIV prevalence. BSI\nrates declined significantly over time (4.6ââ?¬â??3.1, overall rate 3.5 per 1000 patient days; 95% CI 3.3ââ?¬â??3.7; Chi square for trend\np = 0.02). Gram negative pathogens predominated (60% vs 33% Gram positives and 7% fungal); Klebsiella pneumoniae\n(154; 17%), Staphylococcus aureus (131; 14%) and Escherichia coli (97; 11%) were most prevalent. Crude BSI mortality was\n20% (176/864); HIV infection, fungal, Gram negative and hospital-acquired sepsis were significantly associated with\nmortality on multivariate analysis. Hospital-acquired BSI was common (404/864; 47%). Overall antimicrobial resistance\nrates were high (70% in hospital vs 25% in community-acquired infections; p < 0.0001); hospital-acquired infection,\ninfancy, HIV-infection and Gram negative sepsis were associated with resistance. S. pneumoniae BSI declined significantly\nover time (58/465 [12.5%] to 33/399 [8.3%]; p =0.04).\nConclusion: Although BSI rates declined over time, children with BSI had high mortality and pathogens exhibited\nsubstantial antimicrobial resistance in both community and hospital-acquired infections. Blood culture sampling\ntechnique and local options for empiric antimicrobial therapy require re-evaluation.
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