Prevalence of Bacteria Causing Bacteraemia in Children Under Five Years in Agogo, Asante-Akyem and Their Antimicrobial Susceptibility Patterns

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Bloodstream infection is a frequent cause of morbidity and associated with mortality in excess of 25%. We aimed to prospectively determine the prevalence of bacteria causing bacteraemia in children under five years of age in a rural African area and their antimicrobial susceptibility patterns. Between 1st January 2008 and 31stDecember 2008 we studied children under five years of age with medical cases admitted to the Agogo Presbyterian hospital in the Asante Akim North District. One to three (1-3) mls of venous blood were taken from all children admitted in the ward into Becton Dickinson BACTEC™ PEDS PLUS™ culture vials and transported immediately to the laboratory. They were incubated in the BACTEC 9050. Identification of isolates was done by subculturing, cultural morphology, gram staining, biochemical methods, API from biomerieux and several serological testing. Susceptibility testing was by the Kirby-Bauer disk diffusion method and by measuring Minimum Inhibition Concentration (E-test) using the CLSI guidelines. We documented pathogens identified and their susceptibility patterns. During the study period, 1356 patients were admitted and had a blood culture taken. 304 (22.4%) had a positive result and 207 (15.3% overall) were considered a genuine pathogen and 97 (7.1%) were contaminants (Coagulase negative Staphylococci and other skin organisms). Four organisms accounted for 60.9% of bacteraemias: Non typhoid salmonellae (35.2%), Streptococcus pneumoniae (10.2%), Staphylococcus aureus (7.9%) and Salmonella Typhi (7.6%). Majority of non typhoid salmonellae isolates were resistant to chloramphenicol (80.4%), Ampicillin (81.3%) and co-trimoxazole (77.6%), however they were all susceptible to ciprofloxacin and ceftriaxone. Most of the Klebsiella pneumoniae (60%) and Escherichia coli (50%) produced Extended Spectrum Beta lactamases (ESBLs). Four (16.7%) methicillin resistant Staphylococcus aureus (MRSA) isolates were identified. Ceftriaxone and ciprofloxacin turned out to be the best choice as empiric antibiotic therapy. Our study underlines the significance of bacteraemia in this population. Further surveillance of the incidences and the susceptibility patterns of the bacterial pathogens is necessary.
A Thesis Submitted In Partial Fulfillment of the Requirements for the Degree of Master of Philosophy in the Department of Clinical Microbiology, School of Medical Sciences, College of Health Sciences,