Systemic bacteraemia in children presenting with clinical pneumonia and the impact of non-typhoid salmonella (NTS)

• Published in: BMC infectious diseases Vol. 10; no. 1; p. 319
• Main Authors: Schwarz, Norbert G, Sarpong, Nimako, Hünger, Frank, Marks, Florian, Acquah, Samuel Ek, Agyekum, Alex, Nkrumah, Bernard, Loag, Wibke, Hagen, Ralf M, Evans, Jennifer A, Dekker, Denise, Fobil, Julius N, Meyer, Christian G, May, Jürgen, Adu-Sarkodie, Yaw
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 04-11-2010; BioMed Central; BMC
• Subjects: Acquired immune deficiency syndrome; AIDS; Bacteremia; Bacteremia - blood; Bacteremia - epidemiology; Bacteremia - microbiology; Bacteria; Care and treatment; Child, Preschool; Demographic aspects; Diagnosis; Drug resistance; Drug Resistance, Bacterial; Ghana; Humans; Identification and classification; Infant; Microbial Sensitivity Tests; Pneumonia; Pneumonia - blood; Pneumonia - epidemiology; Pneumonia - microbiology; Pneumonia in children; Salmonella; Salmonella - drug effects; Salmonella - isolation & purification; Salmonella Infections - blood; Salmonella Infections - epidemiology; Salmonella Infections - microbiology; Streptococcus infections; Streptococcus pneumoniae; Ghana
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/1471-2334-10-319

The diagnosis and antimicrobial treatment of pneumonia in African children in the absence of diagnostic means such as x-ray facilities or microbiological laboratories relies primarily on clinical symptoms presented by the patients. In order to assess the spectrum of bacterial pathogens, blood cultures were performed in children fulfilling the clinical criteria of pneumonia.
In total, 1032 blood cultures were taken from children between 2 months and 5 years of age who were admitted to a rural hospital in Ghana between September 2007 and July 2009. Pneumonia was diagnosed clinically and according to WHO criteria classified as "non-severe pneumonia" and "severe pneumonia" ("severe pneumonia" includes the WHO categories "severe pneumonia" and "very severe pneumonia").
The proportion of bacteriaemia with non-typhoid salmonella (NTS) was similar in children with pneumonia (16/173, 9.2%) compared to children hospitalized for other reasons (112/859, 13%). NTS were the predominant organisms isolated from children with clinical pneumonia and significantly more frequent than Streptococcus pneumoniae (8/173, 4.6%). Nine percent (9/101) of children presenting with severe pneumonia and 10% (7/72) of children with non-severe pneumonia were infected with NTS. Nineteen out of 123 NTS isolates (15%) were susceptible to aminopenicillins (amoxycillin/ampicillin), 23/127 (18%) to chlorampenicol, and 23/98 (23%) to co-trimoxazole. All NTS isolates were sensitive to ceftriaxone and ciprofloxacin.
In Sub-saharan Africa, sepsis with NTS should be considered in children with symptoms of pneumonia and aminopenicillins might often not be the adequate drugs for treatment.