Bacteremia in hospitalized black South African children. A one-year study emphasizing nosocomial bacteremia and bacteremia in severely malnourished children.

During a one-year period, 315 of 5,397 children admitted to the general pediatric wards of a hospital had bacteremia. The commonest causative organisms were Streptococcus pneumoniae, Salmonella enteritidis, Hemophilus influenzae, and Escherichia coli. Most episodes of bacteremia were associated with gastroenteritis, pneumonia, or meningitis. Seventy-eight episodes occurred in children with severe protein-energy malnutrition, and 46 episodes were hospital acquired. The overall case fatality rate was 23.2%, being highest in children with severe malnutrition and in those with other underlying conditions. The high proportion of bacteremias due to S pneumoniae and S enteritidis possibly reflects infections occurring in a lower socioeconomic group living in a temperate climate in crowded conditions. The most appropriate antimicrobial therapy for children who have suspected bacteremia in association with gastroenteritis or severe malnutrition is a combination of ampicillin sodium and gentamicin sulfate.