Bloodstream Infections and Frequency of Pretreatment Associated With Age and Hospitalization Status in Sub-Saharan Africa.
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Nichols Chelsea, Cruz Espinoza Ligia Maria, von Kalckreuth Vera, Aaby Peter, Ahmed El Tayeb Muna, Ali Mohammad, Aseffa Abraham, Bjerregaard-Andersen Morten, Breiman Robert F, Cosmas Leonard, Crump John A, Dekker Denise Myriam, Gassama Sow Amy, Gasmelseed Nagla, Hertz Julian T, Im Justin, Kabore Leon Parfait, Keddy Karen H, Konings Frank, Valborg Løfberg Sandra, Meyer Christian G, Montgomery Joel M, Niang Aissatou, Njariharinjakamampionona Andriamampionona, Olack Beatrice, Pak Gi Deok, Panzner Ursula, Park Jin Kyung, Park Se Eun, Rabezanahary Henintsoa, Rakotondrainiarivelo Jean Philibert, Rakotozandrindrainy Raphaël, Raminosoa Tiana Mirana, Rubach Matthew P, Teferi Mekonnen, Seo Hye Jin, Sooka Arvinda, Soura Abdramane, Tall Adama, Toy Trevor, Yeshitela Biruk, Clemens John D, Wierzba Thomas F, Baker Stephen, Marks Florian
Аннотация
METHODS: Inpatients and outpatients of all ages with tympanic or axillary temperatures of ≥38.0 or ≥37.5°C, respectively, and inpatients only reporting fever within the previous 72 hours were eligible for recruitment. All recruited patients had one blood sample drawn and cultured for microorganisms. Data from 11 TSAP surveillance sites in nine different countries were used in the analysis. Bivariate analysis was used to compare frequencies of pretreatment and BSIs in febrile children (<15 years old) and adults (≥15 years old) in each country. Pooled Cochran Mantel-Haenszel odds ratios (ORs) were calculated for overall trends.
RESULTS: There was no significant difference in the odds of a culture-proven BSI between children and adults among inpatients or outpatients. Among both inpatients and outpatients, children had significantly higher odds of having a contaminated blood culture compared with adults. Using country-pooled data, child outpatients had 66% higher odds of having Salmonella Typhi in their bloodstream than adults (OR, 1.66; 95% confidence interval [CI], 1.01-2.73). Overall, inpatient children had 59% higher odds of pretreatment with analgesics in comparison to inpatient adults (OR, 1.59; 95% CI, 1.28-1.97).
CONCLUSIONS: The proportion of patients with culture-proven BSIs in children compared with adults was similar across the TSAP study population; however, outpatient children were more likely to have Salmonella Typhi infections than outpatient adults. This finding points to the importance of including outpatient facilities in surveillance efforts, particularly for the surveillance of typhoid fever. Strategies to reduce contamination among pediatric blood cultures are needed across the continent to prevent the misdiagnosis of BSI cases in children.