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Bloodstream Infections and Frequency of Pretreatment Associated With Age and Hospitalization Status in Sub-Saharan Africa.

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Date
2015-11-01
Authors
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
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Abstract
BACKGROUND: The clinical diagnosis of bacterial bloodstream infections (BSIs) in sub-Saharan Africa is routinely confused with malaria due to overlapping symptoms. The Typhoid Surveillance in Africa Program (TSAP) recruited febrile inpatients and outpatients of all ages using identical study procedures and enrollment criteria, thus providing an opportunity to assess disease etiology and pretreatment patterns among children and adults. 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.
Type
Journal article
Subject
bloodstream infections
hospitalization
pretreatment
sub-Saharan Africa
Adolescent
Adult
Africa South of the Sahara
Age Factors
Bacteremia
Child
Child, Preschool
Female
Fever
Hospitalization
Humans
Inpatients
Malaria
Male
Outpatients
Prevalence
Salmonella Infections
Salmonella typhi
Time-to-Treatment
Typhoid Fever
Young Adult
Permalink
https://hdl.handle.net/10161/13765
Published Version (Please cite this version)
10.1093/cid/civ730
Publication Info
Nichols, Chelsea; Cruz Espinoza, Ligia Maria; von Kalckreuth, Vera; Aaby, Peter; Ahmed El Tayeb, Muna; Ali, Mohammad; ... Marks, Florian (2015). Bloodstream Infections and Frequency of Pretreatment Associated With Age and Hospitalization Status in Sub-Saharan Africa. Clin Infect Dis, 61 Suppl 4. pp. S372-S379. 10.1093/cid/civ730. Retrieved from https://hdl.handle.net/10161/13765.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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Scholars@Duke

John Andrew Crump

Adjunct Professor in the Department of Medicine
I am based in northern Tanzania where I am Site Leader for Duke University&#8217;s collaborative research program based at Kilimanjaro Christian Medical Centre and Director of Tanzania Operations for the Duke Global Health Institute. I oversee the design and implementation of research studies on infectious diseases, particularly febrile illness, invasive bacterial disease, HIV-associated opportunistic infections, clinical trials of antiretroviral therapy and prevention of mother-to-child tr
Hertz

Julian T Hertz

Assistant Professor of Surgery
Rubach

Matthew P. Rubach

Associate Professor of Medicine
Alphabetical list of authors with Scholars@Duke profiles.
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