Bloodstream Infections and Frequency of Pretreatment Associated With Age and Hospitalization Status in Sub-Saharan Africa.
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 articleSubject
bloodstream infectionshospitalization
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
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https://hdl.handle.net/10161/13765Published Version (Please cite this version)
10.1093/cid/civ730Publication 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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John Andrew Crump
Adjunct Professor in the Department of Medicine
I am based in northern Tanzania where I am Site Leader for Duke University’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
Julian T Hertz
Associate Professor of Emergency Medicine
Julian Hertz, MD, MSc, is an Associate Professor of Emergency Medicine & Global Health.
He graduated summa cum laude from Princeton University and attended medical school
at Duke University, where he received the Dean's Merit Scholarship and the Thomas
Jefferson Award for leadership. He completed his residency training in emergency medicine
at Vanderbilt University Medical Center and his fellowship in Global Health at Duke.Dr.
Hertz's primary interests include globa
Matthew P. Rubach
Associate Professor of Medicine
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