TY - JOUR
T1 - Bloodstream infections and frequency of pretreatment associated with age and hospitalization status in Sub-Saharan Africa
AU - Nichols, Chelsea
AU - Cruz Espinoza, Ligia Maria
AU - Von Kalckreuth, Vera
AU - Aaby, Peter
AU - Ahmed El Tayeb, Muna
AU - Ali, Mohammad
AU - Aseffa, Abraham
AU - Bjerregaard-Andersen, Morten
AU - Breiman, Robert F.
AU - Cosmas, Leonard
AU - Crump, John A.
AU - Dekker, Denise Myriam
AU - Gassama Sow, Amy
AU - Gasmelseed, Nagla
AU - Hertz, Julian T.
AU - Im, Justin
AU - Kabore, Leon Parfait
AU - Keddy, Karen H.
AU - Konings, Frank
AU - Valborg Løfberg, Sandra
AU - Meyer, Christian G.
AU - Montgomery, Joel M.
AU - Niang, Aissatou
AU - Njariharinjakamampionona, Andriamampionona
AU - Olack, Beatrice
AU - Pak, Gi Deok
AU - Panzner, Ursula
AU - Park, Jin Kyung
AU - Park, Se Eun
AU - Rabezanahary, Henintsoa
AU - Rakotondrainiarivelo, Jean Philibert
AU - Rakotozandrindrainy, Raphaël
AU - Raminosoa, Tiana Mirana
AU - Rubach, Matthew P.
AU - Teferi, Mekonnen
AU - Seo, Hye Jin
AU - Sooka, Arvinda
AU - Soura, Abdramane
AU - Tall, Adama
AU - Toy, Trevor
AU - Yeshitela, Biruk
AU - Clemens, John D.
AU - Wierzba, Thomas F.
AU - Baker, Stephen
AU - Marks, Florian
N1 - Publisher Copyright:
© The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.
PY - 2015/11/1
Y1 - 2015/11/1
N2 - 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.
AB - 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.
KW - bloodstream infections
KW - hospitalization
KW - pretreatment
KW - sub-Saharan Africa
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U2 - 10.1093/cid/civ730
DO - 10.1093/cid/civ730
M3 - Article
C2 - 26449954
AN - SCOPUS:84946118382
SN - 1058-4838
VL - 61
SP - S372-S379
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
ER -