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Blood stream infections in pediatrics in a tertiary hospital in Nairobi, Kenya-A five- and half--year study.�

Presenter :Jemima Wanjiru

KRN/BScN/MScN Paeds/PhD ongoing

Affiliation :The Nairobi hospital

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Outline

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By the end of the presentation the audience will be able to

  • Get background information on BSI.

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  • Understand objectives of the study.

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  • Be able to understand implications of the study.

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Introduction

Bloodstream infections (BSIs) are associated with high morbidity and mortality in children, especially in neonates.

A recent review on pediatric sepsis demonstrated that bloodstream infections accounted for 26.5% of the global disease burdens and resulted in 25% of deaths in children all over the world.

A systemic study on global burdens of bacterial infections shows that more than 2 million deaths were caused by BSIs.

Many factors are associated with BSIs, such as prolonged skin rupture, extensive use of catheters and bone marrow transplantation.

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Introduction

  • In many studies, a wide range of bacteria strains have been described to be mainly responsible for BSIs, such as E. coli, P. aeruginosa, K. pneumoniae, H. influenza, Coagulase negative staphylococci (CoNS), S. aureus, P. aeruginosa, and S. pneumoniae.
  • The majority of studies related to the laboratory diagnosis of BSI focus on the adult population. Thus, this minireview will be devoted to children.

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Background

  • Blood stream infection (BSI) is the leading cause of morbidity and mortality in pediatric patients.
  • According to the WHO, about 3 million cases of sepsis among newborns and 1.2 million among children are detected annually in the world  Fleischmann et al (2018).
  • This study aims to describe the risk factors, the site and isolates microbiological characteristics and outcome of BSI in pediatric patients.

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Objectives

This study aims to describe:

  1. The risk factors to developing BSI in pediatrics.
  2. The most common blood isolates in the pediatric population in a tertiary hospital.
  3. Preventive measures to BSI.

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Methods

  • Retrospective data evaluation of Records of documented BSI among admitted patients between January 2019 to April June 2024.
  • Forty-one cases of BSI were included in the study. Swabs Blood cultures were collected from patients with signs of sepsis and processed by the conventional microbiological methods.

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Findings

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Findings

  • 22 (54%) were from the non-critical departments. 19(46%) were from the general wards.
  • Twenty -nine (71%) had acute illness ,12(29%)had chronic illness and had been on prolonged antibiotic use.
  • Fourteen (34%) had central lines inserted.
  • Thirty-one (76%) of BSI isolates were community acquired.
  • Thirty-eight (93%) had bacteria isolates and 3(7%)were fungal infections.
  • Nine (22%) of the isolates were multi drug resistant, the rest(78%) were sensitive bugs

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Findings

  • Escherichia coli were six (15%),83% which were ESBL
  • Salmonella typhi (15%),
  • Staphylococcus epidermidis (12%)
  • Staphylococcus aureus (12%)
  • Klebsiella pneumoniae (7%)
  • Streptococcus pneumoniae and Pseudomonas aeruginosa (5% each).
  • Three isolates (7%) were Candida sp.

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Conclusion and Recommendations

  • An average rate of BSI was found to be reported, and significant numbers of bacterial isolates were also detected.
  • Periodic surveillance on the incidence rate and bacterial profile along with the determination of their antibiotic susceptibility should be performed in the pediatric population.
  • Care of patients with invasive devices is key to preventing hospital acquired BSI.

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Acknowledgement

  • The Nairobi hospital
  • Administration
  • Infection control department
  • Kenya pediatric nurses' association

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References

  1. Reddy EA, Shaw AV, Crump JA. Community-acquired bloodstream infections in Africa. Lancet Infect Dis. 2010;10:417–32. https://doi.org/10.1016/S1473- 3099(10)70072-4.
  2. Aiken AM, Mturi N, Njuguna P, Mohammed S, Berkley JA, Mwangi I, et al. Risk and causes of paediatric hospital-acquired bacteraemia in Kilifi District Hopsital, Kenya: a prospective cohort study. Lancet. 2011;378:2021–7. https://doi.org/10.1016/S0140-6736(11)61622-X.
  3. Dramowski A, Cotton MF, Rabie H, Whitelaw A. Trends in paediatric bloodstream infections at a south African referral hospital. BMC Paediatrics. 2015;15:33–44. https://doi.org/10.1186/s12887-015-0354-3.
  4. Lochan H, Bamford C, Eley B. Blood cultures in sick children. S Afr Med J. 2013;103(12):918–20. https://doi.org/10.7196/SAMJ.6979.
  5. WHO/UNICEF. Integrated Management of Childhood Illness Chart Booklet. Geneva: WHO/UNICEF; 2008.

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