Bacteraemia in patients admitted to an urban hospital in West Africa

• Main Authors: Howie Stephen R, Donkor Simon A, Simmonds Naomi, Ameyaw Samuel, Secka Ousman, Ikumapayi Usman NA, Onyeama Charles O, Hill Philip C, Tapgun Mary, Corrah Tumani, Adegbola Richard A
• Format: Article
• Language: English
• Published: BMC 2007-01-01
• Series: BMC Infectious Diseases
• Online Access: http://www.biomedcentral.com/1471-2334/7/2

<p>Abstract</p> <p>Background</p> <p>Few studies on bacteraemia in Africa have been published. We aimed to prospectively identify the causative organisms of bacteraemia in The Gambia and their relation to clinical diagnoses, outcome and antimicrobial susceptibility.</p> <p>Methods</p> <p>Between November 2003 and February 2005 we studied those admitted to the Medical Research Council hospital who were suspected of having bacteraemia. We documented clinical features, outcome, pathogens identified and their susceptibility patterns, and searched for factors associated with bacteraemia.</p> <p>Results</p> <p>871 patients were admitted and had a blood culture taken. The median age was 2 years (range 2 months to 80 years) and 36 of 119 tested were HIV positive; 54.5% were male. 297 (34%) had a positive result and 93 (10.7% overall) were considered a genuine pathogen. Those with bacteraemia were more likely to die in hospital (OR 2.79; 1.17–6.65, p = 0.017) and to have a high white cell count (WCC; OR 1.81;95% CI 1.09–3.02; p = 0.022). Three organisms accounted for 73% of bacteraemias: <it>Streptococcus pneumoniae </it>(45.2%), <it>Staphylococcus aureus </it>(18.3%) and <it>Escherichia coli </it>(9.7%) while non-typhoidal salmonellae (NTS) accounted for 8.6%. Antimicrobial susceptibility of <it>S. pneumoniae </it>was very high to penicillin (97.5%); high resistance was found to co-trimoxazole. <it>S. aureus </it>was generally highly susceptible to cloxacillin, gentamicin and chloramphenicol. <it>E. coli </it>and NTS were all susceptible to ciprofloxacin and mostly susceptible to gentamicin. Thirteen (33%) <it>S. pneumoniae </it>isolates were of serotypes contained in a 7-valent pneumococcal conjugate vaccine and 20 (51.3%) were of the same serogroup.</p> <p>Conclusion</p> <p>In The Gambia, those with bacteraemia are more likely than those without to die in hospital and to have a raised peripheral blood WCC. <it>S. pneumoniae</it> is the most common organism isolated. Introduction of a pneumococcal conjugate vaccine can be expected to lead to a reduction in disease incidence.</p>