Resistant Bacteria in Children with Community-Acquired Febrile Illness in a Tertiary Hospital in Nigeria

Author(s): Shittu Abdulwahab Adewale, Oseni Saheed BA, Aboderin Aron Oladipo

Background: Blood bacterial infection is a cause of serious illness in children, especially the antibiotic resistant organisms. Since there is variation in the causative organisms with different location, there is need to determine the burden in our location aside the low data recorded. This study determined prevalence of bacteraemia, resistance pattern of implicated organisms and the role of Procalcitonin (PCT) in children with Community Acquired Bacteraemia (CAB) at a tertiary hospital in Nigeria. It is to enhance focus on antibiotic stewardship in clinical practice. Methods: Children clinically suspected to have bacteraemia at presentation during 13 months of the period of study were recruited. Their blood samples were cultured and assayed for serum procalcitonin. Antibiotic resistance was determined on isolated bacteria, and polymerase chain reaction was used to confirm implicated genes. The data generated were analyzed using appropriate descriptive and inferential statistics. Results: A total of 343 children ≤ 14-years were evaluated, and 94 (27.4%) had bacteraemia. The most common organisms were Staphylococcus aureus (n=66; 70.2%), Stenotrophomonas maltophilia (n=7; 7.4%), and coagulase negative staphylococci (n=6; 6.4%). More than fifty percent of all the isolates were multidrug-resistant. Twenty-one of 21 Staphylococcus aureus had mecA gene and three Gram-negative isolates had at least one of blaCTX-M/blaSHV/blaTEM genes. Elevated serum procalcitonin level was significantly associated with bacteraemia (χ²=21.652, ρ =<0.001), sensitivity of 83.0% and negative predictive value of 87.3% (80.4-92.0). Congenital malformation was most associated with community acquired bacteraemia. Conclusion: Nearly 30% of children suspected with bacteraemia in the studied population had positive blood-culture. The most isolated pathogen was Staphylococcus aureus; and a third of the pathogens were multi-drug resistant. Procalcitonin assay is useful in excluding bacteraemia in febrile children. Resistant bacteria pathogens are not uncommon in the community.