Prevalence and factors associated with concomitant bacteremia among adults admitted with severe malaria at Kayunga Regional Referral Hospital, Uganda

TL;DR

This study finds that about 14.5% of adults with severe malaria in Uganda also have bacteremia, with certain symptoms and lab results indicating higher risk.

Contribution

The study provides new data on bacteremia prevalence and risk factors in adults with severe malaria in a Ugandan hospital setting.

Findings

14.5% of adults with severe malaria had bacteremia.

CNS symptoms, low oxygen saturation, hyperparasitaemia, and leucocytosis were linked to higher bacteremia risk.

Salmonella typhi, Staph aureus, and Streptococcus spp. were the most common bacteria.

Abstract

Malaria-bacteremia co-infection significantly increases mortality and the risk of ICU admission. Diagnostic overlap with bacterial infections often results in misdiagnosis, impacting outcomes. While pediatric data exists, adult studies in Uganda are limited. This study aimed to determine the prevalence, bacterial isolates, and associated factors of bacteremia in adults with severe malaria at Kayunga Regional Referral Hospital.

A cross-sectional study enrolled 207 adults with severe malaria. Blood samples were cultured, and isolates tested for antimicrobial susceptibility. Sociodemographic, clinical, and laboratory data were collected using structured tools. Logistic regression in SPSS version 26 was done to determine the significant factors. The outcome predicted was the presence of bacterium. P < 0.05 was considered significant.

Of the 207 participants, 14.5% had bacteremia. Central nervous system (CNS) symptoms, low peripheral oxygen saturation (SPO2), hyperparasitaemia, and leucocytosis were significantly associated with bacteremia. Salmonella typhi (33.3%), Staph aureus (30%), and Streptococcus spp. (16.7%) were the most common isolates. Ciprofloxacin and penicillin derivatives showed strong coverage.

The prevalence of bacteremia among patients with malaria was high, seen in over one of every seven patients with malaria. Malaria patients with CNS symptoms, low peripheral oxygen saturation, malaria hyperparasitaemia and leucocytosis should be considered to be at high risk for bacteremia. If bacteria co-infection is suspected among patients with malaria, in the absence of culture and sensitivity results, a combination of ciprofloxacin and a penicillin can be considered since these two can provide an acceptable cover of the most common isolates, yet readily available in our resource limited setting.

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