Bacterial isolates, antibiotic susceptibility, and determinants of positive blood culture in children with community-acquired pneumonia in Central Tanzania

TL;DR

This study in Tanzania found that a significant number of children with pneumonia had blood infections caused by bacteria resistant to common antibiotics.

Contribution

The study identifies factors predicting blood culture positivity and highlights antibiotic resistance in bacterial isolates from children with pneumonia.

Findings

Bacteremia was found in 7.2% of children with pneumonia, with Staphylococcus aureus being the most common bacteria.

Bacterial isolates showed resistance to WHO-recommended antibiotics like penicillin and cephalosporins.

Factors like high fever, low oxygen, and high respiratory rate predicted positive blood cultures.

Abstract

despite the widespread coverage of Haemophilus influenzae type b (Hib) and pneumococcal conjugate vaccines, the mortality of children under five years due to community-acquired pneumonia (CAP) in Tanzania remains unacceptably high. This study aimed to identify bacterial isolates, antibiotic susceptibility, and factors associated with blood culture positivity in children under five with CAP.

a cross-sectional study involving 195 children under-five years of age who were clinically diagnosed with CAP was conducted at a referral hospital in central Tanzania from October 2018 to March 2019. Blood samples were taken, identification of culture isolates was performed through conventional bacteriological methods, followed by antibiotic susceptibility testing. Demographic and other data were collected using a standardized tool.

bacteremia was prevalent in 7.2% of participants, with Staphylococcus aureus being the most common isolate (57.1%). Overall, isolates were less sensitive to the WHO first-line antibiotics recommended for CAP treatment (penicillin and cephalosporins) but were sensitive to ciprofloxacin and clindamycin. Fever (>38.5°C), oxygen saturation (<90%), the need for oxygen therapy, a high respiratory rate (>60 cycles/minute), and leucocytosis (>15,000 cells/μl) were independent factors associated with positive blood culture.

bacteraemia in children with CAP was nearly 10%, predicted by high respiratory rates, hypoxia, fever, and leucocytosis. Most of the isolates were insensitive to antimicrobials listed in the WHO-recommended first-line treatment for CAP, outlining the importance of routine culture and antimicrobial susceptibility.

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