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Open Access Highly Accessed Research article

Systemic bacteraemia in children presenting with clinical pneumonia and the impact of non-typhoid salmonella (NTS)

Norbert G Schwarz1*, Nimako Sarpong2, Frank Hünger2, Florian Marks3, Samuel EK Acquah2, Alex Agyekum2, Bernard Nkrumah2, Wibke Loag1, Ralf M Hagen1, Jennifer A Evans4, Denise Dekker2, Julius N Fobil1, Christian G Meyer1, Jürgen May1 and Yaw Adu-Sarkodie5

Author Affiliations

1 Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany

2 Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana

3 International Vaccine Institute, Seoul, South Korea

4 University Hospital of Wales, Cardiff, UK

5 School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

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BMC Infectious Diseases 2010, 10:319  doi:10.1186/1471-2334-10-319

Published: 4 November 2010

Abstract

Background

The diagnosis and antimicrobial treatment of pneumonia in African children in the absence of diagnostic means such as x-ray facilities or microbiological laboratories relies primarily on clinical symptoms presented by the patients. In order to assess the spectrum of bacterial pathogens, blood cultures were performed in children fulfilling the clinical criteria of pneumonia.

Methods

In total, 1032 blood cultures were taken from children between 2 months and 5 years of age who were admitted to a rural hospital in Ghana between September 2007 and July 2009. Pneumonia was diagnosed clinically and according to WHO criteria classified as "non-severe pneumonia" and "severe pneumonia" ("severe pneumonia" includes the WHO categories "severe pneumonia" and "very severe pneumonia").

Results

The proportion of bacteriaemia with non-typhoid salmonella (NTS) was similar in children with pneumonia (16/173, 9.2%) compared to children hospitalized for other reasons (112/859, 13%). NTS were the predominant organisms isolated from children with clinical pneumonia and significantly more frequent than Streptococcus pneumoniae (8/173, 4.6%). Nine percent (9/101) of children presenting with severe pneumonia and 10% (7/72) of children with non-severe pneumonia were infected with NTS. Nineteen out of 123 NTS isolates (15%) were susceptible to aminopenicillins (amoxycillin/ampicillin), 23/127 (18%) to chlorampenicol, and 23/98 (23%) to co-trimoxazole. All NTS isolates were sensitive to ceftriaxone and ciprofloxacin.

Conclusion

In Sub-saharan Africa, sepsis with NTS should be considered in children with symptoms of pneumonia and aminopenicillins might often not be the adequate drugs for treatment.