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Open Access Research article

Community Acquired Bacteremia in Young Children from Central Nigeria- A Pilot Study

Stephen Obaro12*, Lovett Lawson3, Uduak Essen3, Khalid Ibrahim1, Kevin Brooks1, Adekunle Otuneye2, Denis Shetima2, Patience Ahmed2, Theresa Ajose3, Michael Olugbile3, David Idiong3, Damola Ogundeji2, Comfort Ochigbo3, Grace Olanipekun3, Walid Khalife1 and Richard Adegbola4

Author Affiliations

1 Michigan State University, East Lansing 48824, Michigan, USA

2 Visiting Consultant Paediatrician, National Hospital, Abuja, Nigeria

3 Chief Medical Director, Zankli Medical Center, Abuja, Nigeria

4 Medical Research Council Laboratories, Fajara, The Gambia

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BMC Infectious Diseases 2011, 11:137  doi:10.1186/1471-2334-11-137

Published: 19 May 2011

Abstract

Background

Reports of the etiology of bacteremia in children from Nigeria are sparse and have been confounded by wide spread non-prescription antibiotic use and suboptimal laboratory culture techniques. We aimed to determine causative agents and underlying predisposing conditions of bacteremia in Nigerian children using data arising during the introduction of an automated blood culture system accessed by 7 hospitals and clinics in the Abuja area.

Methods

Between September 2008 and November 2009, we enrolled children with clinically suspected bacteremia at rural and urban clinical facilities in Abuja or within the Federal Capital Territory of Nigeria. Blood was cultured using an automated system with antibiotic removing device. We documented clinical features in all children and tested for prior antibiotic use in a random sample of sera from children from each site.

Results

969 children aged 2 months-5 years were evaluated. Mean age was 21 ± 15.2 months. All children were not systematically screened but there were 59 (6%) children with established diagnosis of sickle cell disease and 42 (4.3%) with HIV infection. Overall, 212 (20.7%) had a positive blood culture but in only 105 (10.8%) were these considered to be clinically significant. Three agents, Staphylococcus aureus (20.9%), Salmonella typhi (20.9%) and Acinetobacter (12.3%) accounted for over half of the positive cultures. Streptococcus pneumoniae and non-typhi Salmonellae each accounted for 7.6%. Although not the leading cause of bacteremia, Streptococcus pneumoniae was the single leading cause of all deaths that occurred during hospitalization and after hospital discharge.

Conclusion

S. typhi is a significant cause of vaccine-preventable morbidity while S. pneumoniae may be a leading cause of mortality in this setting. This observation contrasts with reports from most other African countries where non-typhi Salmonellae are predominant in young children. Expanded surveillance is required to confirm the preliminary observations from this pilot study to inform implementation of appropriate public health control measures.