Stephen K Obaro1, Fatimah Hassan-Hanga2, Eyinade K Olateju3, Dominic Umoru4, Lovett Lawson5, Grace Olanipekun6, Sadeeq Ibrahim7, Huda Munir8, Gabriel Ihesiolor8, Augustine Maduekwe9, Chinatu Ohiaeri10, Anthony Adetola11, Denis Shetima12, Binta W Jibir13, Hafsat Nakaura14, Nicholas Kocmich15, Therasa Ajose6, David Idiong16, Kabir Masokano17, Adeyemi Ifabiyi6, Nnenna Ihebuzor18, Baojiang Chen19, Jane Meza19, Adebayo Akindele6, Amy Rezac-Elgohary15, Rasaq Olaosebikan15, Salman Suwaid13, Mahmoud Gambo2, Roxanne Alter20, Herbert D Davies21, Paul D Fey20. 1. Division of Pediatric Infectious Diseases Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha International Foundation Against Infectious Diseases in Nigeria, Abuja Department of Pediatrics Department of Pediatrics, University of Abuja Teaching Hospital, Gwagwalada. 2. Department of Pediatrics. 3. Department of Pediatrics, University of Abuja Teaching Hospital, Gwagwalada. 4. Department of Pediatrics, Nyanya General Hospital. 5. Zankli Medical Center, Utako. 6. International Foundation Against Infectious Diseases in Nigeria, Abuja. 7. Department of Pediatrics Department of Medical Microbiology, Aminu Kano Teaching Hospital. 8. Department of Medical Microbiology, Aminu Kano Teaching Hospital. 9. Department of Pediatrics, Wuse General Hospital, Abuja, Federal Capital Territory. 10. Department of Pediatrics, Federal Medical Center, Keffi, Nassarawa State. 11. Department of Pediatrics, Asokoro General Hospital. 12. Department of Pediatrics, National Hospital, Central Business Area, Abuja, Federal Capital Territory. 13. Department of Pediatrics, Murtala Specialist Hospital. 14. Hasiya Bayero Pediatric Hospital, Kano. 15. Division of Pediatric Infectious Diseases. 16. International Foundation Against Infectious Diseases in Nigeria, Abuja Department of Microbiology, Bingham University, Karu, Nassarawa State. 17. Hospital Services Management Board, Kano. 18. National Primary Health Care Development Agency, Abuja, Federal Capital Territory, Nigeria. 19. Department of Biostatistics, College of Public Health. 20. Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha. 21. Division of Pediatric Infectious Diseases Department of Biostatistics, College of Public Health Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha.
Abstract
BACKGROUND: Etiologic agents of childhood bacteremia remain poorly defined in Nigeria. The absence of such data promotes indiscriminate use of antibiotics and delays implementation of appropriate preventive strategies. METHODS: We established diagnostic laboratories for bacteremia surveillance at regional sites in central and northwest Nigeria. Acutely ill children aged <5 years with clinically suspected bacteremia were evaluated at rural and urban clinical facilities in the Federal Capital Territory, central region and in Kano, northwest Nigeria. Blood was cultured using the automated Bactec incubator system. RESULTS: Between September 2008 and April 2015, we screened 10,133 children. Clinically significant bacteremia was detected in 609 of 4051 (15%) in the northwest and 457 of 6082 (7.5%) in the central region. Across both regions, Salmonella species account for 24%-59.8% of bacteremias and are the commonest cause of childhood bacteremia, with a predominance of Salmonella enterica serovar Typhi. The prevalence of resistance to ampicillin, chloramphenicol, and cotrimoxazole was 38.11%, with regional differences in susceptibility to different antibiotics but high prevalence of resistance to readily available oral antibiotics. CONCLUSIONS: Salmonella Typhi is the leading cause of childhood bacteremia in central Nigeria. Expanded surveillance is planned to define the dynamics of transmission. The high prevalence of multidrug-resistant strains calls for improvement in environmental sanitation in the long term and vaccination in the short term.
BACKGROUND: Etiologic agents of childhood bacteremia remain poorly defined in Nigeria. The absence of such data promotes indiscriminate use of antibiotics and delays implementation of appropriate preventive strategies. METHODS: We established diagnostic laboratories for bacteremia surveillance at regional sites in central and northwest Nigeria. Acutely ill children aged <5 years with clinically suspected bacteremia were evaluated at rural and urban clinical facilities in the Federal Capital Territory, central region and in Kano, northwest Nigeria. Blood was cultured using the automated Bactec incubator system. RESULTS: Between September 2008 and April 2015, we screened 10,133 children. Clinically significant bacteremia was detected in 609 of 4051 (15%) in the northwest and 457 of 6082 (7.5%) in the central region. Across both regions, Salmonella species account for 24%-59.8% of bacteremias and are the commonest cause of childhood bacteremia, with a predominance of Salmonella enterica serovar Typhi. The prevalence of resistance to ampicillin, chloramphenicol, and cotrimoxazole was 38.11%, with regional differences in susceptibility to different antibiotics but high prevalence of resistance to readily available oral antibiotics. CONCLUSIONS:Salmonella Typhi is the leading cause of childhood bacteremia in central Nigeria. Expanded surveillance is planned to define the dynamics of transmission. The high prevalence of multidrug-resistant strains calls for improvement in environmental sanitation in the long term and vaccination in the short term.
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