THE PATTERN OF BACTERAEMIA IN CHILDREN WITH SEVERE PROTEIN ENERGY MALNUTRITION AT THE UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN

Abstract

Protein energy malnutrition is estimated to affect every fourth child in the developing
world. The combination of the immunological dysfunction of malnutrition and common
infectious diseases associated with malnutrition cause more than 250,000 deaths daily.

There is increasing resistance of bacterial pathogens to antimicrobial agents with little
data to determine the pattern of resistance of pathogens isolated in malnourished patients.
The paucity of literature on the agents of bacteraemia and their sensitivity pattern in
children with severe Protein Energy Malnutrition is the justification for this study.

The study was a case controlled, cross sectional, study in which eighty-six children were
subjects (severe PEM) and eighty well nourished. Age and sex matched children were
controls.

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The incidence of bacteraemia in the malnourished subjects was 52.3% with 13.9%
having multiple infections while the incidence of bacterial isolates in the control group
was significantly lower 21.3% (OR=3.08; X2=10.70 :p=0.001). Bacterial isolates in the
subjects included Staphylococcus aureus in 53.3%, Salmonella spp in 35%,
Pseudomonas spp in 8.9%, Escherichia coli and Klebsiella spp 6.7% each, Citrobacter
spp in 4.4%, Enterobacter spp and Staphylococcus saprophyticus in 2.2%. The isolates in
the control group include: Staphylococcus aureus in 47.6%, Salmonella spp in 23.8%,
Escherichia coli in 9.5% and Klebsiella spp in 9.5%. There was no significant difference
in most of the isolates (in both the severely malnourished and well-nourished subjects
and controls). Staphylococcus aureus (2 =0.03:p=0.87), Staphylococcus saprophyticus
(2=0.04:p=0.83), Salmonella spp(2=0.22:p=0.64), Pseudomonas spp(2=0.01:p=0.93),
Klebsiella spp(2=0.01:p=0.93), Escherichia coli(2=0.01:p=0.93), Citrobacter
spp(2=0.04:p=0.83) and Enterobacter spp(2=0.15:p=0.69)

The incidence of Urinary Tract Infections of 10.5% in malnourished subjects was
comparable to that of controls of 2.5% (p=0.8). The incidence of enteric infections in the
subjects was 20.9% compared to 8.75% in the controls this was not significant (P=0.05).

Concomitant bacteraemia, urinary tract infections and enteric infections occurred in
3.5% of the malnourished subjects. Urinary tract infections and bacteraemia occurred in
3.5% while enteric infections and bacteraemia occurred in 5.8%, enteric infections and
urinary tract infections occurred in 1.2% of the malnourished children.
The sensitivity pattern of all the isolates in the malnourished subjects showed the isolates
had 65% sensitivity to amoxicillin-clavunalate and gentamicin, 90% to ceftriaxone, 91%
to ceftazidime, 81% to ofloxacin and 96% to ciprofloxacin..

Based on these findings, the use of a third generation cephalosporin (ceftriaxone or
ceftazidime) as a first line antibiotic in the treatment of children with severe PEM is
proposed with the Flouroquinolones as a second line drugs.

THE PATTERN OF BACTERAEMIA IN CHILDREN WITH SEVERE PROTEIN ENERGY MALNUTRITION AT THE UNIVERSITY OF ILORIN TEACHING HOSPITAL, ILORIN