Nosocomial bacterial infections among children with severe protein energy malnutrition

Abstract

The incidence of hospital acquired acute bacterial infections among 164 severely malnourished children admitted to the paediatric wards at the Muhimbili Medical Centre in Dar es Salaam were studied. On admission, ninety two per cent of the patients had at least one form of bacterial infection. During the subsequent two weeks hospital stay, 49% of the patients acquired a new infection. Septicaemia and urinary tract infection (UTI) were the commonest infections. Staphylococcus aureus was the commonest organism in the former, while gram negative organisms, Escherichia coli and Klebsiella species, were predominant in the latter. Pathogens similar to those found from patients were cultured from random samples taken from the floor, beds, towels, sinks and antiseptic containers in the wards. Sensitivity patterns of isolated pathogens to antimicrobial agents showed that S. aureus was highly sensitive to cloxacillin, erythromycin, and gentamicin, while the gram negative organisms were highly sensitive to gentamicin. Our study shows that the problem of nosocomial infection in paediatric wards requires urgent attention. There is a need to institute preventive measures including provision of proper nursing care, maintenance of sterile environment, and reduction of duration of hospital stay.

PIP: The incidence of hospital acquired acute bacterial infections among 164 several malnourished children admitted to the pediatric wards at the Muhimbili Medical Centre in Dar es Salaam, Tanzania, were studied. On admission, a thorough physical examination and blood and urine cultures were done on each child. Cultures from ears, throat, skin, rectum, or stools were taken. 89 (54%) were males and 75 (46%) were females with an age range of 2-59 months. 90 (55%) had marasmus, 39 (24%) had kwashiorkor, and 35 (21%) had marasmic-kwashiorkor. On admission, 32 (82%) of the kwashiorkor cases and 88 (98%) of the marasmus cases had at least 1 bacterial infection (p 0.05), a statistically significant difference. The children were followed up for 2 weeks when repeat blood and urine cultures were done for all. Antibiotic sensitivity was determined by the single disc diffusion method for antimicrobial agents used (penicillin, ampicillin, erythromycin, gentamicin, cloxacillin, chloramphenicol, contrimoxazole, nitrofurantoin, and sulphonamide). Samples were taken from randomly selected sites in the wards: 20 from floors, 20 from sinks, 20 from towels, 20 from beds, and 20 from antiseptic container. By the end of their stay in the hospital, 80 (49%) of the patients had acquired a nosocomial infection. 24 (62%) kwashiorkor cases had a nosocomial infection, while 15 (44%) of marasmus-kwashiorkor as well as 41 (45%) of the marasmus patients had such an infection. 72% of female patients were at a higher risk of acquiring an infection compared with the males (46%) (P 0.05). E. coli and Klebsiella species were the most frequently detected organisms in urine, while Staphylococcus aureus was most common in blood. Of the 100 specimens taken from the wards, 38 yielded S. aureus, 26 yielded Klebsiella species, 10 had Streptococcus faecalis, and 4 had E. coli. Erythromycin, cloxacillin, and gentamicin had a strong effect against s. aureus. Klebsiella species and E. coli were completely sensitive to gentamicin. All 10 isolates of S. faecalis from the wards were sensitive to ampicillin, erythromycin, and penicillin.