Epidemiology of Community-acquired Bacteremia Among Children One to Fifty-nine Months of Age Admitted to a Tertiary Hospital in Harar, Eastern Ethiopia

Abstract

Background: Community-acquired bacteremia is a leading cause of mortality in children <5 years of age in Ethiopia, yet data on etiology are scarce. We described the etiology and risk factors for bacteremia and in-hospital mortality in a tertiary hospital in eastern Ethiopia.

Methods: Clinical surveillance was conducted at Hiwot Fana Comprehensive Specialized Hospital from December 2021 to November 2023. All admitted children 29 days to 59 months old were eligible for blood culture collection, excluding elective surgery or poisoning.

Results: Of 3384 admissions, 2366 were sampled; 2070 had uncontaminated blood cultures, and 236 (11.4%) had bacteremia. The incidence risk was 69.7 per 1000 admissions. Klebsiella oxytoca (n = 59, 25.0%) and Klebsiella pneumoniae (n = 30, 12.7%) were the most common pathogens. The leading Gram-positive pathogen was Streptococcus pneumoniae (n = 16, 6.8%). Gram-negative bacteria showed high resistance to ampicillin and gentamicin. Of 2070, 122 died, yielding a case fatality ratio of 13.1% in bacteremia cases compared to 5.0% in nonbacteremic cases. Severe wasting [adjusted odds ratio, 1.49, (95% confidence interval: 1.10-2.01)] was associated with bacteremia risk. Bacteremic cases had a high risk of death across all nutritional statuses, while nonbacteremic admissions exhibited increased mortality risk with the severity of the nutritional status.

Conclusion: A high proportion of children admitted to Hiwot Fana Comprehensive Specialized Hospital had bacteremia with attendant high mortality. K. oxytoca was the commonest cause, showing significant resistance to first-line antimicrobials.

Keywords: Ethiopia; bacteremia; child mortality; children; surveillance.

FIGURE 1.

Flow diagram of children 29 days–59 months of age admitted to Hiwot Fana Comprehensive Specialized Hospital between December 1, 2021 and November 30, 2023.