Prevalence, Aetiology and associated factors of bacteraemia among febrile children with sickle cell anaemia presenting to Mulago hospital.

Abstract

BACKGROUND: Bacteraemia is a common occurenace in children with sickle cell anaemia in whom it is frequently associated with high morbidity and mortality. The prevalence, causative organisms and their sensitivity patterns have been shown to vary from palce to place. However, in uganda there is scanty information on the prevalence, aetiology and associated factors of bacteraemia among febrile children with sickle cell anaemia. OBJECTIVE: To determine the prevalence, aetiology and associted factors of bacteraemia among febrile children with sickle cell anaemia presenting to Mulago hospital in Kampala, Uganda. METHODOLOGY: This was a descriptive cross sectional study carried out from October 2001 to January 2002 in the acute care unit and sickle cell clinic of mulago hospital kampala, the national referral and teaching hospital. One hundred and seventy three children with axillary temperatures >_ 38.0 C known sickle cell anaemia and aged 12 years and below were studied. Relevant history, physical examination and a sample of blood was taken from these children. Blood was screened for malaria parasites. Blood and urine cultures were obtained. Antimicrobial sensitivity of isolated organisms was determed. Chest x-rays were taken for some of the children with respiratory findings. MAIN OUTCOME MEASUREMENTS: The main measurements were the prevalence, aetiology and associated factors (such as age, immunization status, signs and symptoms) of bacteraemia among febrile children with sickle cell anaemia. DATA ANALYSIS: The data was analyzed using Epi-Info 6.04 and SPSS 7.0. Children were categorized as having bacteraemia or no bacteraemia. Differences between the two groups were assessed using the chi-squared test for categorical variables and student's t test for continous variables. Logistic regression was used to determine variables assiciated with bacteraemia. RESULTS: Of the 173 febrile children studied, 28.3% had positive blood cultures while 8% had positive urine cultures. The age range was 4 months to 12 years with a mean ag of 5 years and median of 4.5 years. The predominant organism in the blood stream was staphylococcus aureus (57.1%), followed by Haemophilus influnzae (22.4%). Others included coagulase negative staphylococcus (10.2%), Streptococcus pneumoniae (6.2%), Streptococcus viridans (2%) and Escherichia coli (2%). Most of the isolated organisms were sensitive to cefuroxime, ciprofloxacin, cloxacillin, gentamicin and chloramphenicol but resistant to cotrimoxazole and penicillin. With the exception of staphylococcus aureus the rest of the isolated organisms were sensitive to ceftriaxone. In urine, the organisms isolated were Escherichia coli (64.2%), Klebsiella pneumoniac (22%), Staphylococcus aureus (7%) and coagulase negative staphylococcus (7%). These were sensitive to ciprofloxazole, ampicillin and penicillin. Factors significantly associated with occurrence of bacteraemia were age less than 5 years (p=0.003), being female (p=0.032), a history of bone pains (p=0.001) and splenomegally (p=0.0285) Other causes of fever among these children included pneumonia (26%) and malaria (15%). However in (42.5%) of the patients, the causes of fever could not be established. CONCLUSIONS: About one third of the febrile children with sickle cell anaemia had positive blood cultures. The most common organism isolated was staphylococcus aureus. Of note was the low isolation of streptococcus pneumonia and none of salmonella species. RECOMMENDATIONS: This study suggests either ciprofloxacin or a combination of cloxacillin or gentamicin with chloramphenicol would be appropriate as first line drugs for the initial treatment of febrile children with SCA and suspected bacteraemia.