Clinical profile and antimicrobial susceptibility of pneumococcal bacteremia among febrile patients admitted to the emergency medical ward at Mulago Hospital.

Abstract

INTRODUCTION: Streptococcus pneumonia is a major cause of morbidity and mortality worldwide more especially in the immunocompromised individuals. An estimated 50-60% of in-patients on the medical wards of Mulago hospital are immunocompromised due to HIV infection. Increasing resistance of S. pneumoniac bacteremia to available antimicrobial agents may worsen clinical outcome in resource constrained settings. There are limited data on prevalence, clinical profile and antimivrobial susceptibity of S. pneumoniac bacteremia among hospitalized patients in Uganda. OBJECTIVES: To determine the prevalence, clinical profile and antimicrobial susceptibility patterns of S. Pneumoniac among febrile patients admitted to the emergency medical ward at mulago hospital. METHODS: Descriptive cross sectional study with follow up of patients with confimed S. Pneumoniac becteremia on blood culture. Febrile patients with an oral temperature of ≥ 37.8Oc were sampled consecutively until the sample size was achieved. Using a standardized questionnaire, data on socio-demographics clinical features and outcome were collected. Blood was drawn for complete blood count, serum chemistry, bacterial culture and sensitivity. Data was analyzed using SPSS version 12.0. STUDY SETTING: Emergency medical ward, Mulago Hospital Kampala, Uganda. STUDY PARTICIPANTS: A total of 386 febrile patients aged 13-81 years, who were admitted from November 2006 to March 2007 in the emergency medical wards were enrolled. RESULTS: The prevalence of S. pneumoniac bacteremia was 9.8% (38/386). Of these, 68 (26/38) were HIV infected. The mean oral temperature was 38.6Oc and mean duration of fever was 3 weeks. Cough was reported by 78.9% (30/38) ahd headache by 36.8% (14/38) with a mean duration of 3 weeks. Cirarette smoking was reported by 15.8%. Multilobar consolidation on chest x-ray, was noted in 58% 911/19). The mean neutrophil percentage was 77.4 +_ 12.6% with a neutrophilia of ≥ 75% present in 68% (26/38). Impaired renal function with creatinine of ≥ 1.3mg/dl was found in 68% (26/38). Cough (p=0.014), chest signs (p=0.048), meningeal signs (p=0.001), neutrophil percentage (p=0.004), Multilobar consolidation (p=0.001) were significantly associated with S. Pneumoniac bacteremia, but cigarette smoking (p=0.775) was not. All S.Pneumoniac bacteremia isolates were resistant to cotrimoxazole, but all were susceptible to penicillin. On follow up of the patients, the mean hospital stay was 8.6 days; 34.2% developed septicaemia, 28.9% pneumonia while 13.0% developed meningitis. Complete recovery was noted in 78.9% (30/38), and mortality in 7.9% (3/38) due to meningitis. Other bacteria isolated included salmonella 3.4% (13/386, stsphylococcus aureus 1.6% (6/386), pseudomonas aeruginosa 5, E.coli 5, Klebsiella Pneumoniac 3, Haemophilus influenza 2, Acinetobacter 2 and Norcadia 1. CONCLUSION: S.Pneumoniae bacteremia is common among febrile patients admitted on the medical emergency ward at Mulago hospital. Presentation is characterized by fever, cough and headache. The isolates are resistant to cotrimoxazole and penicillin which are the commonly available antibiotics. Mortality is more likely in patients with leucopenia, anamia, HIV infection, meningitis and dehydration.