Bacterial aetiology and outcome of severe pneumonia among children aged 2-59 months admitted to the Acute Care Unit, Mulago Hospital
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Introduction: Acute lower respiratory tract infections (ALRI) are a major cause of morbidity and mortality in the "under fives" worldwide, accounting for 10-30% of childhood deaths. Pneumonia contributes up to 50% of all ALRI. It causes 1.6-2.2 million deaths worldwide, 70% of them in developing countries, and is responsible for up to 19% of overall mortality. We undertook a study to describe the bacterial aetiology, antimicrobial sensitivity patterns and outcome of severe pneumonia among children aged 2-59 months admitted in Acute Care Unit Mulago Hospital. Methods: Between December 2005 and March 2006, a cross sectional descriptive study of 157 children aged 2-59 months admitted with severe pneumonia was done. The history, physical examination and investigations such as blood culture, induced sputum for culture and sensitivity and chest X-rays were done. The children were followed up for a maximum of seven days. The data collected was entered using EPI-INFO and analysed with SPSS packages. Results: Bacteraemia was present in 15.9% of the 157 children. The commonest organisms causing bacteraemia were Staphylococcus aureus (36%), Streptococcus pneumoniae (28%). Fifty four (54%) of the children had bacteria isolated from their sputum and the commonest organisms were Streptococcus pneumoniae, Haemophilus influenzae and Klebsiella species accounting for 45.9%, 23.5% and 22.4% of the total isolates respectively. Most of the organisms isolated were sensitive to ceftriaxone, ciprofloxacin and amoxicillin-clavulinic acid in up to 95% of cases. Death occurred in 24 (15.3%) of the 157 children studied. Most of the children (66.7%) had bacterial pneumonia. The predictors of death were very severe pneumonia (OR 12.9), oxygen saturation on admission <92% (OR 4.9) and malnutrition (OR 16.5). Conclusions: Bacteria were isolated in 54% of children aged 2-59 months. The commonest bacteria isolated were Streptococcus pneumoniae (45.9%), Haemophilus influenzae (23.5%) and Klebsiella species (22.4%). Majority of the organisms were sensitive to ceftriaxone. Streptococci pneumoniae, the commonest cause of severe pneumonia, was sensitive to chloramphenicol in 87.4% of cases. The case fatality rate among children with severe pneumonia was 15.3%, while 1.9% developed complications. One hundred and thirty (82.8%) showed clinical improvement within 7 days. The independent predictors of death were malnutrition, arterial oxygen saturation less than 92% and having very severe pneumonia. Recommendations: Children with severe pneumonia should be routinely assessed for arterial oxygen saturation, severity of pneumonia and nutritional status because these are predictors of adverse outcome. A study to determine the most efficacious antibiotic for treatment of severe pneumonia in children in Mulago Hospital is recommended.