Antimicrobial treatment practices among Ugandan children with suspicion of central nervous system infection

Hdl Handle:
http://hdl.handle.net/10144/619271
Title:
Antimicrobial treatment practices among Ugandan children with suspicion of central nervous system infection
Authors:
Kemigisha, E; Nanjebe, D; Boum, Y; Langendorf, Céline; Aberrane, S; Nyehangane, D; Nackers, F; Mueller, Y; Charrel, R; Murphy, RA; Page, AL; Mwanga-Amumpaire, J
Journal:
PloS one
Abstract:
Acute central nervous system (CNS) infections in children in sub-Saharan Africa are often fatal. Potential contributors include late presentation, limited diagnostic capacity and inadequate treatment. A more nuanced understanding of treatment practices with a goal of optimizing such practices is critical to prevent avoidable case fatality. We describe empiric antimicrobial treatment, antibiotic resistance and treatment adequacy in a prospective cohort of 459 children aged two months to 12 years hospitalised for suspected acute CNS infections in Mbarara, Uganda, from 2009 to 2012. Among these 459 children, 155 had a laboratory-confirmed diagnosis of malaria (case-fatality rate [CFR] 14%), 58 had bacterial infections (CFR 24%) and 6 children had mixed malaria and bacterial infections (CFR 17%). Overall case fatality was 18.1% (n = 83). Of 219 children with laboratory-confirmed malaria and/or bacterial infections, 182 (83.1%) received an adequate antimalarial and/or antibiotic on the day of admission and 211 (96.3%) within 48 hours of admission. The proportion of those receiving adequate treatment was similar among survivors and non-survivors. All bacterial isolates were sensitive to ceftriaxone except one Escherichia coli isolate with extended-spectrum beta-lactamase (ESBL). The observed high mortality was not a result of inadequate initial antimicrobial treatment at the hospital. The epidemiology of CNS infection in this setting justifies empirical use of a third-generation cephalosporin, however antibiotic resistance should be monitored closely.
Publisher:
PLoS One
Issue Date:
9-Oct-2018
URI:
http://hdl.handle.net/10144/619271
DOI:
10.1371/journal.pone.0205316
PubMed ID:
30300411
Submitted date:
2018-10-15
Language:
en
ISSN:
1932-6203
Appears in Collections:
Paediatrics

Full metadata record

DC FieldValue Language
dc.contributor.authorKemigisha, Een
dc.contributor.authorNanjebe, Den
dc.contributor.authorBoum, Yen
dc.contributor.authorLangendorf, Célineen
dc.contributor.authorAberrane, Sen
dc.contributor.authorNyehangane, Den
dc.contributor.authorNackers, Fen
dc.contributor.authorMueller, Yen
dc.contributor.authorCharrel, Ren
dc.contributor.authorMurphy, RAen
dc.contributor.authorPage, ALen
dc.contributor.authorMwanga-Amumpaire, Jen
dc.date.accessioned2018-10-16T16:33:28Z-
dc.date.available2018-10-16T16:33:28Z-
dc.date.issued2018-10-09-
dc.date.submitted2018-10-15-
dc.identifier.citationAntimicrobial treatment practices among Ugandan children with suspicion of central nervous system infection. 2018, 13 (10):e0205316 PLoS ONEen
dc.identifier.issn1932-6203-
dc.identifier.pmid30300411-
dc.identifier.doi10.1371/journal.pone.0205316-
dc.identifier.urihttp://hdl.handle.net/10144/619271-
dc.description.abstractAcute central nervous system (CNS) infections in children in sub-Saharan Africa are often fatal. Potential contributors include late presentation, limited diagnostic capacity and inadequate treatment. A more nuanced understanding of treatment practices with a goal of optimizing such practices is critical to prevent avoidable case fatality. We describe empiric antimicrobial treatment, antibiotic resistance and treatment adequacy in a prospective cohort of 459 children aged two months to 12 years hospitalised for suspected acute CNS infections in Mbarara, Uganda, from 2009 to 2012. Among these 459 children, 155 had a laboratory-confirmed diagnosis of malaria (case-fatality rate [CFR] 14%), 58 had bacterial infections (CFR 24%) and 6 children had mixed malaria and bacterial infections (CFR 17%). Overall case fatality was 18.1% (n = 83). Of 219 children with laboratory-confirmed malaria and/or bacterial infections, 182 (83.1%) received an adequate antimalarial and/or antibiotic on the day of admission and 211 (96.3%) within 48 hours of admission. The proportion of those receiving adequate treatment was similar among survivors and non-survivors. All bacterial isolates were sensitive to ceftriaxone except one Escherichia coli isolate with extended-spectrum beta-lactamase (ESBL). The observed high mortality was not a result of inadequate initial antimicrobial treatment at the hospital. The epidemiology of CNS infection in this setting justifies empirical use of a third-generation cephalosporin, however antibiotic resistance should be monitored closely.en
dc.language.isoenen
dc.publisherPLoS Oneen
dc.rightsPublished by Public Library of Science, [url]http://www.plosone.org/[/url] Archived on this site by Open Access permissionen
dc.titleAntimicrobial treatment practices among Ugandan children with suspicion of central nervous system infectionen
dc.identifier.journalPloS oneen

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