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dc.contributor.authorKemigisha, E
dc.contributor.authorNanjebe, D
dc.contributor.authorBoum, Y
dc.contributor.authorLangendorf, Céline
dc.contributor.authorAberrane, S
dc.contributor.authorNyehangane, D
dc.contributor.authorNackers, F
dc.contributor.authorMueller, Y
dc.contributor.authorCharrel, R
dc.contributor.authorMurphy, RA
dc.contributor.authorPage, AL
dc.contributor.authorMwanga-Amumpaire, J
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.
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
refterms.dateFOA2019-03-04T14:09:33Z
html.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.


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