Browsing by Subject "Paediatric Infectious Diseases"

Now showing 1 - 6 of 6
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    A ten-year review of ESBL and non-ESBL Escherichia Coli Bloodstream infections among children at a tertiary referral hospital in South Africa
    (2019) Malande, Oliver Ombeva; Eley, Brian; Nuttall, James
    Introduction: Bloodstream infection (BSI) is an important cause of morbidity and mortality in children (1). There are few descriptions of Escherichia coli (E. coli) BSI in children, particularly in Africa, yet E. coli is increasing in importance as a cause of antibiotic-resistant infection in paediatric settings. Methods: In this retrospective, descriptive study aspects of E. coli BSI epidemiology are described over a 10-year period including incidence risk, risk factors for extended spectrum β-lactamase (ESBL)- producing E. coli BSI, antibiotic susceptibility of the bacterial isolates and outcome including risk factors for severe disease. Results: There were 583 new E. coli BSI episodes among 217,483 admissions, an overall incidence risk of 2.7 events/1,000 hospital admissions. Of 455 of these E. coli BSI episodes that were analysed, 136 (29.9%) were caused by ESBL-producing isolates. Risk factors for ESBL-producing E. coli BSI included hospitalization in the 28-day period preceding E. coli BSI episodes and having an underlying chronic illness other than HIV infection at the time of the E. coli BSI. None of the E. coli isolates were resistant to carbapenems or colistin. The mortality rate was 5.9% and admission to the intensive care unit was required in 12.3% of BSI episodes. Predictors of severe disease included age less than 1 month, hospitalization in the 28-day period preceding E. coli BSI and BSI without a definable focus. Conclusions: These findings extend our understanding of E. coli BSI in a sub-Saharan African setting, provide useful information that can guide empiric treatment choices for community- and hospitalacquired BSI and help inform prevention strategies.
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    Candida bloodstream infection among children hospitalized in three public sector hospitals in the Metro West region of Cape Town, South Africa
    (2022) Gebremicael, Mulugeta Naizgi; Eley, Brian; Nuttall, James
    Introduction Candida bloodstream infection (BSI) causes appreciable mortality in children. There are few studies describing the epidemiology of Candida BSI in children living in the Western Cape province of South Africa. Methods A retrospective descriptive study was conducted at three public sector hospitals in Cape Town from January 2015 to December 2019. Demographic, clinical, antifungal management and patient outcome data were obtained by medical record review. Candida species and antifungal susceptibility results were extracted from the National Health Laboratory Service microbiology database Results Of the 97 Candida BSI episodes identified during the study period, 48/97 (49.5%) were C. albicans, 49/97 (50.5%) non-C. albicans species. The overall incidence risk was 0.84 Candida BSI episodes per 1000 admissions at Red Cross War Memorial Children's Hospital. Of the 77 Candida BSI episodes with available clinical information, median age (interquartile range) at the time of BSI was 6.8 (1.3-24.7) months, 46.8% were associated with moderate or severe underweight-for-age and vasopressor therapy was administered to 22 (28.6%) participants. Fluconazole resistance was documented among 25% and 0% of non-C. albicans and C. albicans isolates respectively. All Candida isolates tested were susceptible to amphotericin B and the echinocandins. The mortality rate within 30 days of BSI diagnosis was 17.3% (13/75). On multivariable analysis, concomitant bacterial infection during Candida BSI was associated with 30-day mortality, adjusted OR 5.7, 95% confidence interval: 1.4-24.0. Conclusion The study adds to the limited number of studies describing paediatric Candida BSI in sub Saharan Africa. Concomitant bacterial infection was associated with 30-day mortality.
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    Epidemiology of Staphylococcus aureus bacteraemia at a tertiary children's hospital in Cape Town, South Africa
    (2012) Naidoo, Reené; Eley, Brian; Nuttall, James
    Includes abstract. Includes bibliographical references.
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    Impact of measles epidemic at Red Cross Children's Hospital, 2009-2010 : a retrospective record review
    (2013) Le Roux, David Martin; Eley, Brian
    Includes abstract. Includes bibliographical references.
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    Longitudinal changes in clinical symptoms and signs in children with confirmed, unconfirmed, and unlikely pulmonary tuberculosis
    (2021) Copelyn, Julie; Eley, Brian; Zar, Heather
    Background: The paucibacillary nature of paediatric pulmonary tuberculosis (PTB) makes microbiological diagnosis difficult and limits the usefulness of microbiology for assessing treatment efficacy. Clinical response to treatment has thus been used by clinicians to monitor disease activity, as well as by researchers in clinical case definitions of intrathoracic TB to differentiate those with unconfirmed PTB from those with other lower respiratory tract infections (LRTIs). There is, however, limited data on the expected pattern and timing of resolution of symptoms and signs, and whether this does indeed differ between those with PTB and those without. Objectives: To longitudinally investigate clinical response to TB treatment in children treated for PTB, to compare this to the clinical course of children with other LRTIs, and to identify factors associated with persistence of symptoms and signs. Methods: This study is a secondary analysis of data collected prospectively in a TB diagnostic study from 1 February 2009 to 31 December 2018. We enrolled children ≤15 years with features suggestive of PTB. Study participants were categorized into 3 groups according to NIH consensus definitions; confirmed PTB, unconfirmed PTB and unlikely PTB. Children were followed at 1 and 3 months after enrolment. Those with confirmed or unconfirmed TB were also followed at 6 months. At enrolment and follow-up symptoms of PTB were recorded using a standardized questionnaire and physical examination was done including anthropometry and respiratory parameters. Data were analysed using STATA version 16.1. The effect of potential predictors of persistence of symptoms and signs was explored with univariable and multivariable logistic regression modelling. Results: Two thousand and nineteen children were included in this analysis, 427 (21%) with confirmed PTB, 810 (40%) with unconfirmed PTB, and 782 (39%) with unlikely PTB. Symptoms resolved rapidly in the vast majority of participants. At 1 month, 9.2% (129/1402) of all participants who had a cough and 11.1% (111/999) of those with loss of appetite at baseline reported no improvement in these symptoms. At 3 months this declined to 2.0% (24/1222) and 2.6% (23/886) respectively, with no differences between the groups. Clinical signs persisted in a greater proportion of participants. At 3 months, tachypnoea persisted in 56.7% (410/723) of participants. Abnormal auscultatory findings (including wheeze, crackles, reduced breath sounds or abnormal breath sounds) similarly persisted in almost a third of participants, with greater proportion in the confirmed group (37.1%) than unconfirmed (23.0%) and unlikely (26.2%) groups (p=0.002). Children living with HIV and those with abnormal baseline chest radiographs had greater odds of persistence of signs or symptoms (including cough, loss of appetite, abnormal auscultatory findings, or no weight improvement if underweight at baseline). No features of clinical response differentiated those with PTB from those without. Conclusion: Symptoms resolved rapidly in the majority of children investigated for PTB whilst clinical signs took longer to resolve. The timing and pattern of resolution of symptoms and signs cannot differentiate those with PTB from those without – and is thus not a suitable parameter for confirming disease classification in paediatric TB research.
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    Pseudomonas aeruginosa bloomstream infection at a tertiary referral hospital for children
    (2020) Dame, Joycelyn Assimeng; Eley, Brian; Nuttall, James
    Introduction This study describes the disease burden, clinical characteristics, antibiotic management, impact of multidrug resistance and outcome of Pseudomonas aeruginosa bloodstream infection (PABSI) among children admitted to a tertiary referral hospital for children in Cape Town, South Africa. Methods A retrospective descriptive study was conducted at a paediatric referral hospital in Cape Town, South Africa. Demographic and clinical details, antibiotic management and patient outcome information were extracted from medical and laboratory records. Antibiotic susceptibility results of identified organisms were obtained from the National Health Laboratory Service database. Results The overall incidence risk of PABSI was 5.4 PABSI episodes / 10,000 hospital admissions and the most common presenting feature was respiratory distress, 34/91 (37%). Overall, 69/91 (76%) of the PA isolates were susceptible to all antipseudomonal antibiotic classes evaluated. Fifty (55%) of the PABSI episodes were treated with appropriate empiric antibiotic therapy. The mortality rate was 24% and in multivariable analysis, empiric antibiotic therapy to which PA isolate was not susceptible to, infections present on admission, and not being in the intensive care unit at the time that PABSI was diagnosed were significantly associated with 14-day mortality. Conclusion The study provided insight into factors associated with PABSI in a tertiary hospital in SubSaharan Africa. Empiric antipseudomonal antibiotic therapy was associated with a decrease in 14-day mortality.