Coagulase-negative staphylococcal bacteraemia in severely malnourished Jamaican children - abstract

ABSTRACT

Immunosuppression increases the susceptibility to infection and changes the inflammatory response in children with severe protein-energy malnutrition. In this five-year prospective study, bacteraemia was documented in 16 percent of 336 severely malnourished children (2-34 months of age), who were hospitalized consecutively in the Tropical Metabolism Research Unit, UWI, Kingston, Jamaica. The fifty-three children had 60 episodes of noscomial and community-acquired bacteraemia with 69 blood isolates. Community-acquired bacteraemia accounted for 72 percent (43/60) of bacteraemic episodes. Thirty-five per cent (24/69) of the strains were coagulase-negative staphylococci, 19 percent (13/69) were Staphylococcus aureus and 11 percent (8/69) were Streptococcus Group D. Seventeen episodes of coagulase-negative staphylococcal bacteraemia were acquired in the community, and seven were nosocomial. These patients were more likely to have pneumonic consolidation than children with all other bacteraemias combined (p<0.02, Fisher Exact Test). The bacteraemia-related case fatality rate was 8 percent (5/60). Polymicrobial and gram-negative septicaemia were independent positive predictive factors for mortality when compared with single-agent and gram-positive sepsis (p<0.02). This 71 percent (49/69) prevalence of gram-positive organisms suggests a change in the epidemiology from the predominant gram-negative aetiologies described in previous reports (AU)