Background
Methods
Study design and settings
Level/rank of HCF | HCF involved | HCF catchment population | HCF bed capacity | Study participants enrolled (%) |
---|---|---|---|---|
Tertiary | BMC (urban) | 16,252,410 | 950 | 514 (54.1) |
Regional/referral | SRRH (urban) | 2,772,509 | 375 | 218 (23.0) |
District | NDH (urban) | 363,452 | 88 | 80 (8.4) |
SDDH (rural) | 663,034 | 320 | 138 (14.5) |
Study population, inclusion and exclusion criteria
Data collection and laboratory procedures
Data management
Results
Socio-demographic and clinical characteristics of children enrolled
Characteristic | Number (%) | |
---|---|---|
Sex | Boys | 558 (58.7) |
Girls | 392 (41.3) | |
Age group | ≤ 1 month | 346 (36.4) |
2–12 months | 209 (22.0) | |
13–60 months | 395 (41.6) | |
Weight (kg)a | Normal | 539 (56.7) |
Underweight | 373 (39.3) | |
Overweight | 38 (4.0) | |
Residence | Rural | 315 (33.2) |
Urban | 635 (66.8) | |
Mwanza city | No | 313 (33.0) |
Yes | 637 (67.0) | |
Current antibiotic use | No | 545 (57.4) |
Yes | 405 (42.6) | |
History of admission in the last 3 monthsb | No | 525 (86.9) |
Yes | 79 (13.1) | |
Presence of i/v line | No | 254 (26.7) |
Yes | 696 (73.3) | |
Presence of indwelling urinary catheter | No | 930 (97.9) |
Yes | 20 (2.1) | |
Co-morbiditiesc | No | 558 (58.7) |
Yes | 392 (41.3) | |
Presenting symptoms and signs | ||
Fever | Yes | 819 (86.2) |
Tachypnoea | Yes | 235 (24.7) |
Tachycardia | Yes | 186 (19.6) |
Convulsions | Yes | 123 (13.0) |
Loss of consciousness | Yes | 14 (1.5) |
Prevalence of blood stream infections among children in North-Western Tanzania
Antimicrobial resistance patterns of bacteria causing blood stream infections
Bacteria (n) | Antimicrobial resistance (%) | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
AMP | SXT | GEN | CIP | ERY | VAN | AMC | CAZ | CRO | MER | |
K. pneumoniae (55) | 100 | 96.3 | 78.2 | 29.1 | NA | NA | 94.6 | 90.9 | 95.7 | 0.0 |
S. aureus (23) | 100 | 82.6 | 26.1 | 34.8 | 65.2 | 13.0 | NA | NA | NA | NA |
E. coli (17) | 100 | 94.1 | 40.1 | 52.9 | NA | NA | 94.1 | 52.9 | 58.8 | 0.0 |
Acinetobacter spp. (10) | NA | 90.0 | 40.0 | 10.0 | NA | NA | NA | 100 | NA | 10.0 |
Other GNB (23) | 95.6 | 78.3 | 60.9 | 17.4 | NA | NA | 82.6 | 60.6 | 69.6 | 0.0 |
Other GPB (6) | 83.3 | 66.7 | 33.3 | 50.0 | 50.0 | 0.0 | NA | NA | NA | NA |
Cephalosporin resistant and multi-drug resistant bacterial strains attributable blood stream infections
Health facility (N) | Cephalosporin resistant strains attributable blood stream infections | ||
---|---|---|---|
(n, %) | OR (95%CI) | p-value | |
NDH & SDDH (9) | 5 (55.6) | 1 | |
SRRH (7) | 2 (28.6) | 0.32 (0.04–2.62) | 0.288 |
BMC (79) | 68 (86.1) | 4.95 (1.15–21.32) | 0.032 |
Total (95) | 75 (79.0) |
Risk factors of blood stream infections among children in North-Western Tanzania
Variable | BSIs (n, %) | Univariate OR (95%CI) | p-value | Multivariate OR (95%CI) | p-value | |
---|---|---|---|---|---|---|
Hospital | NDH & SDDH (218) | 18 (8.3) | 1 | |||
SRRH (218) | 14 (6.4) | 0.76 (0.37–1.57) | 0.464 | 0.90 (0.43–1.90) | 0.917 | |
BMC (514) | 103 (20.0) | 2.78 (1.64–4.72) | < 0.001 | 2.01 (1.08–3.74) | 0.028 | |
Sex | Boys (558) | 80 (14.3) | 1 | |||
Girls (392) | 55 (14.0) | 0.97 (0.67–1.41) | 0.894 | |||
Age category | 13–60 months (395) | 35 (8.9) | 1 | |||
2–12 months (209) | 12 (5.7) | 0.63 (0.32–1.23) | 0.177 | 0.59 (0.30–1.17) | 0.128 | |
≤1 month (346) | 88 (25.4) | 3.51 (2.30–5.36) | < 0.001 | 1.93 (1.07–3.48) | 0.030 | |
Weight (kg) | Normal (539) | 85 (15.8) | 1 | |||
Underweight (373) | 49 (13.1) | 0.81 (0.55–1.18) | 0.270 | |||
Overweight (38) | 1 (2.6) | 0.14 (0.02–1.07) | 0.058 | |||
Residence | Rural (315) | 39 (12.4) | 1 | |||
Urban (635) | 96 (15.1) | 1.26 (0.85–1.88) | 0.256 | |||
Mwanza city | No (313) | 41 (13.1) | 1 | |||
Yes (637) | 94 (14.8) | 1.15 (0.78–1.71) | 0.492 | |||
Current antibiotic use | No (545) | 66 (12.1) | 1 | |||
Yes (405) | 69 (17.0) | 1.49 (1.03–2.15) | 0.032 | 1.42 (0.97–2.08) | 0.069 | |
Previous admission* | No (525) | 39 (7.4) | 1 | |||
Yes (79) | 8 (10.1) | 1.40 (0.63–3.13) | 0.406 | |||
Intravenous line | No (254) | 27 (10.6) | 1 | |||
Yes (696) | 108 (15.5) | 1.54 (0.99–2.42) | 0.058 | |||
Urinary catheter | No (930) | 132 (14.2) | 1 | |||
Yes (20) | 3 (15.0) | 1.07 (0.31–3.69) | 0.919 | |||
Co-morbidities** | No (558) | 85 (15.2) | 1 | |||
Yes (392) | 50 (12.8) | 0.81 (0.56–1.18) | 0.282 | |||
Prematurity | No (900) | 121 (13.4) | 1 | |||
Yes (50) | 14 (28.0) | 2.50 (1.31–4.78) | 0.005 | 1.15 (0.58–2.25) | 0.691 | |
Malnutrition | No (825) | 126 (15.3) | 1 | |||
Yes (125) | 9 (7.2) | 0.43 (0.21–0.87) | 0.019 | 0.52 (0.22–1.20) | 0.126 | |
HIV | Negative (913) | 129 (14.1) | 1 | |||
Positive (37) | 6 (16.2) | 1.18 (0.48–2.88) | 0.722 | |||
SCD | No (921) | 132 (14.3) | 1 | |||
Yes (29) | 3 (10.3) | 0.69 (0.21–2.31) | 0.547 |
Management outcomes among children with blood stream infections
Variable | Deaths (n, %) | Univariate OR (95%CI) | p-value | Multivariate OR (95%CI) | p-value | |
---|---|---|---|---|---|---|
Hospital | NDH & SDDH (217) | 2 (0.9) | 1 | |||
SRRH (203) | 0 (0.0) | – | – | |||
BMC (512) | 59 (11.5) | 14.0 (3.39–57.84) | < 0.001 | 4.95 (1.95–12.5) | 0.001 | |
Sex | Boys (548) | 43 (7.9) | 1 | |||
Girls (384) | 18 (4.7) | 0.58 (0.33–1.02) | 0.058 | |||
Age category | 13–60 months (386) | 9 (2.3) | 1 | |||
2–12 months (203) | 7 (3.5) | 1.50 (0.55–4.08) | 0.431 | 1.32 (0.48–3.66) | 0.592 | |
≤1 month (343) | 45 (13.1) | 6.33 (3.04–13.15) | < 0.001 | 2.25 (1.02–5.00) | 0.045 | |
Residence | Rural (308) | 17 (5.5) | 1 | |||
Urban (624) | 44 (7.1) | 1.30 (0.73–2.31) | 0.375 | |||
Mwanza city | No (307) | 18 (5.86) | 1 | |||
Yes (625) | 43 (6.88) | 1.19 (0.67–2.09) | 0.556 | |||
Co-morbidities | No (549) | 35 (6.4) | 1 | |||
Yes (383) | 26 (6.8) | 1.07 (0.63–1.81) | 0.802 | |||
Prematurity | No (883) | 51 (5.8) | 1 | |||
Yes (49) | 10 (20.4) | 4.18 (1.98–8.86) | < 0.001 | 1.70 (0.77–3.73) | 0.186 | |
Culture | Negative (799) | 41 (5.1) | 1 | |||
Positive (133) | 20 (15.0) | 3.27 (1.85–5.79) | < 0.001 | 1.95 (1.07–3.56) | 0.028 | |
3rd gen. Ceph-R | No (18) | 3 (16.7) | 1 | |||
Yes (75) | 14 (18.7) | 1.15 (0.29–4.51) | 0.844 | |||
MDR | No (29) | 3 (10.3) | 1 | |||
Yes (104) | 17 (16.4) | 1.69 (0.46–6.23) | 0.428 |