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

Details

Ressource 1Download: 2018_pone_CNS_Uganda.pdf (1934.44 [Ko])
State: Public
Version: Final published version
Serval ID
serval:BIB_025C18152AF2
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Antimicrobial treatment practices among Ugandan children with suspicion of central nervous system infection.
Journal
PloS one
Author(s)
Kemigisha E., Nanjebe D., Boum Y., Langendorf C., Aberrane S., Nyehangane D., Nackers F., Mueller Y., Charrel R., Murphy R.A., Page A.L., Mwanga-Amumpaire J.
ISSN
1932-6203 (Electronic)
ISSN-L
1932-6203
Publication state
Published
Issued date
2018
Peer-reviewed
Oui
Volume
13
Number
10
Pages
e0205316
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: epublish
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.
Keywords
Anti-Bacterial Agents/therapeutic use, Anti-Infective Agents/therapeutic use, Ceftriaxone/therapeutic use, Central Nervous System Infections/drug therapy, Central Nervous System Infections/epidemiology, Child, Child, Preschool, Coinfection/drug therapy, Coinfection/epidemiology, Coinfection/microbiology, Drug Resistance, Bacterial/genetics, Escherichia coli/drug effects, Escherichia coli/pathogenicity, Escherichia coli Infections/drug therapy, Escherichia coli Infections/epidemiology, Escherichia coli Infections/microbiology, Female, Humans, Infant, Malaria/drug therapy, Malaria/epidemiology, Malaria/microbiology, Male, Uganda/epidemiology, beta-Lactamases/genetics
Pubmed
Web of science
Open Access
Yes
Create date
11/10/2018 14:41
Last modification date
20/08/2019 13:24
Usage data