During a 5-month study period, 323 of 863 (37.5%) children below 5 years of age admitted to Shongwe Mission Hospital in rural South Africa were malnourished, two-thirds severely so. The incidence of bacteraemia in malnourished children was 9.6%, 11.8% in those severely malnourished and 5.8% in nutritional dwarfs. The predominant organisms retrieved were Gram-negative enteric bacilli (48.5%). Amongst the severely malnourished, who empirically receive intravenous ampicillin and gentamicin, 95.8% of all isolates were sensitive to this antibiotic combination. The case fatality rate of severely malnourished bacteraemic children was 20.8%. In malnutrition categories overall, the case fatality rate for bacteraemic children (22.6%) was significantly greater than in those without bacteraemia (9.3%). In hospitals with limited resources, full identification of bacteria may not be necessary, provided that regular surveillance for emerging resistance is conducted.
PIP: There are an estimated 170 million children in the world who are malnourished, 20 million severely. The authors determined the prevalence of bacteremia in malnourished children admitted to Shongwe Mission Hospital, documented the effect of bacteremia upon mortality, and provide a basis for antimicrobial use in malnourished children with suspected bacteremia. 323 of 863 children under age 5 years admitted to the hospital between May 23 and October 22, 1992, were malnourished, 66% severely. There was a 9.6% prevalence of bacteremia in malnourished children, 11.8% in those severely malnourished, and 5.8% in nutritional dwarfs. Gram-negative enteric bacilli were retrieved in 48.5% of cases. 95.8% of all isolates among the severely malnourished children were sensitive to the combination of intravenous ampicillin and gentamicin. There was a 20.8% case fatality rate among severely malnourished bacteremic children. In malnutrition categories overall, the case fatality rate for bacteremic children (22.6%) was significantly greater than in those without bacteremia (9.3%). The authors note that it may not be necessary to fully identify bacteria in hospitals with limited resources as long as regular surveillance for emerging resistance is conducted.