Bacterial aetiology and outcome in children with severe pneumonia in Uganda

• Published in: Annals of tropical paediatrics Vol. 28; no. 4; pp. 253 - 260
• Main Authors: Nantanda, R., Hildenwall, H., Peterson, S., Kaddu-Mulindwa, D., Kalyesubula, I., K.Tumwine, J.
• Format: Journal Article
• Language: English
• Published: Leeds Taylor & Francis 01.12.2008; Maney
• Subjects: Anti-Bacterial Agents - pharmacology; Biological and medical sciences; Child, Preschool; Chloramphenicol - pharmacology; Developing Countries; Disease Progression; Drug Resistance, Bacterial; Epidemiologic Methods; General aspects; Haemophilus influenzae - isolation & purification; Hospitalization; Humans; Infant; Medical sciences; MEDICIN; Medicin och hälsovetenskap; MEDICINE; Microbial Sensitivity Tests; Pneumology; Pneumonia, Bacterial - drug therapy; Pneumonia, Bacterial - microbiology; Pneumonia, Pneumococcal - drug therapy; Prognosis; Respiratory system : syndromes and miscellaneous diseases; Sputum - microbiology; Staphylococcal Infections - drug therapy; Staphylococcus aureus - drug effects; Staphylococcus aureus - isolation & purification; Streptococcus pneumoniae - drug effects; Streptococcus pneumoniae - isolation & purification; Treatment Outcome; Uganda; Uganda; Africa; Human; Infection; Lung disease; Pediatrics; Pneumonia; Prognosis; Respiratory disease; Etiology; Bacteriosis; Tropical medicine; Child
• ISSN: 0272-4936; 1465-3281; 1465-3281
• DOI: 10.1179/146532808X375404

Background: Pneumonia is a major cause of morbidity and mortality in the 'under-5s' and in Uganda accounts for 10-30% of childhood deaths. Antibiotic resistance is increasing. Objective: To describe the bacterial aetiology, antimicrobial sensitivity and outcome of severe pneumonia among children aged 2-59 months admitted to the Acute Care Unit, Mulago Hospital, Uganda. Methods: A total of 157 children aged 2-59 months with symptoms of severe pneumonia according to WHO guidelines were recruited over a 4-month period in 2005/2006. Blood and induced sputum were obtained for culture, and chest radiographs were undertaken. Children were clinically classified as having severe or very severe pneumonia and were followed up for a maximum of 7 days. Results: Bacteraemia was detected in 15.9% of patients with Staphylococcus aureus (36%) and Streptococcus pneumoniae (28%) were the organisms most commonly isolated. Bacteria were isolated from sputum in half of the children, the commonest organisms being Streptococcus pneumoniae (45.9%), Haemophilus influenzae (23.5%) and Klebsiella species (22.4%). Staphylococcus aureus had only 33.3% sensitivity to chloramphenicol and H. influenzae isolates were completely resistant. S. pneumoniae was sensitive to chloramphenicol in 87.4% of cases. The case fatality rate was 15.5%. Independent predictors of death were very severe pneumonia (OR 12.9, CI 2.5-65.8), hypoxaemia (SaO 2 <92%, OR 4.9, CI 1.2-19.5) and severe malnutrition (OR 16.5, CI 4.2-65.5). Conclusion: S. aureus, S. pneumoniae and H. influenzae are common bacterial causes of severe pneumonia. Chloramphenicol, the current first-line antibiotic for treating severe pneumonia in Ugandan children, is useful in pneumonia caused by S. pneumoniae but other common bacteria show resistance. The presence of severe malnutrition, hypoxaemia and very severe pneumonia increase the risk of death and should be considered in case management protocols.