Risk of community- and hospital-acquired bacteremia and profile of antibiotic resistance in children hospitalized with severe acute malnutrition in Niger

Objective: To estimate the prevalence and antibiotic resistance profile of community-and hospital acquired bacteremia among hospitalized children with severe acute malnutrition in Niger. Methods: A descriptive, longitudinal study was conducted in an intensive nutritional rehabilitation center in Madarounfa, Niger. Children aged 6 to 59 months admitted for inpatient treatment of complicated severe acute malnutrition (n = 2187) had blood specimens drawn at admission to assess prevalence of community-acquired bacteremia. Subsequent specimens were drawn per physician discretion to assess incidence of hospital-acquired bacteremia. Antibiotic susceptibility testing was performed on positive blood cultures. Results: The prevalence of community-acquired bacteremia at admission was at least 9.1% (95% confidence interval [CI]: 8.1, 10.4%), with non-typhoid Salmonella identified in over half (57.8%) of cases. The cumulative incidence of hospital-acquired bacteremia was estimated at 1.2% (95% CI: 0.8, 1.7%), among which the most common organisms were Klebsiella pneumoniae (19.4%), Acinetobacter baumannii (16.1%), Enterococcus faecalis (12.9%), and Escherichia coli (12.9%). In community-acquired bacteremia, 58% cases were resistant to amoxicillin-clavulanate; 100% of hospital-acquired bacteremia cases were resistant to amoxicillin and amoxicillin-clavulanate. Mortality risk was elevated among children with hospital acquired bacteremia (risk ratio [RR] = 9.32) and community-acquired bacteremia (RR = 2.67). Conclusion: Bacteremia was a significant contributor to mortality. Antibiotic resistance poses a challenge to effective clinical management of severe acute malnutrition. (C) 2022 Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

Automated summary

This study estimated the prevalence and antibiotic resistance profile of community-and hospital acquired bacteremia among hospitalized children with severe acute malnutrition in Niger. The results showed that bacteremia significantly increased the risk of mortality among children, and antibiotic resistance posed a challenge to clinical management.