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Cited by 851Pneumonia and Respiratory InfectionsNeonatal and Maternal InfectionsSepsis Diagnosis and Treatment

Bacteremia among Children Admitted to a Rural Hospital in Kenya

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Berkley, James A., Lowe, Brett S., Mwangi, Isaiah, Williams, Thomas, Bauni, Evasius, Mwarumba, Saleem, Ngetsa, Caroline, Slack, Mary P.E. +6 more·2005·New England Journal of Medicine
DOI 10.1056/nejmoa040275
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Abstract

BACKGROUND: There are few epidemiologic data on invasive bacterial infections among children in sub-Saharan Africa. We studied every acute pediatric admission to a rural district hospital in Kenya to examine the prevalence, incidence, types, and outcome of community-acquired bacteremia. METHODS: Between August 1998 and July 2002, we cultured blood on admission from 19,339 inpatients and calculated the incidence of bacteremia on the basis of the population served by the hospital. RESULTS: Of a total of 1783 infants who were under 60 days old, 228 had bacteremia (12.8 percent), as did 866 of 14,787 children who were 60 or more days of age (5.9 percent). Among infants who were under 60 days old, Escherichia coli and group B streptococci predominated among a broad range of isolates (14 percent and 11 percent, respectively). Among infants who were 60 or more days of age, Streptococcus pneumoniae, nontyphoidal salmonella species, Haemophilus influenzae, and E. coli accounted for more than 70 percent of isolates. The minimal annual incidence of community-acquired bacteremia was estimated at 1457 cases per 100,000 children among infants under a year old, 1080 among children under 2 years, and 505 among children under 5 years. Of all in-hospital deaths, 26 percent were in children with community-acquired bacteremia. Of 308 deaths in children with bacteremia, 103 (33.4 percent) occurred on the day of admission and 217 (70.5 percent) within two days. CONCLUSIONS: Community-acquired bacteremia is a major cause of death among children at a rural sub-Saharan district hospital, a finding that highlights the need for prevention and for overcoming the political and financial barriers to widespread use of existing vaccines for bacterial diseases.

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  • The incidence of bacteriologically proven EONS in this study (0.7 per 1,000 live births) is lower than that reported from other developing country settings, for example Kenya (5.5 per 1,000 live births).

    “This incidence is lower than that reported from other developing country settings. For example, in Kenya, Berkley et al. report a minimal rate for neonatal bacteraemia of 5.5 per 1,000 live births [14].”

    From A three year descriptive study of early onset neonatal sepsis in a refugee population on the Thailand Myanmar border (2013) · cites this paper as [14]

  • A further possible explanation for the low bacteraemia incidence is the amount of blood collected for each blood culture sample and the high bacterial contamination rate, but both values were similar to that reported by Berkley et al.

    “A further possible explanation for the low bacteraemia incidence is the amount of blood collected for each blood culture sample and the high bacterial contamination rate. However both values were similar to that reported by Berkley et al. [14].”

    From A three year descriptive study of early onset neonatal sepsis in a refugee population on the Thailand Myanmar border (2013) · cites this paper as [14]

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  1. [27]27. World Health Organization. Proportional mortality among under fives, worldwide 2001. (Accessed November 29, 2004, at www.who.int/child-adolescent-health/ overview/child\_health/map\_01\_world.jpg.) Copyright © 2005 Massachusetts Medical Society. n engl j med 352;1 www.nejm.org january 6, 2005

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Authors
Berkley, J. A., Lowe, B. S., Mwangi, I., Williams, T., Bauni, E., Mwarumba, S., Ngetsa, C., Slack, M. P. E., Njenga, S., Hart, C. A., Maitland, K., English, M., Marsh, K., & Scott, J. A. G.
Affiliations
  • University of Oxford (GB)
  • John Radcliffe Hospital (GB)
  • University of Liverpool (GB)
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2005-01-06
Volume
352
Issue
1
Pages
39-47
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa040275
OpenAlex
W2115179234
Cited by
851
References
23
Citations by year
2026: 15 · 2025: 13 · 2024: 19 · 2023: 23 · 2022: 20 · 2021: 21 · 2020: 41 · 2019: 43 · 2018: 33 · 2017: 37 · 2016: 42 · 2015: 62 · 2014: 58 · 2013: 44 · 2012: 61
FWCI
34.05
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
Funders
Wellcome Trust (061089, 081835)
Topics
  • Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
Keywords
community-acquired bacteremia, pediatric bacteremia, invasive bacterial infection, infants, Escherichia coli, Streptococcus agalactiae, Streptococcus pneumoniae, non-typhoidal Salmonella, Haemophilus influenzae, in-hospital mortality, sub-Saharan Africa, rural Kenya, bacterial vaccines
MeSH terms
Bacteria, Cause of Death, Child, Child, Preschool, Female, Haemophilus Infections, Hospitals, Rural, Humans, Infant, Kenya, Male, Pneumococcal Infections, Prospective Studies, HIV Infections, Incidence, Logistic Models, Bacteremia, Hospital Mortality, Community-Acquired Infections, Haemophilus influenzae type b, Malnutrition

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