Surveillance of the Community Acquired Septicaemia among Children in Mbita Subcounty, South Nyanza, Kenya

Abstract

Septicaemia is a systemic disease associated with presence of pathogenic microorganisms or their toxins in the blood. Septicaemia remains the leading cause of mortality and morbidity, especially in sub-Saharan Africa and leads to complications characterized by inflammation throughout the body referred as sepsis which are caused by viral, parasitic and bacterial agents. Studies have shown that bacterial septicaemia is the most fatal and prevalent in hospitalised cases. According to the UNICEF, 76% of children under five years of age globally die due to septicaemia. In East Africa a mortality rate of 40% have been reported. In these studies, septicaemia has normally been found to be community acquired. In Kenya, South Nyanza regions have reported higher morbidity and mortality cases among children. This has been associated with higher cases of immunosuppressive diseases in the region. This hospital based descriptive cross-sectional study aimed to determine the aetiology, antibiotic susceptibility and pathogenic profile of bacteria causing septicaemia cases in Mbita district hospital South Nyanza. Blood samples were obtained from 248 children who met the recruitment criteria and their guardian consented to participate in the study. A detailed sociodemographic questionnaire was administered to the guardian to gather information relevant to this study. Bacterial isolation and characterization was done using the automated BACTEC 9240 system while the antimicrobial susceptibility testing was done using the disc diffusion technique. Molecular characterization for resistance markers was done using PCR and plasmid profiling methods. The mean age of the participants was 27.9 (SD ±20.7) months with the majority (30.6%) aged between 1 to 12 months. The majority of the participants were males (50.8%), were from Rusinga (48%) while only 8.1% were HIV seropositive. The mean body temperature of the participants was 38 (SD 0.5) OC and the majority (58.9%) had body temperatures above 37.6 OC. The mean white blood cells (WBC) of the participants were 17720.9 (SD 8929.1) cells/ml and majority, 25.4%, had WBC above the normal levels. The mean heart rate (HR) of the participants was 111.7 (SD 12.2) beat/min and the majority (34.3%) had HR between 101 to 110 beat/min. A total of 84 of the 248 (33.9%) of the children had septicaemia with the majority (28.6%) caused by Staphylococcus epidermidis followed by S. aureus and E. coli each at 13.1%. The majority of the Gram negative bacteria causing septicaemia in this study were resistant to penicillin (Ampicillins) at 100% followed by tetracycline at 96.1%, sulphonamides (Trimethoprim/sulfamethoxazole) at 84.6%, Aminoglycosides (Gentamicin) at 73.1% while they were least resistant to Quinolones (Ciprofloxacin) at 19.2%. For the Gram positive bacteria, majority (96.7%) were resistant to sulphonamides (Trimethoprim/sulfamethoxazole) followed by tetracycline at 76.7%, penicillin (Oxacillin) at 73.3% and least resistant to Quinolone (Ciprofloxacin) at 30%. In conclusion, this study reported significantly higher proportion of the children with septicaemia. Majority of the cases were caused by Gram positive bacteria. Compared to Gram positive, majority of Gram negative bacteria were resistant to penicillin, tetracycline, Trimethoprim/sulfamethoxazole and Gentamicin. This community could benefit from rapid testing and etiological characterisation of children with suspected symptoms of septicaemia in order to institute appropriate treatment and management.