Aetiological Agents And Their Antimicrobial Susceptibility Patterns In Children Under Five Years Of Age Presenting With Bloodstream Infections At The Kintampo Municipal Hospital

ABSTRACT Introduction: The major organisms that cause septicaemia in children have been established in different geographic locations. However, these causative organisms of paediatric septicaemia and their antibiogram change over time, within and across settings. In addition, increased antimicrobial drug resistance among the organisms has been observed over the last decades. Study of the aetiological agents and their antibiogram is therefore imperative for designing community- based management strategies. Aim: This study determined the antimicrobial susceptibility patterns in commonly isolated bloodstream organisms among children below five years of age who attend the Kintampo Municipal Hospital in the Brong-Ahafo Region. Method: Stored and fresh blood culture isolates from a total of 1,965 children below five years of age admitted at the children’s ward and clinically diagnosed with septicaemia between 2008 and 2013 at the Kintampo Municipal Hospital were used. Bacteria isolates were identified using biochemical reactions. Antimicrobial susceptibility testing was performed using qualitative method and minimum inhibitory concentration for selected positive blood culture isolates. Results: Out of the total number of children (1965) enrolled, 47.5% were males and 52.5% were females. Their mean age was 24.6 ± 11.9 months. Three hundred and ninety two children (392) had positive blood cultures of which 261 (66.6%) were considered pathogens and 97 (24.7%), including 34 yeast cells, were considered contaminants. The predominant isolated organisms were non typhoidal Salmonellae (NTS) (42.5%), S. aureus (38.7%), S. Typhi (4.6%) and S. pneumoniae (3.8%). Both gram positive and negative bacteria isolates were susceptible to ciprofloxacin (5µg), imipenem (10µg), ceftriaxone (30µg), gentamicin (10µg), amoxicillin clavulanic acid (30mµg), amikacin vi (30µg) and cefuroxime (30µg). Sixty five point nine percent (65.9%) S. aureus were resistant to ampicillin, 60.8% to cotrimoxazole, 78.9% chloramphenicol, and 60.0% to amoxicillin. Fifty two point eight percent (52.8%) NTS were resistant to amoxicillin, 57.7% to ampicillin, 56.3 to chloramphenicol and 63.9% cotrimoxazole. Eighty seven point five percent (87.5%) of S. Typhi were resistant to amoxicillin and 57.7% to ampicillin. Eighty three point three percent (83.3%) of the S. pneumoniae isolates were resistant to cotrimoxazole. Ciprofloxacin and ceftriaxone appeared to be the best choice for empiric therapy. Multi- drug resistance (resistance to amoxicillin, chloramphenicol and cotrimoxazole) was observed in NTS (58.6%), S. aureus (63.4%) S. Typhi (100%) and S. pneumoniae (50%). Conclusion: The investigation undertaken has shown the importance of septicaemia in this population. Continuous monitoring of the incidence and susceptibility patterns of these aetiological agents is therefore important.