Antimicrobial treatment practices among Ugandan children with suspicion of central nervous system infection
In: PLOS ONE, Jg. 13 (2018-10-09), Heft 10, p e0205316, S. e0205316
Online
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Zugriff:
Acute central nervous system (CNS) infections in children in sub-Saharan Africa are often fatal. Potential contributors include late presentation, limited diagnostic capacity and inadequate treatment. A more nuanced understanding of treatment practices with a goal of optimizing such practices is critical to prevent avoidable case fatality. We describe empiric antimicrobial treatment, antibiotic resistance and treatment adequacy in a prospective cohort of 459 children aged two months to 12 years hospitalised for suspected acute CNS infections in Mbarara, Uganda, from 2009 to 2012. Among these 459 children, 155 had a laboratory-confirmed diagnosis of malaria (case-fatality rate [CFR] 14%), 58 had bacterial infections (CFR 24%) and 6 children had mixed malaria and bacterial infections (CFR 17%). Overall case fatality was 18.1% (n = 83). Of 219 children with laboratory-confirmed malaria and/or bacterial infections, 182 (83.1%) received an adequate antimalarial and/or antibiotic on the day of admission and 211 (96.3%) within 48 hours of admission. The proportion of those receiving adequate treatment was similar among survivors and non-survivors. All bacterial isolates were sensitive to ceftriaxone except one Escherichia coli isolate with extended-spectrum beta-lactamase (ESBL). The observed high mortality was not a result of inadequate initial antimicrobial treatment at the hospital. The epidemiology of CNS infection in this setting justifies empirical use of a third-generation cephalosporin, however antibiotic resistance should be monitored closely.
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Antimicrobial treatment practices among Ugandan children with suspicion of central nervous system infection
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Autor/in / Beteiligte Person: | Nanjebe, Deborah ; Mueller, Yolanda ; Nackers, Fabienne ; Kemigisha, Elizabeth ; Murphy, Richard A. ; Charrel, Rémi N. ; Nyehangane, Dan ; Mwanga-Amumpaire, Juliet ; Boum, Yap ; Aberrane, Said ; Page, Anne-Laure ; Langendorf, Céline |
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Zeitschrift: | PLOS ONE, Jg. 13 (2018-10-09), Heft 10, p e0205316, S. e0205316 |
Veröffentlichung: | Public Library of Science (PLoS), 2018 |
Medientyp: | unknown |
ISSN: | 1932-6203 (print) |
DOI: | 10.1371/journal.pone.0205316 |
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