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Journal Article > Research

Antimicrobial treatment practices among Ugandan children with suspicion of central nervous system infection

Kemigisha E, Nanjebe D, Langendorf C, Aberrane S, Nyehangane D, Nackers F, Mueller YK, Charrel R, Murphy RA, Page AL, Mwanga-Amumpaire J
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Abstract
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.
Countries
Uganda
Subject Area
infections, other
DOI
10.1371/journal.pone.0205316
Published Date
09-Oct-2018
PubMed ID
30300411
Languages
English
Journal
PLOS One
Volume / Issue / Pages
Volume 13, Issue 10
Issue Date
09-Oct-2018
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