Volume 25, Number 4—April 2019
Research
Staphylococcus aureus Bacteremia in Children of Rural Areas of The Gambia, 2008–2015
, Christian Bottomley, Syed A. Zaman, Jodi Lindsay, Muhammed Shah, Ilias Hossain, Malick Ndiaye, Chidebere D.I. Osuorah, Yekini Olatunji, Henry Badji, Usman N.A. Ikumapayi, Ahmad Manjang, Rasheed Salaudeen, Lamin Ceesay, Momodou Jasseh, Richard A. Adegbola, Tumani Corrah, Philip C. Hill, Brian M. Greenwood, and Grant A. Mackenzie
Table 1
Characteristics of patients <5 years of age with suspected pneumonia, septicemia, or meningitis with or without Staphylococcus aureus bacteremia identified through 2 surveillance systems, The Gambia, 2008–2015*
| Patient characteristic | Patients with S. aureus bacteremia, n = 198 | Patients with bacteremia caused by other pathogen, n = 932 | Patients without bacteremia, n = 24,182 |
|---|---|---|---|
| Age, mo | |||
| <1 | 84/198 (42.4) | 97/932 (10.4) | 1,911/24,177 (7.9) |
| 1–11 | 61/198 (30.8) | 310/932 (33.3) | 8,675/24,177 (35.9) |
| 12–23 | 33/198 (16.7) | 265/932 (28.4) | 7,505/24,177 (31.0) |
| 24–59 |
20/198 (10.1) |
260/932 (27.9) |
6,086/24,177 (25.2) |
| Sex | |||
| M | 97/198 (49.0) | 532/932 (57.1) | 13,740/24,177 (56.8) |
| F |
101/198 (51.0) |
400/932 (42.9) |
10,437/24,177 (43.2) |
| Severely stunted† | 20/109 (18.3) | 216/884 (24.4) | 3,425/21,736 (15.8) |
| Mid-upper arm circumference <11 cm |
81/198 (40.9) |
184/932 (19.7) |
3,080/24,182 (12.7) |
| Admitted in previous 2 weeks | 31/162 (19.1) | 157/843 (18.6) | 3,995/21,897 (18.2) |
| Hospital stay, d, median (IQR) | 5 (2–6) | 4 (3–6) | 3 (2–4) |
| Disease onset during wet season‡ | 97/198 (49.0) | 335/932 (35.9) | 10,335/24,171 (42.8) |
| Died |
28/198 (14.1) |
161/932 (17.3) |
860/24,182 (3.6) |
| Symptoms | |||
| Cough | 103/198 (52.0) | 675/928 (72.7) | 19,523/24,148 (80.8) |
| Difficult breathing | 89/197 (45.2) | 535/927 (57.7) | 14,280/24,102 (59.2) |
| Prostration | 29/197 (14.7) | 147/918 (16.0) | 1,602/23,906 (6.7) |
| Diarrhea | 38/190 (20.0) | 271/861 (31.5) | 5,798/22,772 (25.5) |
| Convulsion |
8/198 (4.0) |
72/927 (7.8) |
1,174/24,127 (4.9) |
| Signs | |||
| Lower chest wall in-drawing | 164/198 (82.8) | 732/927 (79.0) | 17,856/24,129 (74.0) |
| Meningism | 1/192 (0.5) | 34/867 (3.9) | 174/22,841 (0.8) |
| Altered level of consciousness |
124/193 (64.2) |
407/873 (46.6) |
9,590/23,518 (40.8) |
| Axillary temperature | |||
| <36.5°C | 18/198 (9.1) | 79/932 (8.5) | 2,405/24,182 (9.9) |
| 36.5°C–37.5°C | 40/198 (20.2) | 147/932 (15.8) | 6,819/24,182 (28.2) |
| >37.5°C |
140/198 (70.7) |
706/932 (75.7) |
14,958/24,182 (61.9) |
| Pulse rate, beats/min§ | |||
| Increased for age |
84/198 (42.4) |
621/932 (66.6) |
15,107/24,182 (62.5) |
| Respiratory rate, breaths/min¶ | |||
| Increased for age |
128/198 (64.6) |
682/932 (73.2) |
17,157/24,177 (71.0) |
| Oxygen saturation <92% |
33/198 (16.7) |
116/932 (12.4) |
2,140/24,182 (8.8) |
| Suspected diagnosis# | |||
| Septicemia | 109/194 (56.2) | 434/896 (48.4) | 8,549/23,068 (37.1) |
| Pneumonia | 55/194 (28.4) | 347/896 (38.8) | 13,244/23,068 (57.4) |
| Meningitis | 13/194 (6.7) | 96/896 (10.7) | 718/23,068 (3.1) |
| Other focal sepsis |
17/194 (8.8) |
19/896 (2.1) |
557/23,068 (2.4) |
| Malaria positivity** | 14/131 (10.7) | 84/723 (11.6) | 3,276/21,626 (15.1) |
*Values are no. patients/total no. in category (%) except as indicated. Surveillance data are from the Basse Health and Demographic Surveillance System and the Fuladu West Health and Demographic Surveillance System. IQR, interquartile range.
†Defined as weight-for-height z-score <3 SDs from median weight-for-height for the corresponding age group. We calculated weight-for-height using z-scores from the 2006 World Health Organization child growth standards in Stata 14.0 (https://www.stata.com/stata14). Neonates were not included in weight-for-height measurements.
‡The wet season occurs during July–November and the dry season during December–June.
§The reference ranges for pulse rates were 70–190 beats/min for children <1 month of age, 80–160 beats/min for children 1–11 months of age, 80–130 beats/min for children 1–2 years of age, 80–120 beats/min for children 3–4 years of age, 75–115 beats/min for children 5–6 years of age, 70–110 beats/min for children 7–9 years of age, and 60–100 beats/min for children >10 years of age.
¶Increased respiratory rate was defined as >60 breaths/min for children <2 months of age, >50 breaths/min for children 2–12 months of age, >40 breaths/ min for children >1–5 years of age.
#Surveillance diagnosis was categorized into mutually exclusive groups in order of severity; meningitis was considered more severe than septicemia, which was considered more severe than pneumonia.
**Malaria was tested using a rapid diagnostic test (ICT Malaria P.f. Antigen, ICT Diagnostics, http://www.ictdiagnostics.co.za).