부산대학교 도서관

Background: Bacterial sepsis and severe focal infections are common admission diagnoses amongst Gambian children admitted to the Edward Francis Small Teaching Hospital (EFSTH) and the Medical Research Council (MRC) Unit, The Gambia. However, blood cultures are frequently negative. To understand the causes of the low blood culture yields we documented history of antibiotic use and measured antimicrobial activity in clean catch urine collected at the time of admission or before the start of antibiotic therapy. Methods & Materials: Children aged between 1 month to 18 years presenting with sepsis or severe focal infections were recruited into the European Union Childhood Life-threatening Infectious Diseases Study (EUCLIDS) at the EFSTH and MRC wards. Participants were interviewed for history of antibiotic use in the last seven days. Asterile What man No.1 filter paper disc (6mm) was inoculated with 20 ul of patient urine collected pre-antibiotics and placed on a Mueller-Hinton agar plate pre-streaked with antibiotic sensitive Staphylococcu aureus (ATCC 25923 strain). After 18-24 hrs incubation at 35-37 C, growth inhibition around the disc was considered evidence of pre-hospital antibiotic exposure. Results: Of 253 cases recruited, 128 (40%) were from MRC and the rest from EFSTH. Half of the cases were less than five yrs old. 182 (72%) were diagnosed with sepsis or focal infections with no organism identified. An organism was identified in 71 (28%) cases with the most common isolates Staphylococcus aureus 26 (35%), Streptococcus pneumoniae 13 (18%) and Neisseria meningitidis 10 (14%). Patients with osteomyelitis and meningitis were most likely to have a positive culture (80% and 46% respectively). The antimicrobial results did not tally with patient reports of antibiotic use: only 91 (36%) reported antibiotic use while antimicrobial activity was detected in 197 (78%). Conclusion: A high rate of pre-hospital antibiotics in this setting makes conventional microbiology a poor diagnostic tool for sepsis and focal infections. The urine antibiogram assay is a sensitive and cheap approach for detection of antimicrobial activities and may serve as a useful tool for assessing the accuracy of antibiotic reports. There is an urgent need for more sensitive and cost effective molecular diagnostics for bacterial detection in low resource settings. [ABSTRACT FROM AUTHOR]