Niger J Paed 2015; 42 (1): 6 –13
ORIGINAL
AbdulAziz ZA
Bacterial aetiology of septicaemia in
Ehinmidu JO
children of post-neonatal age at the
Adeshina GO
Bugaje MA
Institute of Child Health,
Banzazzau, Zaria, Nigeria
DOI:http://dx.doi.org/10.4314/njp.v42i1,2
Accepted: 28th September 2013
Abstract Introduction: Septicae-
agar plates, Gram stain reaction
mia is a clinical syndrome charac-
and biochemical properties.
AbdulAziz ZA
(
)
terized by systemic inflammatory
Results: The mean age was three
Ehinmidu JO, Adeshina GO
response. It is has been reported
years with a peak in the first year
Department of Pharmaceutics and
Pharmaceutical Microbiology,
to be one of the major causes of
of life. The male: female ratio was
Faculty of Pharmaceutical Sciences
morbidity and mortality among
1:1.3. Staphylococcus aureus and
Ahmadu Bello University, Zaria
children in developing countries
Salmonella species were the com-
Email: zubaydaabdul@gmail.com
of the world.
monest isolates accounting for 24
Objectives: the aims of the study
(43.64%) and 13 (23.64%) respec-
Bugaje MA
were to determine the prevalence
tively. Other bacterial isolates in-
Department of Paediatrics,
of septicaemia in children brought
cluded Coagulase negative staphy-
Ahmadu Bello University Teaching
to the Institute of Child Health
lococci (CoNS) (7.27%), Citro-
Hospital, Zaria
Banzazzau, Ahmadu Bello Uni-
bacter specie (10.94%), Pseudo-
versity
Teaching
Hospital,
monas specie (7.24%), Proteus
(ABUTH) Zaria and to isolate the
species (3.64%) and Klebsiella
aetiologic agents responsible for
species (3.64%).
septicaemia in these children.
Conclusion: Results show both
Methods: Blood samples of chil-
Gram positive and Gram negative
dren (aged one month – 12 years)
bacteria to be implicated with sep-
with clinical symptoms of sus-
ticaemia with Staph aureus and
pected septicaemia was taken
Salmonella being the most fre-
under strict aseptic condition and
quent aetiologic agents, children
inoculated into thioglycolate broth
less than or equal to five years
then incubated for 24hrs Subcul-
were mostly affected, there is a
tures were made after the first 24
need for routine monitoring of
hrs onto blood, chocolate and
bacterial isolates and the age group
MacConkey agar plates and also
at risk.
when there were signs of bacterial
growth shown by turbidity of the
Keywords: Bacterial isolates,
samples. Identification of isolates
children, septicaemia.
was based on their morphology on
Introduction
larly in developing countries and are commonly commu-
nity acquired . The epidemiologic pattern of septicae-
4
Septicaemia is a clinical term used to describe severe
mia varies from one region to another and even within a
particular region it varies with time and age . In Nigeria,
5
life threatening bacteraemia in which multiplying bacte-
ria release toxins into the blood stream and trigger the
the epidemiologic pattern of neonatal septicaemia has
received greater attention than in infants and children
6-10
production of cytokines causing fever, chills, toxicity,
.
tissue anoxia, reduced blood pressure and collapse,
A number of reports showed that Staphylococcus aureus
septic shock is usually a complication with Gram nega-
and gram-negative enteric bacteria including Salmonella
tive bacilli and less frequently Gram positive organ-
are the most common causes of septicaemia in neonates
and older children
6, 9, 11-15
isms , Purpura or petechie may be present . The inclin-
1
2
. There is little information
ing aetiology may be bacterial, fungal, viral or other
about the incidence of septicaemia in infants and young
stimuli . This condition is frequently reported in
2
children in our locality hence the rationale behind this
neonates and young children and those with severe mal-
3
study. The aims of the study were to determine the
nutrition. There has been a substantial increase in the
prevalence of septicaemia in children brought to the
incidence of septicaemia during the last decade particu-
Institute of Child Health Banzazzau, Ahmadu Bello Uni-
7
versity Teaching Hospital, (ABUTH) Zaria and to iso-
Table 1: Age distribution of children with suspected septicaemia and
late the aetiologic agents responsible for septicaemia in
their respective pathogens
these children.
Month
All
Staph
Salmo-
Citro
Pro
CO
Kleb-
Pseu-
s
organ-
aure
nella
bacte
teus
NS
siella
domo
ism
us
sp .
r sp
sp .
sp
nas
sp
1 – 12
16
7
3
3
1
2
-
1
13 –
28
13
9
3
-
1
1
1
Materials and methods
60
>60
11
4
2
-
1
1
1
4
A cross sectional study of children with suspected septi-
caemia was done. The consent of the medical and scien-
tific ethical committee of the Ahmadu Bello University
Teaching Hospital, Zaria was sought and obtained
Discussion
before the research work commenced. Informed verbal
consent from parents or caretakers of the patients was
Septicaemia has been reported to be one of the major
also sought prior to collection of blood sample. This
causes of morbidity and mortality among children in
developing countries of the world . The prevalence of
4
study was carried out between December 2005 - Decem-
ber 2006 in the Institute of Child Health, Ahmadu Bello
suspected bacterial septicaemia in this study was
University Teaching Hospital, Zaria in children brought
40.74%. This is lower than the incidences reported from
to out-patient clinic. The ICH caters for children 12
Ilorin (49.1%), Calabar (48.9%) but similar to Ibadan
(41.3%) among children
12, 17, 14
years and below and provides outpatient services only.
. However, this incidence
All children requiring admission are admitted into
may not be the actual incidence in the locality as neo-
department of Paediatrics ABUTH Zaria.
nates were excluded from this study. The observed inci-
dence was generally community-acquired as only chil-
Venous blood samples of children aged (one month-12
dren on outpatient clinics were investigated. Although
years) with clinical symptoms of septicaemia were col-
females were slightly in the majority, in contrast to other
lected under strict aseptic precautions. Two millimeters
studies were males were reported to be more implicated,
of blood sample was collected, inoculated into thiogly-
no evidence has been given to be responsible for gender
colate broth and then incubated at 37ēC. Subcultures
difference. The most common bacterial aetiological
were made after the first 24 hrs onto blood, chocolate
agent was Staphylococcus aureus (43.64%).
and MacConkey agar plates and also when there were
signs of bacterial growth shown by turbidity of the sam-
The observation agrees with the reports from other cen-
ples. The culture bottles were then discarded after seven
tres, where Staphylococcus aureus septicaemia had a
days if no detectable bacterial growth. Identification of
prevalence of 30.3%, 50%, 33.1% and 48.7% respec-
tively
12-14, 17
isolates was based on their morphology on agar plates,
. Salmonella is also another major cause
Gram stain reaction and biochemical properties as
septicaemia, it accounted for 23.64% of bacteria isolated
described by Cheesebrough .
1
in this study. This incidence is much higher than
(12.6%, S . typhi and 3.9%, S.paratyphi ) as reported from
Ibadan and 10.7% reported earlier in the same locality
13
14
. Salmonellae was observed commonly associated with
Results
septicaemia in children aged five (5) and below, in con-
Prevalence
trast with an earlier report were Salmonella species dis-
played a high incidence of septicaemia in children of age
bracket five and 11years . The high isolation rate of
13
Out of 135 blood samples of children investigated, an
incidence of bacterial septicaemia was recorded in fifty-
Salmonella may be due to inadequate facilities used in
five (40.74%) of the cases, Candida albican was iso-
disposing human faeces, potable water and close contact
lated in one case.
between heavily faecally contaminated water supplies
and humans. The incidence of Klebsiella septicaemia
Age
was quite low 3.64%, when compared with reports from
Ibadan 21.4%, Kano 14.3% and Ilorin 7.3%
14, 17, 12
.
The age range of the fifty-five children was from 30
Coagulase negative Staphylococci previously considered
days to 12 years with a mean age of 3 years. Majority of
a contaminant has been recognized increasingly as a
cause of bacteraemia . CoNS was isolated in 7.27% of
18
the children were less than or equal to five years, with a
peak in the first year of life (29.1%), 50.9% of those
cases, mostly affecting children below the ages of five
implicated were between 13- 60 months and 17.3% were
years. Similarly in Ilorin CoNS was isolated highest
(34.0%) in children less than five years . It has been
12
over 60 months of age.
Salmonella and Staphylococci
were associated
with
reported that the aetiologic agents of septicaemia may
septicaemia in almost all age groups. Citrobacter was
vary from place to place and even within the same
isolated in children aged 3 and less, children below 1
region it varies with time and age.
year were implicated with one organism or the other
except Klebsiella sp. Table 1 shows age distribution of
Both Gram positive and Gram negative bacteria still
children with suspected septicaemia and their respective
pose a great threat to lives of children in this locality,
pathogens.
there is need for regular monitoring of the aetiologic
8
agents of septicaemia so as to determine any change in
management of septicaemia especially in our setting
the epidemiologic pattern, this will help in the
where there are limited laboratory facilities.
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