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Community-Acquired Bacteremia Among Children Admitted to a Rural Hospital in Mozambique

Sigaúque, Betuel MD*†‡; Roca, Anna MSc, PhD*‡; Mandomando, Inácio DVM*†‡; Morais, Luís DVM*; Quintó, Llorenç MPH; Sacarlal, Jahit MD, MPH*‡§; Macete, Eusébio MD, MPH, PhD*†; Nhamposa, Tacilta MD*†; Machevo, Sónia MD; Aide, Pedro MD*†‡; Bassat, Quique MD*‡; Bardají, Azucena MD, MSc*‡; Nhalungo, Delino MSc*; Soriano-Gabarró, Montse MD, MSc; Flannery, Brendan PhD; Menendez, Clara MD, PhD*‡; Levine, Myron M. MD, DTPH; Alonso, Pedro L. MD, MSc, PhD*‡

The Pediatric Infectious Disease Journal: February 2009 - Volume 28 - Issue 2 - p 108-113
doi: 10.1097/INF.0b013e318187a87d
Original Studies

Background: Although community-acquired bacteremia is an important cause of childhood mortality in Africa, recognition of disease burden and potential impact of bacterial vaccines is limited.

Methods: Blood cultures for bacterial pathogens were conducted systematically among children <15 years of age admitted to Manhiça District Hospital, from 2001 to 2006.

Results: Blood-stream infections were identified in 8% (1550/19,896) of pediatric hospital admissions. Nontyphoidal Salmonella (NTS) and Pneumococcus were the most prevalent pathogens isolated (26% and 25% of 1550 cases, respectively). Until 28 days of life, Staphylococcus aureus (39%) and group B Streptococcus (20%) predominated. Incidence of community-acquired bacteremia per 100,000 child-years was 1730/105 in children <1 year old, 782/105 in 1–4 year oldd, and 49/105 in children 5 years and older. Case-fatality of bacteremia was 12%. Community-acquired bacteremia associated mortality accounted for 21% (162/788) of hospital deaths. Resistance to antibiotics commonly used in Mozambique was high among invasive isolates of Haemophilus influenzae, Escherichia coli, and NTS.

Conclusions: Community-acquired bacteremia is an important cause of pediatric hospital admission and death in rural African hospitals. The high burden of disease, mortality, and pattern of antibiotic resistance associated with bacteremia underscore the need for prevention in Sub-Saharan Africa.

From the *Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique; †Instituto Nacional de Saúde, Ministerio de Saúde, Maputo, Mozambique; ‡Centre de Recerca en Salut Internacional de Barcelona (CRESIB), Hospital Clinic/IDIBAPS, Universitat de Barcelona, Barcelona, Spain; §Facultade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique; ¶Centers for Disease Control and Prevention, Atlanta, GA; and ∥Center for Vaccine Development, University of Maryland, School of Medicine, Baltimore, MD.

Accepted for publication July 22, 2008.

Supported by CISM core funding provided by the Spanish Agency for International Cooperation (AECI-Ministry of Foreign Affairs, Spain). This study was also partly supported by funds from The Program for Appropriate Technology in Health (PATH) through to the pneumonia and Pneumococcus surveillance study (GAT.770-790-01350-LPS), and Bill and Melinda Gates Foundation through Center for Vaccine Development, University of Maryland, School of Medicine (Grant: S00957).

Address for correspondence: Betuel Sigaúque, MD, Rua 12, P.O. Box 1929, Maputo, Moçambique. E-mail: or

© 2009 Lippincott Williams & Wilkins, Inc.