Bacterial Isolates From Blood Cultures Of Children With Suspected Sepsis In An Urban Hospital In Lagos: A Prospective Study Using BACTEC Blood Culture System

摘要

Sepsis is a major cause of morbidity and mortality in children in the developing world, [1-4]. It is a systemic response to infection with bacteria, fungi, viruses, protozoa or rickettsia, [5]. Sepsis is therefore one of the causes of systemic inflammatory response syndrome (SIRS) which may manifest as hyperthermia, hypothermia, tachypnoea, tachycardia and increased or decreased white blood cell count, [5] Sepsis can progress to severe sepsis, septic shock and multiple organ dysfunction syndrome (MODS), [5].Definite diagnosis of sepsis is made by isolation of organism in blood specimen culture. International guidelines recommend that appropriate blood cultures should be obtained before starting antibiotics and the latter should be started as soon as possible especially within the first hour of recognising severe sepsis, [6]. The results of routine blood culture and antibiotics susceptibility tests take about a week thereby necessitating initial empirical treatment of suspected cases with broad spectrum antibiotics. Knowledge of pattern of common pathogens and the antimicrobial susceptibility pattern of these pathogens is therefore useful for guiding the initial treatment of patients.On the other hand, the administration of antibiotics before the collection of samples may decrease blood culture yields. A previous study in Ibadan, Nigeria showed that up to one third of patients have taken antibiotics prior to presenting to the physician, [7]. The implication is that a considerable number of children with definite sepsis are likely to be misdiagnosed if they have received antibiotics before their blood sampling for cultures. The BACTEC instrumented blood culture system is impregnated with antimicrobial removal system which is proven to enhance recovery of bacteria from blood and other specimen even if there has been prior antibiotic administration, [8-9]. The current study uses the BACTEC blood culture system to study bacteriological profile in children with suspected sepsis in our practice where the incidence of pre-hospital administration of antibiotics is known to be enormous. INTRODUCTION Sepsis is a major cause of morbidity and mortality in children in the developing world, [1-4]. It is a systemic response to infection with bacteria, fungi, viruses, protozoa or rickettsia, [5]. Sepsis is therefore one of the causes of systemic inflammatory response syndrome (SIRS) which may manifest as hyperthermia, hypothermia, tachypnoea, tachycardia and increased or decreased white blood cell count, [5] Sepsis can progress to severe sepsis, septic shock and multiple organ dysfunction syndrome (MODS), [5].Definite diagnosis of sepsis is made by isolation of organism in blood specimen culture. International guidelines recommend that appropriate blood cultures should be obtained before starting antibiotics and the latter should be started as soon as possible especially within the first hour of recognising severe sepsis, [6]. The results of routine blood culture and antibiotics susceptibility tests take about a week thereby necessitating initial empirical treatment of suspected cases with broad spectrum antibiotics. Knowledge of pattern of common pathogens and the antimicrobial susceptibility pattern of these pathogens is therefore useful for guiding the initial treatment of patients.On the other hand, the administration of antibiotics before the collection of samples may decrease blood culture yields. A previous study in Ibadan, Nigeria showed that up to one third of patients have taken antibiotics prior to presenting to the physician, [7]. The implication is that a considerable number of children with definite sepsis are likely to be misdiagnosed if they have received antibiotics before their blood sampling for cultures. The BACTEC instrumented blood culture system is impregnated with antimicrobial removal system which is proven to enhance recovery of bacteria from blood and other specimen even if there has been prior antibiotic administrat