The pattern of bacterial infections among the severely malnourished children in the paediatric wards of Muhimbili Medical Centre

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University of Dar es Salaam
The pattern of bacterial infections occurring in 208 severely malnourished patients in paediatric wards at Muhimbili Medical Centre was determined. The prevalence of infections at the time of admission was 78.8%, and incidence of hospital acquired infection was 50.0%. Septicaemia (35.6%) and UTI (33.7%) were the commonest bacterial infections but pneumonia (21.6%) and PTB (14.9%) were also common among the study population. Marasmic-kwashiorkor patients had the highest prevalence of septicaemia while the marasmic ones had a significantly higher incidence of nosocomial bacterial infections than the kwashiorkor or marasmic kwashiorkor patients. A high degree of suspicion is needed and confirmatory tests done with bacteriological cultures (as much as possible for the diagnosis of bacterial infections in severe PEM. There was little agreement between the signs and symptoms (provisional diagnosis) of bacterial infections and bacteriologically confirmed diagnosis. Staphylococci aureus was the commonest organism cultured from blood and other miscellaneous specimens while gram negative organisms were the commonest bacteriae isolated from urine. Pathogens cultured from the patients were similar to those isolated from the swabs taken in the paediatric wards. Staphyaureus and Klebsiella species beying the commonest organisms. Hence preventive measures for nosocomial infections to these immune compromised patients should be considered. Shorter durations of hospital stay and sterile nursing environment might be helpful. Staphylococci were highly sensitive to Cloxacillin and erythromycin. While gram negative organisms were hingly sensitive to gentamicin, they were also sensitive to cortrimoxazole. In case of gentamycin shortage, cortrimoxazole can be used for treatment of gram negative organisms. A furrther study for staphylococci aureus sensitivity to gentamicin needs a further study so that one drug might be used for all the possible infections among the severely malnounrished patients. Antimicrobial therapy should however be based as far as possible on gram stain, culture and antibiotic sensitivity data.
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Bacterial disease, Deficiency diseases, Diagnosis, Tanzania
Isaack, H (1990) The pattern of bacterial infections among the severely malnourished children in the paediatric wards of Muhimbili Medical Centre, Masters dissertation, University of Dar es Salaam. Available at ( )