Bacterial aetiology and outcome of severe pneumonia among children aged 2-59 months admitted to the Acute Care Unit, Mulago Hospital

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dc.creatorNantanda, Rebecca
dc.date2012-11-22T07:22:18Z
dc.date2012-11-22T07:22:18Z
dc.date2006-05
dc.date.accessioned2018-09-04T12:33:03Z
dc.date.available2018-09-04T12:33:03Z
dc.descriptionA dissertation submitted in partial fulfilment of the requirement for the award of the degree of Master of Medicine (Paediatrics and Child Health) of Makerere University
dc.descriptionIntroduction: Acute lower respiratory tract infections (ALRI) are a major cause of morbidity and mortality in the "under fives" worldwide, accounting for 10-30% of childhood deaths. Pneumonia contributes up to 50% of all ALRI. It causes 1.6-2.2 million deaths worldwide, 70% of them in developing countries, and is responsible for up to 19% of overall mortality. We undertook a study to describe the bacterial aetiology, antimicrobial sensitivity patterns and outcome of severe pneumonia among children aged 2-59 months admitted in Acute Care Unit Mulago Hospital. Methods: Between December 2005 and March 2006, a cross sectional descriptive study of 157 children aged 2-59 months admitted with severe pneumonia was done. The history, physical examination and investigations such as blood culture, induced sputum for culture and sensitivity and chest X-rays were done. The children were followed up for a maximum of seven days. The data collected was entered using EPI-INFO and analysed with SPSS packages. Results: Bacteraemia was present in 15.9% of the 157 children. The commonest organisms causing bacteraemia were Staphylococcus aureus (36%), Streptococcus pneumoniae (28%). Fifty four (54%) of the children had bacteria isolated from their sputum and the commonest organisms were Streptococcus pneumoniae, Haemophilus influenzae and Klebsiella species accounting for 45.9%, 23.5% and 22.4% of the total isolates respectively. Most of the organisms isolated were sensitive to ceftriaxone, ciprofloxacin and amoxicillin-clavulinic acid in up to 95% of cases. Death occurred in 24 (15.3%) of the 157 children studied. Most of the children (66.7%) had bacterial pneumonia. The predictors of death were very severe pneumonia (OR 12.9), oxygen saturation on admission <92% (OR 4.9) and malnutrition (OR 16.5). Conclusions: Bacteria were isolated in 54% of children aged 2-59 months. The commonest bacteria isolated were Streptococcus pneumoniae (45.9%), Haemophilus influenzae (23.5%) and Klebsiella species (22.4%). Majority of the organisms were sensitive to ceftriaxone. Streptococci pneumoniae, the commonest cause of severe pneumonia, was sensitive to chloramphenicol in 87.4% of cases. The case fatality rate among children with severe pneumonia was 15.3%, while 1.9% developed complications. One hundred and thirty (82.8%) showed clinical improvement within 7 days. The independent predictors of death were malnutrition, arterial oxygen saturation less than 92% and having very severe pneumonia. Recommendations: Children with severe pneumonia should be routinely assessed for arterial oxygen saturation, severity of pneumonia and nutritional status because these are predictors of adverse outcome. A study to determine the most efficacious antibiotic for treatment of severe pneumonia in children in Mulago Hospital is recommended.
dc.identifierNantanda, R. (2006). Bacterial aetiology and outcome of severe pneumonia among children aged 2-59 months admitted to the Acute Care Unit, Mulago Hospital. Unpublished master's thesis, Makerere University, Kampala, Uganda.
dc.identifierhttp://hdl.handle.net/10570/887
dc.identifier.urihttp://hdl.handle.net/10570/887
dc.languageen
dc.subjectPneumonia
dc.subjectPneumonia in children
dc.subjectBacteraemia
dc.subjectBacterial pneumonia
dc.subjectKlebsiella
dc.subjectBacterial aetiology
dc.titleBacterial aetiology and outcome of severe pneumonia among children aged 2-59 months admitted to the Acute Care Unit, Mulago Hospital
dc.typeThesis, masters
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