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Bacteremic community-acquired pneumonia in Ethiopian children : etiology, antibiotic resistance, risk factors, and clinical outcome

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Abstract
Background: Community-acquired pneumonia (CAP) remains a leading cause of morbidity and mortality. We sought to determine the magnitude, etiology, and risk factors of CAP in children 5 years after introduction of pneumococcal conjugate vaccine (PCV) 10 in Ethiopia. Methods: We conducted a prospective observational study on the bacterial etiology and risk factors of CAP among children aged 0–15 years in 2 pediatric emergency departments in Addis Ababa, Ethiopia. Blood culture, antibiotic susceptibility testing, and amplification of pneumococcal lytA and cpsB genes were performed. Serotypes of Streptococcus pneumoniae were determined by Quellung reaction and sequencing the cpsB gene. Results: Out of 643 eligible children, 549 were enrolled. The prevalence of bacteremic pneumonia was 5.6%. Staphylococcus aureus (26.5%) was the predominant pathogenic species, followed by Enterococcus faecium (11.8%), Escherichia coli (11.8%), and Klebsiella pneumoniae (11.8%). In univariate analysis, parental smoking and nonvaccination with PCV10 were associated with bacteremic CAP. In multivariable analysis, female sex (adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.1–4.9), weight-for-age z-score (WAZ) <–2 SDs (aOR, 2.2; 95% CI, 1.1–4.8), and lower chest indrawing (aOR, 0.44; 95% CI, 0.2–0.95) were independently associated with bacteremic CAP. The overall in-hospital case fatality rate was 2.37% (13/549), and WAZ <–3 SDs (OR, 13.5; 95% CI, 3.95–46.12) was associated with mortality. Conclusions: Five years after the introduction of PCV10 in Ethiopia, S. aureus was the main cause of bacteremic CAP in children, the contribution of S. pneumoniae was low, and there was a high level of antibiotic resistance among isolates.
Keywords
Ethiopia, PCV10, Staphylococcus aureus, Streptococcus pneumoniae, bacteremic community-acquired pneumonia

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Chicago
Negash, Abel Abera, Daniel Asrat, Workeabeba Abebe, Tewodros Hailemariam, Tsegaye Hailu, Abraham Aseffa, and Mario Vaneechoutte. 2019. “Bacteremic Community-acquired Pneumonia in Ethiopian Children : Etiology, Antibiotic Resistance, Risk Factors, and Clinical Outcome.” Open Forum Infectious Diseases 6 (3).
APA
Negash, A. A., Asrat, D., Abebe, W., Hailemariam, T., Hailu, T., Aseffa, A., & Vaneechoutte, M. (2019). Bacteremic community-acquired pneumonia in Ethiopian children : etiology, antibiotic resistance, risk factors, and clinical outcome. OPEN FORUM INFECTIOUS DISEASES, 6(3).
Vancouver
1.
Negash AA, Asrat D, Abebe W, Hailemariam T, Hailu T, Aseffa A, et al. Bacteremic community-acquired pneumonia in Ethiopian children : etiology, antibiotic resistance, risk factors, and clinical outcome. OPEN FORUM INFECTIOUS DISEASES. 2019;6(3).
MLA
Negash, Abel Abera et al. “Bacteremic Community-acquired Pneumonia in Ethiopian Children : Etiology, Antibiotic Resistance, Risk Factors, and Clinical Outcome.” OPEN FORUM INFECTIOUS DISEASES 6.3 (2019): n. pag. Print.
@article{8606801,
  abstract     = {Background: Community-acquired pneumonia (CAP) remains a leading cause of morbidity and mortality. We sought to determine the magnitude, etiology, and risk factors of CAP in children 5 years after introduction of pneumococcal conjugate vaccine (PCV) 10 in Ethiopia.
Methods: We conducted a prospective observational study on the bacterial etiology and risk factors of CAP among children aged 0--15 years in 2 pediatric emergency departments in Addis Ababa, Ethiopia. Blood culture, antibiotic susceptibility testing, and amplification of pneumococcal lytA and cpsB genes were performed. Serotypes of Streptococcus pneumoniae were determined by Quellung reaction and sequencing the cpsB gene.
Results: Out of 643 eligible children, 549 were enrolled. The prevalence of bacteremic pneumonia was 5.6\%. Staphylococcus aureus (26.5\%) was the predominant pathogenic species, followed by Enterococcus faecium (11.8\%), Escherichia coli (11.8\%), and Klebsiella pneumoniae (11.8\%). In univariate analysis, parental smoking and nonvaccination with PCV10 were associated with bacteremic CAP. In multivariable analysis, female sex (adjusted odds ratio [aOR], 2.3; 95\% confidence interval [CI], 1.1--4.9), weight-for-age z-score (WAZ) {\textlangle}--2 SDs (aOR, 2.2; 95\% CI, 1.1--4.8), and lower chest indrawing (aOR, 0.44; 95\% CI, 0.2--0.95) were independently associated with bacteremic CAP. The overall in-hospital case fatality rate was 2.37\% (13/549), and WAZ {\textlangle}--3 SDs (OR, 13.5; 95\% CI, 3.95--46.12) was associated with mortality.
Conclusions: Five years after the introduction of PCV10 in Ethiopia, S. aureus was the main cause of bacteremic CAP in children, the contribution of S. pneumoniae was low, and there was a high level of antibiotic resistance among isolates.},
  articleno    = {ofz029},
  author       = {Negash, Abel Abera and Asrat, Daniel and Abebe, Workeabeba and Hailemariam, Tewodros and Hailu, Tsegaye and Aseffa, Abraham and Vaneechoutte, Mario},
  issn         = {2328-8957},
  journal      = {OPEN FORUM INFECTIOUS DISEASES},
  language     = {eng},
  number       = {3},
  pages        = {8},
  title        = {Bacteremic community-acquired pneumonia in Ethiopian children : etiology, antibiotic resistance, risk factors, and clinical outcome},
  url          = {http://dx.doi.org/10.1093/ofid/ofz029},
  volume       = {6},
  year         = {2019},
}

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