1. Etiology of bacteremia in children under 5 years in Southern Mali
Rupa Kanapathipillai, Astan Dicko, Christopher Mambula, Lisa Umphrey, Nada Malou
Infectious Diseases Advisor, OCP
Medecins Sans Frontieres

2. Introduction Koutiala, Southern Mali Population: 629 000
2009: MSF-OCP/Malian Ministry of Health
5 community centres; referral hospital
<5 years; malaria, acute malnutrition, diarrhea, respiratory tract infections
Reduce pediatric mortality
R. Kanapathipillai, MSF OCP
Etiology of bacteremia in children under 5 in Southern Mali

3. Project Setting
Emergency Room/Intensive Care/inpatient medical wards/Intensive Therapeutic Feeding Centre/Neonates/Burns
beds
June-October: Malaria peak
Microbiology lab 2014: Diagnose causative pathogens: bacteremia, urinary tract infections, meningitis
Image credit: Medecins Sans Frontieres
R. Kanapathipillai, MSF OCP
Etiology of bacteremia in children under 5 in Southern Mali

4. Introduction
Aim: identify causes of bacteremia in <5 years in Koutiala
Identification causative bacterial pathogen/sensitivity
Adaptation antimicrobial therapy
Increasing rates of antimicrobial resistance globally
appropriate antibiotic first-line for sepsis
R. Kanapathipillai, MSF OCP
Etiology of bacteremia in children under 5 in Southern Mali

5. Methods
Retrospective analysis routinely collected microbiological data
January – December 2016
Admitted clinical suspicion sepsis
Blood culture at admission/no improvement after 48 hours antibiotics
WHONET microbiological database
EUCAST recommendations for antimicrobial susceptibility testing
Analysis of antibiogram: WHO-NET/CLSI guidelines
This retrospective analysis met the criteria of the MSF Ethics Review Board for exemption from ethics review
Nada – is this how the analysis was done?
R. Kanapathipillai, MSF OCP
Etiology of bacteremia in children under 5 in Southern Mali

6. Image credit: Medecins Sans Frontieres
R. Kanapathipillai, MSF OCP
Etiology of bacteremia in children under 5 in Southern Mali

7. Results: blood cultures
patients admitted
479 (14%) positive
10% contaminated
(??average positivity rate for ped population)
(definition contaminated: XXX)
Bacillus and staph coag neg identified as non pathogenic by clinicians
Nb contamination/total number of blood culture
R. Kanapathipillai, MSF OCP
Etiology of bacteremia in children under 5 in Southern Mali

8. Etiology of Bacteremia
Bacterial Pathogens Identified In Blood Cultures
Total number (%)
Salmonella sp
131 (27)
Escherichia coli
46 (9.6)
Staphylococcus aureus
41 (8.6)
Enterococcus faecalis
32 (6.7)
Streptococcus pneumoniae
24 (5)
Klebsiella pneumoniae
23 (4.8)
Among enterobacteriacea (n=227):
Extended Spectrum Beta lactamase (ESBL) producing: 39 (17%)
Klebsiella pneumoniae (36%)
Escherichia Coli (33%)
R. Kanapathipillai, MSF OCP
Etiology of bacteremia in children under 5 in Southern Mali

9. Resistance Rate – salmonella sp
R. Kanapathipillai, MSF OCP
Etiology of bacteremia in children under 5 in Southern Mali

10. Resistance Rate – k.pneumoniae, e.coli
R. Kanapathipillai, MSF OCP
Etiology of bacteremia in children under 5 in Southern Mali

11. Resistance Rate – e.faecalis, s.aureus
% Sensitivity
n=32
R. Kanapathipillai, MSF OCP
Etiology of bacteremia in children under 5 in Southern Mali

12. Limitations Routinely collected data:
blood cultures not systemically collected at admission
inconsistent collection clinical data and correlation to microbiology data
Limited ability to differentiate nosocomial vs community-acquired infection
Inconsistent baseline blood cultures
Limited documentation about patient location
Need increased number samples/positivity rate: significant AST (30 strains)
R. Kanapathipillai, MSF OCP
Etiology of bacteremia in children under 5 in Southern Mali

13. Conclusions
Most frequent pathogens first-line antibiotic therapy appropriate
Salmonella sp; S. aureus
K.pneumoniae (E.coli), consider switching/adding second agent to improve sensitivity while awaiting AST
Better differentiate nosocomial vs community acquired, including rates of resistance
Better correlate clinical outcomes with resistance
R. Kanapathipillai, MSF OCP
Etiology of bacteremia in children under 5 in Southern Mali

14. Acknowledgements Staff and patients MSF Koutiala, Mali
We confirm we have permission to use images from participants included in this presentation.
Image credit: Medecins Sans Frontieres
Staff and patients MSF Koutiala, Mali
R. Kanapathipillai, MSF OCP
Etiology of bacteremia in children under 5 in Southern Mali