Bacterial isolates, antibiotic susceptibility, and determinants of positive blood culture in children with community-acquired pneumonia in Central Tanzania

Abstract

Introduction: despite the widespread coverage of Haemophilus influenzae type b (Hib) and pneumococcal conjugate vaccines, the mortality of children under five years due to community-acquired pneumonia (CAP) in Tanzania remains unacceptably high. This study aimed to identify bacterial isolates, antibiotic susceptibility, and factors associated with blood culture positivity in children under five with CAP. Methods: a cross-sectional study involving 195 children under-five years of age who were clinically diagnosed with CAP was conducted at a referral hospital in central Tanzania from October 2018 to March 2019. Blood samples were taken, identification of culture isolates was performed through conventional bacteriological methods, followed by antibiotic susceptibility testing. Demographic and other data were collected using a standardized tool. Results: bacteremia was prevalent in 7.2% of participants, with Staphylococcus aureus being the most common isolate (57.1%). Overall, isolates were less sensitive to the WHO first-line antibiotics recommended for CAP treatment (penicillin and cephalosporins) but were sensitive to ciprofloxacin and clindamycin. Fever (>38.5°C), oxygen saturation (<90%), the need for oxygen therapy, a high respiratory rate (>60 cycles/minute), and leucocytosis (>15,000 cells/μl) were independent factors associated with positive blood culture. Conclusion: bacteraemia in children with CAP was nearly 10%, predicted by high respiratory rates, hypoxia, fever, and leucocytosis. Most of the isolates were insensitive to antimicrobials listed in the WHO-recommended first-line treatment for CAP, outlining the importance of routine culture and antimicrobial susceptibility.