Systemic bacteraemia in children presenting with clinical pneumonia and the impact of non-typhoid salmonella (NTS)

In total, 1032 blood cultures were taken from children between 2 months and 5 years of age who were admitted to a rural hospital in Ghana between September 2007 and July 2009. Pneumonia was diagnosed clinically and according to WHO criteria classified as "non-severe pneumonia" and "severe pneumonia" ("severe pneumonia" includes the WHO categories "severe pneumonia" and "very severe pneumonia").The proportion of bacteriaemia with non-typhoid salmonella (NTS) was similar in children with pneumonia (16/173, 9.2%) compared to children hospitalized for other reasons (112/859, 13%). NTS were the predominant organisms isolated from children with clinical pneumonia and significantly more frequent than Streptococcus pneumoniae (8/173, 4.6%). Nine percent (9/101) of children presenting with severe pneumonia and 10% (7/72) of children with non-severe pneumonia were infected with NTS. Nineteen out of 123 NTS isolates (15%) were susceptible to aminopenicillins (amoxycillin/ampicillin), 23/127 (18%) to chlorampenicol, and 23/98 (23%) to co-trimoxazole. All NTS isolates were sensitive to ceftriaxone and ciprofloxacin.In Sub-saharan Africa, sepsis with NTS should be considered in children with symptoms of pneumonia and aminopenicillins might often not be the adequate drugs for treatment.Pneumonia is one of the most common diagnoses in African children presenting at hospitals and peripheral health centres and is the most important cause of mortality in children under five years of age [1,2]. Due to the lack of bacteriological laboratory facilities, antibiotic treatment of pneumonia is guided by presumptions based on clinical symptoms. According to the WHO-IMCI (World Health Organisation Integrated Management of Childhood Illness) amoxicillin is the first line drug for empirical treatment of pneumonia as it covers the commonly suspected organisms (e.g. Streptococcus pneumoniae and Haemophilus influenzae) [3]. However, this treatment scheme does not capture enteric bacteria and there