| dc.description.abstract | Bacterial pathogens cause significant number of deadly diseases and widespread epidemics in
man. The mortality associated with these diseases is higher in developing countries where the
impact is difficult to estimate as symptoms are similar to other non- bacterial febrile illnesses.
Bacteria are transmitted through deep unclean wounds, minor skin breaks or bruises, eyes, oral
fecal route, respiratory tract, bites from arthropods and urinary tract. The objective of this study
was to determine the diversity of bacteria isolated from the blood of patients presenting with
febrile illness seeking health care at Alupe District Hospital and KEMRI CIPDCR clinic in
Alupe, Western Kenya. The antibiotic susceptibility profile of drugs commonly used in Alupe
was also determined using a standard interpretative table. A total of 200 patients were recruited
and their social demographic data collected after obtaining their consent. Thereafter, their blood
samples were collected. Laboratory analysis was done at KEMRI-CIPDCR laboratory to identify
and characterize bacteria pathogens by conventional methods using microbial culture on various
agars and biochemical tests. The youngest and oldest patients were 2 and 82 years, respectively.
The proportion of male patients was 38.5% while 61.5% were female. Five bacterial species
were detected in 7 of the 200 blood samples. Of the total isolates, 57.1% were Gram- negative
whilst 42.9% were Gram-positive. The five bacteria species isolated were S. aureus (3 isolates),
E. coli (2 isolates), P. mirabilis and K. pneumoniae (1 isolate each). No blood sample yielded
more than one species. Data were subjected to analysis using Stata version 10.0 and a standard
interpretative table was used for comparison of antimicrobial resistance patterns of the isolates.
The odds of bacteremia increased in patients who had a heart murmur (OR = 15.9, p = 0.0047),
rash (OR = 6.6, p = 0.0162), severe headache (OR = 4.8, p = 0.0305) and swollen lymph nodes
(OR = 28.2, p = 0.0000). The odds of bacteremia were significantly lower in patients who had
mild headache (OR = 0.2, p = 0.0338). Overall, all the isolates were 100% susceptible to
chloramphenicol and gentamicin with the highest resistance being to erythromycin (71.4%),
ampicillin-cloxacillin (57.1%) and cefuroxime (57.1%). The isolates were relatively susceptible
to amoxyllin-clavunic acid, ceftazidime and nitrofurantoin and showed the lowest susceptibility
to nalidixic acid (14.3%). Bacteremia was not common in febrile patients visiting the two health
facilities in Alupe, Western Kenya. This study provided data on specific causative and prevalent
bacterial species that presented febrile illness as a symptom and provides guidelines on antibiotic
use in the management of bacteremia in Alupe where malaria is endemic. If bacteremia is
suspected on admission or at any later stage in management of patients, initial antibiotic therapy
with chloramphenicol should be undertaken. | en |
