Bacteremia in HIV-infected children under 5 years old hospitalized in Mozambique

莫桑比克住院的5岁以下感染艾滋病毒的儿童出现菌血症

• 批准号: 9306755
• 负责人: D. Troy Moon
• 金额: $ 14.84万
• 依托单位: EDUARDO MONDLANE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-22 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9306755
• 关键词: 5 year old; Acquired Immunodeficiency Syndrome; Acute respiratory infection; Admission activity; Adult; Africa; Africa South of the Sahara; African; Anemia; Antibiotic susceptibility; Antibiotics; Bacteremia; Bacteria; Bacterial Infections; Blood; Case Fatality Rates; Cessation of life; Child; Cities; Clinical; Country; Data; Diarrhea; Disease; Escherichia coli; Etiology; Exhibits; Feces; Fever; Formularies; Frequencies; Gastroenteritis; Genomics; Geographic Locations; HIV; Haemophilus influenzae; Health system; Healthcare; High Prevalence; Hospitals; Human; Incidence; Income; Infection; Institution; Intervention; Live Birth; Malaria; Malnutrition; Microbiology; Molecular; Moon; Mozambique; Observational Study; Organism; Outcome; Pathogenicity; Pattern; Pediatric Hospitals; Pharmaceutical Preparations; Phylogenetic Analysis; Population; Predisposition; Prevalence; Province; Public Health; Recurrence; Reporting; Research; Research Infrastructure; Resistance; Resource Allocation; Resources; Rural; Salmonella; Salmonella enterica; Salmonella typhimurium; Sampling; Sepsis; Serotyping; Services; Staphylococcus aureus; Streptococcus pneumoniae; Testing; Universities; Urban Health; Work; aged; base; burden of illness; geographic difference; health difference; health disparity; mortality; multidisciplinary; pathogen; pediatric AIDS; prospective; public health relevance; rural area; rural setting; urban area; urban setting

DESCRIPTION (provided by applicant): Every year 4.6 million children <5 years of age (U5) die in sub-Saharan Africa. Incidence of disease for infections such as malaria, acute respiratory infection (ARI), diarrhea and human immunodeficiency virus (HIV) have been described. Existing estimates as to the incidence, mortality, or hospital burden of most pathogenic bacterial infections is predominantly limited to urban areas, thus the impact of U5 bacteremia is largely unknown as most people live in rural areas. Early studies suggest bacteremia in hospitalized African children exceeds that of high income countries and that gram-negative organisms, in particular non-typhoidal salmonella (NTS) are among the most common isolates, especially where the prevalence of HIV and malaria is high. The incidence of invasive NTS disease in Africa has been estimated at between 175-388 cases per 100,000 children aged 3-5 years. There are important differences by geographic region in U5 mortality, with the northern provinces having the highest rates respectively. Mozambique also has important urban/rural differences in health outcomes. U5 mortality in 2009 was estimated at 135/1000 live births in urban areas compared to 162/1000 live births in rural areas with higher frequency of death occurring in rural areas for each of the three main killers in children. We will conduct a prospective hospital-based observational study of HIV-infected children <5 years old, hospitalized with fever to determine the incidence, etiology, and antibiotic sensitivity patterns o culture confirmed bacteremia in representative rural and urban settings. The study will take place at Hospital Mavalane in Maputo city and the Quelimane Provincial Hospital in the Province of Zambezia, Mozambique. Our specific aims include: 1) To test the hypothesis that the incidence of bacteremia in HIV-infected children U5, hospitalized with fever is higher in children living in rural areas (Zambezia Province) compared with those living in urban areas (Maputo City); and 2) To test the hypothesis that non-typhoidal salmonella (NTS) is a major cause of bacteremia in HIV-infected children U5, hospitalized with fever in both urban Maputo City and rural Zambezia Province, Mozambique. Additionally, we will further genetically characterize NTS samples in blood and stool for the presence of the invasive ST313 strain. To accomplish these aims we have assembled a strong multidisciplinary team representing University Eduardo Mondlane (UEM) and Vanderbilt University and supported by the strong research and service infrastructures of these two major institutions. Our study holds promise to illuminate rural/urban health disparities that can then be targeted for mitigation. The results of this project will also provide crucial but currently unavailable information needed to prioritize resource allocation for microbiology capacity and guide national drug formulary practices.

描述（由申请人提供）：撒哈拉以南非洲地区每年有 460 万 5 岁以下儿童 (U5) 死亡。疟疾、急性呼吸道感染（ARI）、腹泻和人类免疫缺陷病毒（HIV）等感染性疾病的发病率已有描述。目前对大多数致病性细菌感染的发病率、死亡率或医院负担的估计主要限于城市地区，因此，由于大多数人生活在农村地区，U5 菌血症的影响在很大程度上是未知的。早期研究表明，非洲住院儿童的菌血症超过高收入国家，革兰氏阴性菌，特别是非伤寒沙门氏菌 (NTS) 是最常见的分离菌，特别是在艾滋病毒和疟疾流行率较高的地区。据估计，非洲侵袭性 NTS 疾病的发病率为每 10 万名 3-5 岁儿童中 175-388 例。不同地理区域的 U5 死亡率存在显着差异，北部省份的死亡率最高。莫桑比克的城乡健康结果也存在重大差异。 2009 年城市地区 U5 死亡率估计为 135/1000 活产，而农村地区为 162/1000 活产，农村地区儿童三大主要杀手的死亡频率更高。我们将对因发烧住院的 5 岁以下 HIV 感染儿童进行一项前瞻性医院观察性研究，以确定代表性农村和城市环境中培养证实的菌血症的发病率、病因和抗生素敏感性模式。该研究将在马普托市的马瓦拉内医院和莫桑比克赞比西亚省的克利马内省医院进行。我们的具体目标包括： 1) 验证以下假设：与居住在城市地区（马普托市）的儿童相比，农村地区（赞比西亚省）因发烧住院的 HIV 感染儿童 U5 菌血症的发生率更高； 2) 检验非伤寒沙门氏菌 (NTS) 是莫桑比克马普托市和赞比西亚省农村地区因发烧住院的 HIV 感染儿童 U5 菌血症的主要原因这一假设。此外，我们将进一步对血液和粪便中的 NTS 样本进行基因鉴定，以确定是否存在侵入性 ST313 菌株。为了实现这些目标，我们组建了一支强大的多学科团队，代表爱德华多·蒙德拉恩大学 (UEM) 和范德比尔特大学，并得到这两所主要机构强大的研究和服务基础设施的支持。我们的研究有望阐明农村/城市的健康差异，然后可以有针对性地缓解这种差异。该项目的结果还将提供重要但目前无法获得的信息，以优先考虑微生物学能力的资源分配并指导国家药物处方实践。