Etiology, Antibiotic Susceptibility and Prognostic Factors of Pediatric Community-Acquired Sepsis in Addis Ababa, Ethiopia

Abstract Background: There is a scarcity of data on pediatric community-acquired sepsis (CAS) in Ethiopia. We sought to determine the etiology, antibiotic susceptibility pattern, and prognostic factors in children with CAS in Addis Ababa, Ethiopia.Methods: A prospective cross-sectional study of 101 children aged 0-15 yrs with suspected CAS was performed. Blood culture, antibiotic susceptibility testing, Polymerase Chain Reaction (PCR) of the autolysin (lytA) gene from whole blood samples and typing Streptococcus pneumoniae by sequencing the cpsB gene and using Quellung reaction were performed. Data were analyzed using descriptive statistics and binary logistic regression.Results: The prevalence of culture-positive CAS was 14.9 % (15/101). S. pneumoniae (26.7%) and Klebsiella pneumoniae (26.7%) were the most common causes of CAS. The four isolated pneumococci belonged to serotypes 19A (n = 2), 33C and 12F. Half of K. pneumoniae isolates were resistant to gentamicin and ceftriaxone. The case-fatality rate was 11.9% (12/101). In univariate analysis, age of 28 days - 1year (odds ratio (OR), 0.1; 95% confidence interval (CI), 0.01-0.98; P, 0.048), body temperature of 37.5 0C - 38.5 0C (OR, 0.2; 95% CI, 0.05-0.82; P, 0.026) were negatively associated with mortality. Presence of underlying comorbidity (adjusted odds ratio (aOR), 6.8; 95% CI, 1.59-28.7; P, 0.009) was an independent predictor of mortality.Conclusions: Streptococcus pneumoniae and Klebsiella pneumoniae were the major causes of CAS and there was a substantial level of antibiotic resistance among isolates. Presence of underlying comorbidity was a predictor of mortality. Large scale studies on etiology, antibiotic susceptibility pattern and prognostic factors of CAS in Ethiopia are warranted.