ANTIBIOTICS RESISTANCE PATTERN IN MALNOURISHED CHILDREN SUFFERING FROM ACUTE SEVERE BACTERIAL INFECTIONS AT CMC CHILDREN'S HOSPITAL, LARKANA
DOI:
https://doi.org/10.71000/8c6jxf38Keywords:
Pediatric infections, Blood culture, Anti-Bacterial Agents, Child, Preschool, Malnutrition; , Microbial Sensitivity Tests, PakistanAbstract
Background: Severe acute malnutrition (SAM) significantly compromises immunity in children, increasing their vulnerability to life-threatening bacterial infections. These infections often present with nonspecific symptoms and are further complicated by rising antimicrobial resistance. Early detection and understanding of pathogen distribution and antibiotic susceptibility patterns are critical for timely intervention, particularly in resource-limited regions such as Larkana, Pakistan.
Objective: To assess the frequency of acute bacterial infections and determine the antibiotic resistance patterns in children with SAM admitted to healthcare facilities in Larkana.
Methods: A cross-sectional study was conducted from October 2023 to September 2024 at the nutrition ward of Chandka Medical College and a private pediatric facility in Larkana. A total of 105 children aged 5 to 60 months, clinically diagnosed with SAM, were included. Blood samples were collected aseptically before initiating antibiotic therapy. Bacterial identification and antibiotic susceptibility testing were performed using standard microbiological protocols. Demographic, clinical, and laboratory data were recorded and analyzed using SPSS version 25.
Results: Of the 105 children, 67% presented with fever, 63% with diarrhea, 54% with dehydration, 42% with vomiting, 41% with edema, and 30% with cough. Blood cultures were positive in 33 cases (31%). Escherichia coli was the most frequently isolated pathogen (39%), followed by Klebsiella pneumoniae (27%), Staphylococcus aureus (12%), Pseudomonas aeruginosa (9%), and both Streptococcus pneumoniae and Haemophilus influenzae type b (6% each). E. coli showed 85% sensitivity to imipenem, and K. pneumoniae showed 78% sensitivity to amikacin. High resistance was noted against ampicillin and multiple cephalosporins.
Conclusion: Children with SAM, particularly those under one year, are highly susceptible to bacterial infections. The emergence of antibiotic-resistant pathogens underscores the need for localized antibiotic stewardship and evidence-based treatment protocols to improve pediatric outcomes in malnutrition-endemic areas.
References
WHO. Management of Severe Malnutrition: A Manual for Physicians and Other Senior Health Workers. Geneva: World Health Organization; 1999.
Andersen, C. T., Langendorf, C., Garba, S., Sayinzonga-Makombe, N., Mambula, C., Mouniaman, I., ... & Isanaka, S. (2022). Risk of community-and hospital-acquired bacteremia and profile of antibiotic resistance in children hospitalized with severe acute malnutrition in Niger. International Journal of Infectious Diseases, 119, 163-171.
Dhir, S. K., Sundaram, V., Gautam, V., Munda, V. S., Tiewsoh, J. B. A., Angurana, S. K., ... & Kumar, P. (2021). Microorganisms profile and antimicrobial resistance pattern in outborn neonates in Northern India: a hospital-based observational study. Journal of Tropical Pediatrics, 67(3), fmab068.
World Health Organization. (2022). Global antimicrobial resistance and use surveillance system (GLASS) report 2022. World Health Organization.
Shrestha, B., Bastola, A., Pandey, P., & Shrestha, S. (2022). Biofilm Production among Extended Spectrum Beta Lactamase Producing and non-Producing Escherichia coli Isolated from Clinical Specimen. Tribhuvan University Journal of Microbiology, 71-81.
Tesema, G. A., Biney, G. K., Wang, V. Q., Ameyaw, E. K., & Yaya, S. (2025). Antibiotic prescription sources and use among under-5 children with fever/cough in sub-Saharan Africa. International Health, 17(1), 94-104.
Saini, S., Thass, N., Kayesth, J., & Sikhondze, W. (2023). Antimicrobial Resistance Associated with Infectious Diseases. In Handbook on Antimicrobial Resistance: Current Status, Trends in Detection and Mitigation Measures (pp. 1-29). Singapore: Springer Nature Singapore.
Iregbu, K. C., Oduyebo, O. O., Taiwo, S. S., Nwajiobi-Princewill, P. I., Oshun, P. O., Nwafia, I. N., ... & Kudayah, I. O. (2023). The CLIMIDSON Manual for Antimicrobial Stewardship Programmes in Nigerian Health Care Facilities. African Journal of Clinical and Experimental Microbiology, 24(4), 314-338.
Xiao D, Zhang X, Ying J, Zhou Y, Li X, Mu D, et al. Association between vitamin D status and sepsis in children: A meta-analysis of observational studies. Clin Nutr. 2020;39(6):1735-41.
Mohamed SA, Kamel NR, Fouda AE, Elhawary RE, Abdelmegeid MA. Association of low vitamin D level and full-term early-onset neonatal sepsis; a case-control study. Ital J Pediatr. 2024;50(1):101.
Rajvanshi N, Goyal JP. Combating Tuberculosis in Malnourished Children: Addressing a Silent Epidemic. Indian J Pediatr. 2024;91(8):763-4.
Michael H, Srivastava V, Deblais L, Amimo JO, Chepngeno J, Saif LJ, et al. The Combined Escherichia coli Nissle 1917 and Tryptophan Treatment Modulates Immune and Metabolome Responses to Human Rotavirus Infection in a Human Infant Fecal Microbiota-Transplanted Malnourished Gnotobiotic Pig Model. mSphere. 2022;7(5):e0027022.
Libby TE, Delawalla MLM, Al-Shimari F, MacLennan CA, Vannice KS, Pavlinac PB. Consequences of Shigella infection in young children: a systematic review. Int J Infect Dis. 2023;129:78-95.
Sarmin M, Shaly NJ, Sultana T, Tariqujjaman M, Shikha SS, Mariam N, et al. Efficacy of dopamine, epinephrine and blood transfusion for treatment of fluid refractory shock in children with severe acute malnutrition or severe underweight and cholera or other dehydrating diarrhoeas: protocol for a randomised controlled clinical trial. BMJ Open. 2023;13(4):e068660.
Fleckenstein JM, Sheikh A. Emerging Themes in the Molecular Pathogenesis of Enterotoxigenic Escherichia coli. J Infect Dis. 2021;224(12 Suppl 2):S813-s20.
Moretó-Planas L, Sagrado MJ, Mahajan R, Gallo J, Biague E, Gonçalves R, et al. Point-of-care ultrasound for tuberculosis diagnosis in children: a Médecins Sans Frontières cross-sectional study in Guinea-Bissau. BMJ Open. 2023;13(5):e066937.
Gamal Y, Mahmoud AO, Mohamed SAA, J IM, Raheem YFA. Prevalence and impact of malnutrition on outcomes and mortality of under-five years children with pneumonia: a study from Upper Egypt. Eur J Pediatr. 2023;182(10):4583-93.
Coker M, Folayan MO, Michelow IC, Oladokun RE, Torbunde N, Sam-Agudu NA. Things must not fall apart: the ripple effects of the COVID-19 pandemic on children in sub-Saharan Africa. Pediatr Res. 2021;89(5):1078-86.
Vonasek BJ, Radtke KK, Vaz P, Buck WC, Chabala C, McCollum ED, et al. Tuberculosis in children with severe acute malnutrition. Expert Rev Respir Med. 2022;16(3):273-84.
Anyalechi GE, Bain R, Kindra G, Mogashoa M, Sogaula N, Mutiti A, et al. Tuberculosis prevalence, incidence and prevention in a south african cohort of children living with HIV. J Trop Pediatr. 2022;68(6).
Yu W, Ying Q, Zhu W, Huang L, Hou Q. Vitamin D status was associated with sepsis in critically ill children: A PRISMA compliant systematic review and meta-analysis. Medicine (Baltimore). 2021;100(2):e23827.
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Copyright (c) 2025 Ishfaque Ahmed Mugher, Delijan Mugheri, Beenish Ghafar, Ammar Ali, Vinay Kumar Jesrani, Abdul Jabbar Mugheri (Author)

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