BACTEREMIA IN PATIENTS PRESENTING WITH FEVER

In three studies, in Ghana and Kenya, blood from 639 patients admitted with fever was cultured. Standard treatments were antimalarials (54-1 00%) and antibiotics (39-90%). According to the criteria in use, howev er, only 10-31% had malaria alone; of those who received antibiotics, 66% were diagnosed with malaria, gastrointestinal infections, post-ope rative recuperations, circulatory problems, central nervous system dis orders or FUO, and did not need antibiotics at the first encounter. Fo r those with wounds and abscesses (8%), generalised antibiotic treatme nt can also be questioned. Bacteraemia was found in 71 (11.3%) patient s; in the HIV patients, however, 5 (23%) of 22 had bacteraemia. This i s a minimum incidence, since culture techniques were not optimal for t he isolation of fastidious microorganisms. The most prevalent organism s isolated were Salmonella, Klebsiella/Enterobacter and S. aureus. Res istance (intrinsic and extrinsic) in the Gram- bacteria was high: 31-1 00% were resistant to amoxycillin, 0-80% to cotrimoxazole, 15-95% to c hloramphenicol and 9-15% to gentamicin. The need for cultures and sens itivity tests for patients with prolonged or undiagnosed fever is stre ssed. Specific treatment should be given only when infections, whether malarial or bacterial, have been positively diagnosed.