Bacterial infections and antibiotic susceptibility in children with sickle-cell anemia on malaria chemoprevention using Dihydroartemisinin-piperaquine (DP) or Sulfadoxine-pyrimethamine (SP) in Uganda.
Winnie Nambatya, Moses Ocan, Grace Ndeezi et al.
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In 30 seconds
This analysis nested within a randomized, double-blind trial assessed bacterial infections and antimicrobial resistance among Ugandan children aged 6 months to 15 years with sickle-cell anemia receiving weekly dihydroartemisinin-piperaquine (DP) or monthly sulfadoxine-pyrimethamine (SP). Participants were followed for a median of 14.7 months, with blood cultures obtained during febrile episodes. Pathogenic bacteria were infrequently isolated; cumulative incidence of bacterial growth over 22 months was 2.3% (95% CI: 1.12-4.73). All isolates were multidrug-resistant, and sul2 was detected in Klebsiella pneumoniae and Escherichia coli.
Key findings
- Cumulative incidence of bacterial growth over 22 months was 2.3% (95% CI: 1.12-4.73).
- Pathogens isolated included Escherichia coli (3), Klebsiella pneumoniae (2), Staphylococcus aureus (2), Streptococcus agalactiae (1), and Enterococcus faecalis (1).
- All isolates were multidrug-resistant; sul2 was identified in Klebsiella pneumoniae and Escherichia coli.
Why it matters
The findings indicate that culture-confirmed bacterial infection was uncommon in this cohort, while recovered pathogens showed multidrug resistance. Detection of sul2 in two species also highlights a potential mechanism of plasmid-mediated sulfonamide resistance. These observations add context for interpreting febrile illness and resistance surveillance among children with sickle-cell anemia receiving malaria chemoprevention.
What to keep in mind
The analysis was limited to Ugandan participants, and bacterial infections were assessed through blood cultures obtained during febrile episodes; the abstract does not report a direct comparison of infection incidence between DP and SP groups.