Developing a clinical prediction model to modify empirical antibiotics for non-typhoidal Salmonella bloodstream infection in children under-five in the Democratic Republic of Congo
Background - Non-typhoidal Salmonella (NTS) frequently cause bloodstream infection in children under-five in sub-Saharan Africa, particularly in malaria-endemic areas. Due to increasing drug resistance, NTS are often not covered by tandard-of-care empirical antibiotics for severe febrile illness. W...
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| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
27 January 2025
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| In: |
BMC infectious diseases
Year: 2025, Volume: 25, Pages: 1-14 |
| ISSN: | 1471-2334 |
| DOI: | 10.1186/s12879-024-10319-x |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1186/s12879-024-10319-x Verlag, kostenfrei, Volltext: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-10319-x 
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| Author Notes: | Bieke Tack, Daniel Vita, Jules Mbuyamba, Emmanuel Ntangu, Hornela Vuvu, Immaculée Kahindo, Japhet Ngina, Aimée Luyindula, Naomie Nama, Tito Mputu, Justin Im, Hyonjin Jeon, Florian Marks, Jaan Toelen, Octavie Lunguya, Jan Jacobs, and Ben Van Calster |
| Summary: | Background - Non-typhoidal Salmonella (NTS) frequently cause bloodstream infection in children under-five in sub-Saharan Africa, particularly in malaria-endemic areas. Due to increasing drug resistance, NTS are often not covered by tandard-of-care empirical antibiotics for severe febrile illness. We developed a clinical prediction model to orient the choice of empirical antibiotics (standard-of-care versus alternative antibiotics) for children admitted to hospital in settings with high proportions of drug-resistant NTS. Methods - Data were collected during a prospective cohort study in children (> 28 days—< 5 years) admitted with severe febrile illness to Kisantu district hospital, DR Congo. The outcome variable was blood culture confirmed NTS bloodstream infection; the comparison group were children without NTS bloodstream infection. Predictors were selected a priori based on systematic literature review. The prediction model was developed with multivariable logistic regression; a simplified scoring system was derived. Internal validation to estimate optimism-corrected performance was performed using bootstrapping and net benefits were calculated to evaluate clinical usefulness. Results - NTS bloodstream infection was diagnosed in 12.7% (295/2327) of enrolled children. The area under the curve was 0.79 (95%CI: 0.76–0.82) for the prediction model, and 0.78 (0.85–0.80) for the scoring system. The estimated calibration slopes were 0.95 (model) and 0.91 (scoring system). At a decision threshold of 20% NTS risk, the prediction model and scoring system had 57% and 53% sensitivity, and 85% specificity. The net benefit for decisions thresholds < 30% ranged from 2.4 to 3.9 per 100 children. Conclusion - The model predicts NTS bloodstream infection and can support the choice of empiric antibiotics to include coverage of drug-resistant NTS, in particular for decision thresholds < 30%. External validation studies are needed to investigate generalizability. |
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| Item Description: | Gesehen am 30.09.2025 |
| Physical Description: | Online Resource |
| ISSN: | 1471-2334 |
| DOI: | 10.1186/s12879-024-10319-x |