Malaria and bacteremia in febrile children presenting at a teaching hospital in Kumasi, Ghana

BACKGROUND: Fever is a common symptom of many diseases but is frequently presumed to be malaria in many malaria-endemic areas. As a result, many individuals seek malaria treatment without confirming diagnosis, potentially overlooking other serious infections. Notably, febrile children may suffer from bacteremia, which, if undiagnosed, can lead to severe complications. This study, therefore, sought to assess the prevalence of both malaria and bacterial infections among febrile children receiving care at Komfo Anokye Teaching Hospital (KATH) in Ghana and to determine the prevalence of multi-drug resistance amongst isolates. METHODS: This cross-sectional study involved 270 febrile children presenting at KATH between April 2022 and July 2023. Malaria diagnosis was performed using rapid diagnostic test and microscopy while blood culture was performed using a Bactec machine where samples were incubated for 5 days. Positive samples were cultured and bacterial isolates were identified using both biochemical testing and API. Bacterial isolates were tested for antibiotic susceptibility using Kirby-Bauer method. After 5 days of incubation, samples that were negative were recorded as No bacterial growth. Binary logistic regression analysis was employed to identify independent marker of malaria-bacterial co-infection. Data analysis was carried out using Statistical Package for Social Sciences (Version 26.0) and GraphPad Prism (version 8.01), with categorical variables presented as frequencies and percentages. Statistical significance set at p < 0.05. RESULTS: Out of 270 children sampled, malaria and bacteremia were prevalent in 33% and 31% of participants respectively, with coinfection at 10.4% (± 3.6%, 95% CI). Seizures were independently associated with increased odds of malaria-bacterial coinfection [adjusted odds ratio (aOR) = 3.57, 95% confidence interval (CI) 1.28–9.95, p = 0.015]. Staphylococcus aureus (43.8%) and Pseudomonas aeruginosa (6.3%) were the most common gram-positive and gram-negative bacterial isolates, respectively. Multi-drug resistance (MDR) bacteria were identified in 34.5% of bacteria isolates. CONCLUSION: Findings highlight that, about 10% febrile children have malaria-bacterial coinfection, with seizures as a significant risk factor. Multi-drug resistance is common among children with malaria-bacterial coinfection. These findings show the need for effective antibiotic stewardship programs and resistance monitoring programs to prevent the further spread of drug-resistant infections among children.