Clinical Decision Support in Non-typhoidal Salmonella Bloodstream Infections in Children
Condition: Bloodstream Infection; Salmonella Bacteremia; Malaria,Falciparum; Severe Malaria
MeSH terms: Infections; Communicable Diseases; Malaria; Bacteremia; Sepsis; Malaria, Falciparum
Study type: Observational

Summary: 
      In sub-Saharan Africa, non-typhoidal Salmonella (NTS) are a frequent cause of bloodstream
      infection, display high levels of antibiotic resistance and have a high case fatality rate
      (15%). In Kisantu hospital in the Democratic Republic of Congo (DR Congo), NTS account for
      75% of bloodstream infection in children and many children are co-infected with Plasmodium
      falciparum (Pf) malaria. NTS bloodstream infection presents as a non-specific severe febrile
      illness, which challenges early diagnosis and, as a consequence, prompt and appropriate
      antibiotic treatment.Moreover, at the first level of care, frontline health workers have
      limited expertise and diagnostic skills and, as a consequence, clinical danger signs that
      indicate serious bacterial infections are often overlooked.

      Basic handheld diagnostic instruments and point-of-care tests can help to reliably detect
      danger signs and improve triage, referral and the start of antibiotics, but there is need for
      field implementation and adoption to low-resource settings. Further, it is known that some
      clinical signs and symptoms are frequent in NTS bloodstream infections. The integration of
      these clinical signs and symptoms in a clinical decision support model can facilitate the
      diagnosis of NTS bloodstream infections and target antibiotic treatment.

      The investigators aim to develop such a clinical decision support model based on data from
      children under five years old admitted to Kisantu district referral hospital in the
      Democratic republic of the Congo. While developing the model, the investigators will focus on
      the signs and symptoms that can differentiate NTS bloodstream infection from severe Pf
      malaria and on the clinical danger signs that can be assessed by handheld diagnostic
      instruments and point-of-care tests. The deliverable will be a clinical decision support
      model ready to integrate in an electronic decision support system.
    


Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Study site: Pediatric ward of St. Luc general referral hospital in Kisantu health zone
        (Province Kongo Central, DR Congo), further referred to as "Kisantu Hospital"

          -  Capacity: 100 beds, bed occupancy reaches up to 180%

          -  Financial system: Flat fees per admission (10$)

          -  Ongoing blood culture surveillance study:

               -  Routine free-of-charge blood culture sampling & work-up coordinated by INRB/ITM

               -  Since 2017, blood culture surveillance as a part of typhoid conjugate vaccine
                  study

          -  Epidemiological context:

               -  High burden of non-typhoidal Salmonella (NTS) bloodstream infections

               -  High Plasmodium falciparum (Pf) malaria endemicity

               -  High prevalence of malnutrition
      
Keywords: Bloodstream infection; Salmonella non-typhi; Children under five years; Clinical decision support; Democratic Republic of the Congo; Fever; Febrile illness; Malaria; Anemia; Malnutrition; Bacterial infection