Prevalence, Associated Factors, and Antibiogram of Streptococcal Upper Respiratory Tract Infections in Children Under 5 Years at Holy Innocents Children’s Hospital, Mbarara City.
Authors: Sikon Ebenezer Felex , Ritah Kenyange , Emmanuel Abonga , Jastus Lwanga , Mathias Ainomugusha , Enoch Muwanguzi 
Published: July 2024

Abstract

Objectives
This study aimed at understanding the prevalence, associated factors, and antibiogram of streptococcal upper respiratory tract infections in children under 5 years at Holy Innocents Children’s Hospital, Mbarara.
Methods
This was the hospital-based cross-sectional study at Holy Innocents Children’s Hospital (HICH), Mbarara city in Uganda from August to September 2022. The study included children aged 5 years below presenting with signs and symptoms of upper respiratory tract infections. Clinical and demographic data was collected using a well-structured questionnaire and also by use of patient logbooks. The study included 236 participants whose oropharyngeal swabs were collected in Stuart transport media and transported to the Mbarara Diagnostic Laboratory Center(MDLC) for culture to isolate the Streptococci species. Culture was done by standard microbiology procedure for isolation of the Streptococci species from the samples and identification done using gram staining, catalase test, optochin, bacitracin test and bile solubility test. Antibiotic susceptibility testing was done in accordance with the clinical and laboratory standard institute (CLSI) guidelines. The collected data was entered in excel, cleaned and exported to SPSS version 22 for final analysis using the appropriate analysis models.
Results
The prevalence of streptococcal URTIs was 36.6% of the 236 studied participants, most 119/236 (50.4%) were females. The mean age of the children was found to be 31.5 months (SD ± 16.2months [95%CI_29.4–33.6]). Most 175/236 (74.2%) of the children had been weaned from breast milk and antibiotic usage in at least the last one month was reported to be low 26/236 (11.02%). Among the caretakers, the mean age was found to be 33.3 years (SD ± 8.7years[95%CI_32.2–34.4]) and most who presented to hospital were found to be female 161/236 (71.6%). Among the children, the prevalence of Streptococcal URTIs was found to be 86/236 (36.4%). Viridan streptococci accounted for the most 59/86 (68.6%) isolated, followed by Streptococci pyogenes which accounted for 25/86 (29.1%). Streptococci pneumoniae and Streptococci pyogenes were found to be 100% susceptible to ceftriaxone. However, few 4/59 (6.8%) of the Viridans streptococci were observed to be resistant. Very high resistance for observed for penicillin (100%) and Ampicillin (above 80%). Variables that were significantly associated with having an URTI among our study population were education of the caretaker (P = 0.022), Living with other siblings (P = 0.048), anyone smoking a cigarette (P = 0.036) and age of the child (P = 0.037).
Conclusions
The study found that the prevalence of Streptococcal URTIs among children admitted at the hospital was high mostly associated with Viridan streptococci. The following variables that were significantly associated with having an URTI among our study population; education of the caretaker, living with other siblings, anyone smoking a cigarette and age of the child. Resistance to the studied penicillin by the different streptococcal isolates was found to be high. The most effective drug that most streptococcal isolates were susceptible to was found to be ceftriaxone.