Clinical Decision Support in Non-typhoidal Salmonella Bloodstream Infections in Children
Clinical Decision Support in Non-typhoidal Salmonella Bloodstream Infections in Children
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.
Inclusion Criteria:

 1. Be a child of > 28 days and < 5 years old

 2. Be admitted to Kisantu Hospital

 3. Having a blood cultured sampled according to the criteria for suspected bloodstream
 infection embedded in the blood culture surveillance, i.e. presence of objective
 fever, hypothermia or history of fever during past 48 hours + at least one of the
 following criteria:

 -  Hypotension, confusion or increased respiratory rate

 -  Suspicion of severe localized infection: pneumonia, meningitis, osteomyelitis,
 complicated urinary tract infection, abscess, skin/soft tissue infection or
 abdominal infection

 -  Suspicion of typhoid fever

 -  Suspicion of severe Pf malaria

 4. Having a caregiver willing and able to provide written informed consent

 Exclusion Criteria:

 -  None