Predictors of bacteremia in infants with diarrhea and systemic inflammatory response syndrome attending an urban diarrheal treatment center in a developing country*

Chisti, Mohammod Jobayer; Saha, Shuvra; Roy, Chandra Nath; Salam, Mohammed Abdus

doi:10.1097/pcc.0b013e3181b063e1

Cited by 31 publications

(52 citation statements)

References 29 publications

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“…The independent association of ileus with children being reluctant to feed is also understandable. Children with diarrhea and severe malnutrition who were reluctant to feed, more often presented with severe gut infection, leading to an edematous small bowel [18]. This phenomenon might contribute to the narrowing of the small bowel lumen and gaseous abdominal distension resulting in ileus.…”

Section: Discussionmentioning

confidence: 99%

“…Septic shock was defined as severe sepsis that was unresponsive to fluid resuscitation. Severe sepsis in diarrheal children has been defined in recent publications from Bangladesh [14,16]; originally adopted from the surviving sepsis guideline recommended by the American Pediatric Association [17,18], with minor modifications for children with diarrhea. Severe sepsis was defined as sepsis plus the presence of poor peripheral perfusion (weak or absent peripheral pulses), and a capillary refilling time greater than 3 seconds or age-specific hypotension.…”

Section: Methodsmentioning

confidence: 99%

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Ileus in children presenting with diarrhea and severe acute malnutrition: A chart review

et al. 2017

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BackgroundSeverely malnourished children aged under five years requiring hospital admission for diarrheal illness frequently develop ileus during hospitalization with often fatal outcomes. However, there is no data on risk factors and outcome of ileus in such children. We intended to evaluate predictive factors for ileus during hospitalization and their outcomes.Methodology/Principal findingsThis was a retrospective chart review that enrolled severely malnourished children under five years old with diarrhea, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh between April 2011 and August 2012. We used electronic database to have our chart abstraction from previously admitted children in the hospital. The clinical and laboratory characteristics of children with (cases = 45), and without ileus (controls = 261) were compared. Cases were first identified by observation of abnormal bowel sounds on physical examination and confirmed with abdominal radiographs. For this comparison, Chi-square test was used to measure the difference in proportion, Student’s t-test to calculate the difference in mean for normally distributed data and Mann-Whitney test for data that were not normally distributed. Finally, in identifying independent risk factors for ileus, logistical regression analysis was performed. Ileus was defined if a child developed abdominal distension and had hyperactive or sluggish or absent bowel sound and a radiologic evidence of abdominal gas-fluid level during hospitalization. Logistic regression analysis adjusting for potential confounders revealed that the independent risk factors for admission for ileus were reluctance to feed (odds ratio [OR] = 3.22, 95% confidence interval [CI] = 1.24–8.39, p = 0.02), septic shock (OR = 3.62, 95% CI = 1.247–8.95, p<0.01), and hypokalemia (OR = 1.99, 95% CI = 1.03–3.86, p = 0.04). Mortality was significantly higher in cases compared to controls (22% vs. 8%, p<0.01) in univariate analysis; however, in multivariable regression analysis, after adjusting for potential confounders such as septic shock, no association was found between ileus and death (OR = 2.05, 95% CI = 0.68–6.14, p = 0.20). In a separate regression analysis model, after adjusting for potential confounders such as ileus, reluctance to feed, hypokalemia, hypocalcemia, and blood transfusion, septic shock (OR = 168.84, 95% CI = 19.27–1479.17, p<0.01) emerged as the only independent predictor of death in severely malnourished diarrheal children.Conclusions/SignificanceThis study suggests that the identification of simple independent admission risk factors for ileus and risk factors for death in hospitalized severely malnourished diarrheal children may prompt clinicians to be more vigilant in managing these conditions, especially in resource-limited settings in order to decrease ileus and ileus-related fatal outcomes in such children.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Ileus in children presenting with diarrhea and severe acute malnutrition: A chart review

et al. 2017

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“…The observed bacteraemia due to coagulase-negative S. aureus might represent community-acquired pneumonia, which is not uncommon in severely-malnourished children (24). Such children are often deficient in alveolar type II cells and complement, leading to inability to efficiently clear Staphylococcus from their lungs (25) and better survival of the pathogen in alveolar lining epithelial fluid.…”

Section: Discussionmentioning

confidence: 99%

Occult Pneumonia: An Unusual but Perilous Entity Presenting with Severe Malnutrition and Dehydrating Diarrhoea

Chisti

Salam

Sharifuzzaman

et al. 2010

J Health Popul Nutr

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A three-month old boy was admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh, with the problems of acute watery diarrhoea with some dehydration and suspected dyseletrolytaemia, severe malnutrition, and reduced activity. Occult pneumonia was added to the problem list after demonstration of radiologic consolidation in right upper lung, despite the lack of clinical signs, both on admission and after correction of dehydration. The problem list was further expanded to include bacteraemia due to Staphylococcus aureus when the blood culture report was available. Severely-malnourished children may not exhibit typical clinical signs of pneumonia, and the possibility of existence of such problems should be remembered in the assessment and provision of care to hospitalized young children with severe malnutrition.

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“…Increased number of immature neutrophils in the peripheral blood smears of children is an expression of severe illness common in bacterial sepsis [1]. An earlier study from Bangladesh reported that children with leukocytosis and immature neutrophils in their peripheral blood are more likely to be bacteremic and to have a higher risk of death [1]. Thus, the presence of immature neutrophils in peripheral blood in diarrheal children should alert clinicians to look for sepsis in order to reduce morbidity and deaths in such population.…”

Section: Discussionmentioning

confidence: 99%

“…Sepsis is one of the most important causes of death in under-five children in developing countries [1,2]. The largest part of the global sepsis burden occurs in middleand low-income countries.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Death in Under-Five Children with Sepsis Attending an Urban Diarrheal Treatment Centre in Bangladesh

Shahunja¹,

Shahid²,

Ashraf³

et al. 2013

FNS

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In the logistic regression analysis, after adjusting for potential confounders, such as abnormal WBC count, use of intravenous fluid, patient with fatal outcome more often presented with hypernatremia (odds ratio = 16.48, 95% confidence interval = 2.21 -123.12; p = 0.006), lobar consolidation (odds ratio = 19.9, 95% confidence interval = 2.99 -132.80; p = 0.002), hypoxemia (odds ratio = 14.78, 95% confidence interval = 1.38 -157.90; p = 0.026) and severe under-nutrition (odds ratio = 7.57, 95% confidence interval = 1. 24 -46.11; p = 0.028). CONCLUSIONS: Our data suggest that children under-five with clinical sepsis who present with lobar pneumonia, hypoxaemia, severe acute malnutrition and hyperntaemia are at higher risk of death and identification of these simple factors may help clinicians to take prompt initiative for the aggressive management of such children especially in a resource-limited setting like Bangladesh.

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Predictors of bacteremia in infants with diarrhea and systemic inflammatory response syndrome attending an urban diarrheal treatment center in a developing country*

Cited by 31 publications

References 29 publications

Ileus in children presenting with diarrhea and severe acute malnutrition: A chart review

Ileus in children presenting with diarrhea and severe acute malnutrition: A chart review

Occult Pneumonia: An Unusual but Perilous Entity Presenting with Severe Malnutrition and Dehydrating Diarrhoea

Predictors of Death in Under-Five Children with Sepsis Attending an Urban Diarrheal Treatment Centre in Bangladesh

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