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

Shahunja, K. M.; Shahid, Abu Sadat Mohammad Sayeem Bin; Ashraf, Hasan; Faruque, A. S. G.; Das, Sumon Kumar; Kamruzzaman, Md.; Flora, Farhana Pervin; Chisti, Mohammod Jobayer

doi:10.4236/fns.2013.47090

Cited by 5 publications

(6 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Sepsis is a clinical syndrome resulting from a dysregulated systemic inflammatory response to infection and characterized by a generalized pro-inflammatory cascade, which may lead to widespread tissue injury [ 24 ]. So, often it leads to severe sepsis, septic shock and multi-organ failure [ 25 ] where the death rate is very high in both developed and developing countries [ 26 , 27 ]. The mortalities vary from 4–34% in sepsis to septic shock [ 28 – 30 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical and laboratory characteristics of children under five hospitalized with diarrhea and bacteremia

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background Diarrhea is one of the leading causes of mortality in children under five globally. When it is associated with bacteremia, mortality is even higher. However, bacteraemia in diarrheal children has gained little attention in spite of its deleterious impact in under-five mortality. So, we aimed to evaluate associated clinical and laboratory factors for death in under-five children hospitalized with both diarrhea and bacteremia. Methods In this retrospective cross-sectional study, we used patients’ electronic database of Dhaka Hospital of ‘icddr,b’, and enrolled all under-five children with diarrhea and bacterial growth in their blood samples on admission between June-2014 and May-2017. Clinical and laboratory characteristics were compared between those who died and who survived with a special attention to bacterial pathogens related to deaths and their sensitivity pattern. Results In a total of 401 diarrheal children with bacteraemia, 45 (11%) died. Although Salmonella Typhi (34%) was the most predominant isolate followed by Staphylococcus species (16%) and Pseudomonas species (9%), children who died more often had E. coli (OR = 5.69, 95% CI = 2.42–13.39, p = <0.001) and Klebsiella bacteraemia (OR = 4.59, 95% CI = 1.84–11.46, p = 0.001) compared to those who survived. However, none of them was significantly associated with deaths in regression analysis when adjusted with other potential confounders. E. coli was 100% resistant to ampicillin, 41% to gentamicin, and 73% to ceftriaxone and Klebsiella species was 96% resistant to ampicillin, 42% to gentamicin, and 62% to ceftriaxone. Study children who died had significantly higher overall resistance pattern shown in World Health Organization (WHO) recommended one of the first line antibiotics in treating childhood sepsis such as ampicillin (80% vs. 50%, p = 0.001) and in second line antibiotic such as ceftriaxone (49% vs. 22%, p = 0.001) compared to the survivors. In logistic regression analysis, after adjusting for potential confounders, we found that clinical sepsis (aOR 3.79, 95% CI 1.60–8.96, p = 0.002), hypoxemia (aOR 4.20, 95% CI 1.74–10.12, p = 0.001), and hyperkalaemia (aOR 2.69, 95% CI 1.05–6.91, p = 0.039) were found to be independent predictors of deaths and receipt of sensitive antibiotic (aOR 0.42, 95% CI 0.18–0.99, p = 0.048) was revealed as the independent protective factor for deaths in this population. Conclusion and significance The results of our data suggest that diarrheal children with bacteremia who died more often had gram negative bacteremia compared to those who survived and these pathogens are highly resistant to WHO recommended first line and second line antibiotics. The results further emphasize the critical importance of early identification of important clinical problems such as clinical sepsis, hypoxemia and hyperkalaemia in diarrheal children and treat them with potential sensitive antibiotic(s) in order to reduce bacteremia related mortality in children with diarrhea, especially in resource limited settings.

show abstract

Section: Discussionmentioning

confidence: 99%

“…The mortalities vary from 4–34% in sepsis to septic shock [ 28 – 30 ]. An earlier study in Bangladesh showed the mortality was about 15% in this age group (under five) [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical and laboratory characteristics of children under five hospitalized with diarrhea and bacteremia

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…The identification of blood isolates was performed following standard microbiological laboratory procedure in the Dhaka Hospital, icddr,b [33].…”

Section: Methodsmentioning

confidence: 99%

Clinical risk factors, bacterial aetiology, and outcome of urinary tract infection in children hospitalized with diarrhoea in Bangladesh

et al. 2016

Self Cite

View full text Add to dashboard Cite

Urinary tract infection (UTI) is common in children aged <5 years with diarrhoea, but little is known about risk factors, aetiology and outcome of such children. We aimed to evaluate these knowledge gaps of UTI in children aged <5 years with diarrhoea. We enrolled all children aged <5 years with diarrhoea admitted to Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, between May 2011 and April 2013, who had history of fever (⩾38 °C) and obtained a urine sample for culture. Diarrhoea with UTI (confirmed by culture) constituted cases (n = 26) and those without UTI constituted controls (n = 78). Threefold controls were randomly selected. The case-fatality rate was comparable in cases and controls (4% vs. 1%, P = 0·439). Escherichia coli (69%) and Klebsiella (15%) were the most commonly isolated pathogens. Persistent diarrhoea, pneumonia and prior antibiotics use were identified as risk factors for UTI in logistic regression analysis (P < 0·05 for all). Thus, children with diarrhoea presenting with persistent diarrhoea, pneumonia, and prior antibiotic use should be investigated for UTI for their prompt management that may reduce morbidity.

show abstract

“…The identification of blood isolates and the susceptibility testing were done with the routine methods at the microbiological laboratory. Blood culture and serum electrolyte were processed in the Dhaka Hospital, icddr, b [ 20 ].…”

Section: Methodsmentioning

confidence: 99%

Experience with Clinically Diagnosed Down Syndrome Children Admitted with Diarrhea in an Urban Hospital in Bangladesh

Das

Sarker²,

Saha

et al. 2015

International Scholarly Research Notices

Self Cite

View full text Add to dashboard Cite

There is lack of information in the medical literature on clinically diagnosed Down syndrome children presenting with diarrhea. Our aim was to describe our experience with Down syndrome patients admitted with diarrhea by evaluating the factors associated with Down syndrome presenting with diarrheal illness. In this retrospective chart analysis, we enrolled all the diarrheal children aged 0–59 months admitted to the Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (icddr, b), from March 2011 to February 2013. Down syndrome children with diarrhea constituted cases and randomly selected threefold diarrheal children without Down syndrome constituted controls. Among 8422 enrolled children 32 and 96 were the cases and the controls, respectively. Median age (months) of the cases and the controls was comparable (7.6 (4.0, 15.0) versus 9.0 (5.0, 16.8); p = 0.496). The cases more often presented with severe acute malnutrition, developmental delay, congenital heart disease, hypothyroidism, sepsis, hypocalcemia, developed hospital acquired infection (HAI) during hospitalization, and required prolonged stay at hospital compared to the controls (for all p < 0.05). Thus, diarrheal children with clinically diagnosed Down syndrome should be investigated for these simple clinical parameters for their prompt management that may prevent HAI and prolonged hospital stay.

show abstract

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

Cited by 5 publications

References 19 publications

Clinical and laboratory characteristics of children under five hospitalized with diarrhea and bacteremia

Clinical and laboratory characteristics of children under five hospitalized with diarrhea and bacteremia

Clinical risk factors, bacterial aetiology, and outcome of urinary tract infection in children hospitalized with diarrhoea in Bangladesh

Experience with Clinically Diagnosed Down Syndrome Children Admitted with Diarrhea in an Urban Hospital in Bangladesh

Contact Info

Product

Resources

About