title: Concomitant bacteraemia as a risk factor for diarrhoeal disease mortality in Karachi: a case-control study of hospitalized children.
abstract: The objective of this study was to evaluate risk factors for death due to diarrhoea among hospitalized children at the Aga Khan University Hospital (AKUH), Karachi. We conducted a retrospective case-control study of all diarrhoea deaths at AKUH over the period 1988-93. For each death, the next two consecutive admissions matched for gender and type of diarrhoea were identified as controls. Data were analysed by univariate methods and logistic regression analysis. A total of 42 deaths and 84 matched controls were identified. Blood cultures at admission were obtained in all deaths and 94% of controls. The rates of isolation of organisms from blood cultures were significantly higher among deaths [38 versus 9%, odds ratio (OR) 6.5, 95% confidence interval (CI) 2.2-19.9], the majority of which were Gram-negative Enterobacteriaceae (94 versus 57%, Fisher's exact test p < 0.02). Conditional logistic regression revealed that several clinical and laboratory features of systemic infection were associated with a significantly increased risk of mortality, such as anorexia (OR 3.9, 95% CI 1.4-10.9), drowsiness (OR 4.4, 95% CI 1.3-15.3), respiratory distress (OR 7.0, 95% CI 1.4 36.6), anaemia (OR 5.8, 95% CI 2.0-16.6) and a positive blood culture (OR 8.7, 95% CI 2.5-30.7). Our data suggest that bacteraemia with Enterobacteriaceae is common among hospitalized malnourished children with diarrhoea and systemic infection may be an important risk factor for mortality.
authors.affiliation: Department of Paediatrics, Aga Khan University Medical Center, Karachi, Pakistan.
authors.forename: Z A
authors.initials: ZA
authors.lastname: Bhutta
authors.forename: N
authors.initials: N
authors.lastname: Punjwani
authors.forename: B S
authors.initials: BS
authors.lastname: Lindblad
mesh_terms: D016470:Bacteremia / Q000150:complications / Q000453:epidemiology / Q000401:mortality*; D016022:Case-Control Studies; D002673:Child, Hospitalized / Q000706:statistics & numerical data; D002675:Child, Preschool; D016001:Confidence Intervals; D003967:Diarrhea / Q000150:complications / Q000382:microbiology / Q000401:mortality*; D004755:Enterobacteriaceae / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010154:Pakistan / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors