Predictors of bacteremia in infants with diarrhea and systemic inflammatory response syndrome attending an urban diarrheal treatment center in a developing country.
OBJECTIVE
To identify clinical and laboratory predictors of bacteremia in infants with diarrhea and systemic inflammatory response syndrome and to analyze their outcome.


METHODS
Retrospective, case-control study.


METHODS
The Special Care Ward of the Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh, Dhaka, Bangladesh.


METHODS
All the infants (n = 90) admitted to the Special Care Ward between May 2005 and April 2006 who had a blood culture, full peripheral blood count, and serum C-reactive protein performed were included in the study. Infant with systemic inflammatory response syndrome with confirmed bacteremia (n = 18) constituted cases, and those with systemic inflammatory response syndrome but negative blood culture (n = 72) constituted the controls.


RESULTS
The following features were analyzed by comparing the two groups: absent or uncountable peripheral pulses, hypothermia, sclerema, altered mental status, white blood cell count, serum C-reactive protein, total protein concentrations, and outcome. The case-fatality rate was significantly higher among bacteremic infants compared with those without bacteremia (33% vs. 6%, p < .01). In the univariate model, sclerema (56% vs. 28%, p = .05), hyperglycemia (28% vs. 6%, p < .01), immature neutrophils [3.5 (00, 6.5) vs. 0.0 (0.0, 3.25); p = .02], higher C-reactive protein [2.7 (1.2, 7.4) vs. 1.8 (0.5, 4.2); p = .02], and lower serum total protein (51.1 +/- 14.1 vs. 57.6 +/- 12.2; p = .05) were identified as potential predictors of bacteremia. However, in the logistic regression analysis, after adjusting for confounders, only hypothermia (odds ratio = 6.4, 95% confidence Interval, 1.6-25.9; p = .01) and absent or uncountable peripheral pulse (odds ratio, 12.4, 95% confidence interval, 1.9-83.4; p < .01) remained significant independent predictors of bacteremia.


CONCLUSIONS
Our data suggest that, in infants presenting with diarrhea and systemic inflammatory response syndrome, coexistence of hypothermia and absent or uncountable peripheral pulse is strongly associated with bacteremia. Bacteremia in this patient group is associated with high case-fatality rates.
Chisti
Mohammod J
MJ
Clinical Sciences Division, International Centre for Diarrhoeal Disease Research, Bangladesh. chisti@icddrb.org
Saha
Shuvra
S
Roy
Chandra N
CN
Salam
Mohammed A
MA
D016470:Bacteremia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D001459:Bangladesh; D016022:Case-Control Studies; D015897:Comorbidity; D003906:Developing Countries; D003968:Diarrhea, Infantile; D005260:Female; D006801:Humans; D007035:Hypothermia; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D018746:Systemic Inflammatory Response Syndrome; D014505:Urban Population