title: Correlation of Clinical Outcomes With Multiplex Molecular Testing of Stool From Children Admitted to Hospital With Gastroenteritis in Botswana.
abstract: BACKGROUND
  Diarrheal disease is a leading cause of death for young children. Most pediatric gastroenteritis is caused by viral pathogens; consequently, current recommendations advocate against routine antibacterial therapy if children present without bloody stools.
  
  
  METHODS
  In this prospective cohort study, we enrolled children with severe acute gastroenteritis admitted to hospital in Botswana. Details of presenting history, physical examination, and course in the hospital were recorded. Stool samples were characterized using a 15 pathogen polymerase chain reaction assay.
  
  
  RESULTS
  There were 671 participants with a median age of 8.3 months; 77 (11%) had severe acute malnutrition. Only 74 children had bloody stools, of whom 48 (65%) had a detectable bacterial pathogen, compared to 195 of 592 (33%) of those without. There were 26 deaths (3.9%). Covariates associated with death in multivariable logistic regression were the detection of any of Campylobacter/Shigella/enterotoxigenic Escherichia coli (odds ratio [OR] 2.57, 95% confidence interval [CI] 1.07-6.17), severe acute malnutrition (OR 4.34, 95% CI 1.79-10.5), and antibiotic therapy (OR 8.82, 95% CI 2.03-38.2). There was no significant association between bloody stools and death, and the effect of Campylobacter/Shigella/enterotoxigenic E. coli infection on death was not modified by the presence of bloody stools.
  
  
  CONCLUSIONS
  Detection of bacterial enteropathogens is associated with increased mortality in children in sub-Saharan Africa. Unfortunately, most children with these infections do not have bloody stools, and bloody dysentery was not found to be associated with worse outcomes. Clinical trials evaluating outcomes associated with more aggressive diagnostic strategies in children presenting with severe acute gastroenteritis in sub-Saharan Africa should be undertaken.
authors.affiliation: Division of Infectious Disease, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Pernica
authors.affiliation: Botswana-UPenn Partnership, Gaborone Division of Infectious Disease and Section of Global Health, Department of Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania, Philadelphia.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Steenhoff
authors.affiliation: The Children's Hospital of Philadelphia, Pennsylvania.
authors.forename: Henry
authors.initials: H
authors.lastname: Welch
authors.affiliation: National Health Laboratory, Gaborone, Botswana.
authors.forename: Margaret
authors.initials: M
authors.lastname: Mokomane
authors.affiliation: School of Medicine, University of Namibia, Windhoek.
authors.forename: Isaac
authors.initials: I
authors.lastname: Quaye
authors.affiliation: Botswana-UPenn Partnership, Gaborone.
authors.forename: Tonya
authors.initials: T
authors.lastname: Arscott-Mills
authors.affiliation: Department of Pediatrics, University of Botswana, Gaborone.
authors.forename: Loeto
authors.initials: L
authors.lastname: Mazhani
authors.affiliation: Botswana-UPenn Partnership, Gaborone.
authors.forename: Kwana
authors.initials: K
authors.lastname: Lechiile
authors.affiliation: Division of Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Mahony
authors.affiliation: Division of Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Marek
authors.initials: M
authors.lastname: Smieja
authors.affiliation: Division of Infectious Disease, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada Botswana-UPenn Partnership, Gaborone Department of Pediatrics, University of Botswana, Gaborone Division of Microbiology, Department of Pathology, University of British Columbia, Vancouver, Canada.
authors.forename: David M
authors.initials: DM
authors.lastname: Goldfarb
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001902:Botswana / Q000453:epidemiology; D002675:Child, Preschool; D003968:Diarrhea, Infantile / Q000188:drug therapy / Q000382:microbiology / Q000821:virology; D005243:Feces / Q000382:microbiology* / Q000821:virology; D005260:Female; D005759:Gastroenteritis / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality / Q000821:virology; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000150:complications; D060885:Multiplex Polymerase Chain Reaction; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: diagnosis; dysentery; gastroenteritis; polymerase chain reaction; treatment