title: The exploration of risk factors of concurrent bacteraemia in patients critically ill with severe dengue.
abstract: We investigated the clinical features of intensive care unit (ICU) patients with concomitant severe dengue infection and bacteraemia to identify risk factors for this comorbidity. The records of all ICU dengue patients admitted during the period of 31 July-30 November 2015 were reviewed. Patients with 'concurrent bacteremia' (positive bacterial blood culture within 72 h of ICU admission) were identified. ICU admission was required for 142 patients, of which 22 (15.5 %) had concurrent bacteraemia. Species of the genus Streptococcus was the most common pathogens, followed by Escherichia coli then species of the genus Staphylococcus. Patients with a severe dengue infection and bacteraemia had higher APACHE II and TISS scores, C-reactive protein (CRP) levels and leukocyte counts, positive fluid balances, longer activated partial thromboplastin times (APTTs), higher lactate levels and more kidney failure, but controls (severe dengue patients without bacteraemia) had higher Glasgow Coma Scale (GCS) scores, higher albumin levels and more abdominal pain (all P<0.05). Patients with bacteraemia had a higher mortality rate than did ontrols (40.9 vs 18.3 %; P=0.018). Multiple logistic regression analysis showed that bacteraemia was significantly positively associated with the following independent predictors: higher CRP levels [adjusted odds ratio (aOR): 1.026; 95 % confidence interval (CI): 1.008-1.044; P=0.005], and longer APTTs (aOR: 1.034; 95 CI: 1.004-1.065; P=0.027). Concurrent bacteraemia is not uncommon in severe dengue patients in the ICU, and it is associated with high mortality. Higher CRP levels and longer APTTs were two independent risk factors associated with bacteraemia.
authors.affiliation: Department of Recreation and Health-Care Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan, ROC.|Department of Intensive Care Medicine, Chi-Mei Medical Center, Tainan, Taiwan, ROC.
authors.forename: Chin-Ming
authors.initials: CM
authors.lastname: Chen
authors.affiliation: Department of Intensive Care Medicine, Chi-Mei Medical Center, Tainan, Taiwan, ROC.
authors.forename: Khee-Siang
authors.initials: KS
authors.lastname: Chan
authors.affiliation: Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan, ROC.|Department of Safety Health and Environment, Chung Hwa University of Medical Technology, Tainan, Taiwan, ROC.
authors.forename: Kuo-Chen
authors.initials: KC
authors.lastname: Cheng
authors.affiliation: Department of Recreation and Health-Care Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan, ROC.
authors.forename: Willy
authors.initials: W
authors.lastname: Chou
authors.affiliation: Department of Intensive Care Medicine, Chi-Mei Medical Center, Tainan, Taiwan, ROC.
authors.forename: Hui-Chun
authors.initials: HC
authors.lastname: Chao
authors.affiliation: Department of Intensive Care Medicine, Chi-Mei Medical Center, Tainan, Taiwan, ROC.
authors.forename: Chiu-Yin
authors.initials: CY
authors.lastname: Yeh
authors.affiliation: Department of Intensive Care Medicine, Chi-Mei Medical Center, Tainan, Taiwan, ROC.|Department of Medicine, Taipei Medical University, Taipei, Taiwan, ROC.
authors.forename: Wen-Liang
authors.initials: WL
authors.lastname: Yu
mesh_terms: D018806:APACHE; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000401:mortality; D002097:C-Reactive Protein / Q000032:analysis; D015331:Cohort Studies; D060085:Coinfection / Q000453:epidemiology* / Q000382:microbiology / Q000821:virology; D015897:Comorbidity; D016638:Critical Illness; D004926:Escherichia coli / Q000302:isolation & purification; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D012189:Retrospective Studies; D012307:Risk Factors; D019595:Severe Dengue / Q000453:epidemiology* / Q000382:microbiology* / Q000401:mortality; D013210:Staphylococcus / Q000302:isolation & purification; D013291:Streptococcus / Q000302:isolation & purification
chemical_list: D002097:C-Reactive Protein