Bacteremia During Diarrhea: Incidence, Etiology, Risk Factors, and Outcome

Abstract

To determine the importance of bacteremia in hospitalized patients with diarrhea in Bangladesh, from September 1982 through August 1983 the authors obtained blood for culture from 1,824 patients who were suspected of having sepsis (44% of all admissions). Nontyphoid bacteremia occurred in 243 patients. The most common pathogens were the Enterobacteriaceae (n = 66 episodes), Staphylococcus aureus (n = 65), Pseudomonas aeruginosa and other non-glucose-fermenting bacilli (n = 50), Streptococcus pneumoniae (n = 40), and Haemophilus influenzae (n = 16). When compared with an equal number of control patients without bacteremia, bacteremic patients were significantly (p less than 0.05) more likely to be under 1 year of age (46.5% of bacteremic patients vs. 30.0% of control patients) and more often had abdominal tenderness (20.1% vs. 11.5%), hypoproteinemia (a serum protein level less than 60 g/liter) (58.9% vs. 42.9%), and a prior intravenous infusion (49.0% vs. 30.9%). The case-fatality rate was 29.7% in bacteremic patients versus 7.8% in controls (relative risk (RR) = 3.8, p less than 0.001). Factors that were associated with an increased risk of death in bacteremic patients were infection with a Gram-negative pathogen (RR = 2.48), decreased peristalsis (RR = 2.66), hypoproteinemia (RR = 3.36), hypothermia (RR = 2.54), and hypotension (RR = 2.19). Bacteremia appears to be an important link between diarrheal illness and death in Bangladesh. In children with diarrhea who are suspected of being septic, early implementation of antimicrobial therapy that is effective against the broad range of pathogens identified appears to be indicated.

Mortality, morbidity, and microbiology of endemic cholera among hospitalized patients in Dhaka, Bangladesh.

“…OR ϭ odds ratio; CI ϭ confidence interval. ated with cholera, 14,16,[26][27][28][29] its role as a leading cause of death has not previously been reported. This finding is in large part due to the success of rehydration therapy programs and the virtual elimination of hypovolemia as a cause of death among hospitalized patients with cholera in this setting.…”

Necrotizing bowel lesions complicated byPseudomonas septicaemia in previously healthy infants

“…Preceding diarrhoea was observed in 8 of 27 (30%) cases, including one of our cases. The damaged intestinal mucosa induced by various pathogens may serve as the port of entry for Pseudomonas aeruginosa, which is the inhabitant of 5%-30% of normal individuals [2,7].…”

Factors Associated with Streptococcal Bacteremia in Diarrheal Children under Five Years of Age and Their Outcome in an Urban Hospital in Bangladesh

“…Streptococcus has been found to have higher resistance to cotrimoxazole, ciprofloxacin, and erythromycin and lower resistance to penicillin in a number of studies involving children with pneumonia and/or sepsis [ 15 – 19 ]. Mortality may be even higher when children with Streptococcal bacteremia also suffer from diarrhea, although Gram-negative bacteremia is predominate among diarrheal children, as observed in previous studies in the last few decades [ 20 – 22 ]. Breaches of integrity of bowel mucosa followed by reduced immunity are perceived to be common in diarrheal children that make them more vulnerable to bacteremia.…”