Bacteraemia and meningitis among hospital patients with diarrhoea

To characterize bacteraemia and meningitis in diarrhoeal patients, the records of 3395 blood cultures and 120 cerebrospinal fluid (CSF) cultures from 6132 patients admitted with diarrhoea to the Clinical Research Centre of the International Centre for Diarrhoeal Disease Research, Bangladesh during 1989 were analysed. Microorganisms were isolated from 12% (417 of 3395) of blood cultures and 9% (11 of 120) of CSF cultures. Children below 5 years of age represented 80% of all patients who had blood cultures and 82% of those who had CSF cultures made. The nutritional status was significantly lower in patients who had positive blood cultures than in those who had negative cultures. 23% (97 of 417) of patients with positive blood cultures and 45% (5 of 11) with positive CSF cultures died. Deaths occurred twice as often among patients who had organisms isolated than among those who had no organisms isolated from blood cultures. The organisms isolated from blood cultures which predicted most deaths were Pseudomonas aeruginosa, Neisseria meningitidis, Escherichia coli and Klebsiella sp., and they were multiresistant. We conclude that bacteraemia and meningitis remain serious complications associated with diarrhoea, especially in malnourished children; the therapeutic problem is further complicated by multiple drug resistance of the isolates.