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Concomitant bacteraemia as a risk factor for diarrhoeal disease mortality in Karachi: a case-control study of

Z A Bhutta1, N Punjwani, B S Lindblad

  • 1Department of Paediatrics, Aga Khan University Medical Center, Karachi, Pakistan.

Acta Paediatrica (Oslo, Norway : 1992)
|July 1, 1996
PubMed

Insights

Systemic infection, particularly bacteraemia with Enterobacteriaceae, significantly increases mortality risk in hospitalized children with diarrhoea. Early identification of systemic infection signs is crucial for improving outcomes in pediatric patients.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Epidemiology

Background:

  • Diarrhoea remains a leading cause of mortality in hospitalized children globally.
  • Identifying specific risk factors for fatal outcomes is essential for targeted interventions.
  • Bacteraemia and systemic infections are recognized complications of severe diarrhoea.

Purpose of the Study:

  • To investigate the risk factors associated with death due to diarrhoea in hospitalized children.
  • To identify clinical and laboratory predictors of mortality in pediatric patients with diarrhoea.
  • To determine the role of bacteraemia, specifically Enterobacteriaceae, in diarrhoeal deaths.

Main Methods:

  • A retrospective case-control study design was employed.
  • Cases included all children who died from diarrhoea at Aga Khan University Hospital (AKUH) between 1988-1993.
  • Controls were matched for gender and diarrhoea type, with two controls selected for each death.
  • Univariate and conditional logistic regression analyses were used to assess risk factors.

Main Results:

  • Forty-two deaths and 84 matched controls were analyzed.
  • Isolation rates of organisms from blood cultures were significantly higher in deaths (38%) compared to controls (9%).
  • Gram-negative Enterobacteriaceae were the predominant organisms identified in blood cultures of deceased children.
  • Clinical indicators such as anorexia, drowsiness, respiratory distress, and anaemia, along with positive blood cultures, were significantly associated with increased mortality risk.

Conclusions:

  • Bacteraemia with Enterobacteriaceae is a common finding in hospitalized children with diarrhoea, particularly those who are malnourished.
  • Systemic infection, indicated by clinical signs and positive blood cultures, represents a critical risk factor for mortality in this population.
  • These findings underscore the importance of early diagnosis and management of systemic infections in children with severe diarrhoea to reduce fatality rates.

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