Stool isolates of <i>Shigella</i> children with & without encephalopathy.

<p>Stool isolates of <i>Shigella</i> children with & without encephalopathy.</p

Clinical characteristics of diarrheal children under five years of age with <i>Shigella</i> encephalopathy compared to those without encephalopathy.

<p>Clinical characteristics of diarrheal children under five years of age with <i>Shigella</i> encephalopathy compared to those without encephalopathy.</p

Antimicrobial resistance of <i>Shigella</i> isolates among cases and controls.

<p>Antimicrobial resistance of <i>Shigella</i> isolates among cases and controls.</p

Electrolytes profile and other laboratory findings of under-five diarrheal children with and without <i>Shigella</i> encephalopathy on admission.

<p>Electrolytes profile and other laboratory findings of under-five diarrheal children with and without <i>Shigella</i> encephalopathy on admission.</p

Results of logistic regression analysis to explore independent risk factors for childhood <i>Shigella</i> encephalopathy.

<p>Results of logistic regression analysis to explore independent risk factors for childhood <i>Shigella</i> encephalopathy.</p

Factors Associated with Non-typhoidal Salmonella Bacteremia versus Typhoidal Salmonella Bacteremia in Patients Presenting for Care in an Urban Diarrheal Disease Hospital in Bangladesh

<div><p>Background</p><p>Non-typhoidal <i>Salmonella</i> (NTS) and <i>Salmonella enterica</i> serovar Typhi bacteremia are the causes of significant morbidity and mortality worldwide. There is a paucity of data regarding NTS bacteremia in South Asia, a region with a high incidence of typhoidal bacteremia. We sought to determine clinical predictors and outcomes associated with NTS bacteremia compared with typhoidal bacteremia.</p><p>Methodology</p><p>We performed a retrospective age-matched case-control study of patients admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, between February 2009 and March 2013. We compared demographic, clinical, microbiological, and outcome variables of NTS bacteremic patients with age-matched <i>S</i>. Typhi bacteremic patients, and a separate comparison of patients with NTS bacteremia and patients with NTS gastroenteritis.</p><p>Principal Findings</p><p>Of 20 patients with NTS bacteremia, 5 died (25% case fatality), compared to none of 60 age-matched cases of <i>S</i>. Typhi bacteremia. In univariate analysis, we found that compared with <i>S</i>. Typhi bacteremia, cases of NTS bacteremia had more severe acute malnutrition (SAM) in children under five years of age, less often presented with a duration of fever ≥ 5 days, and were more likely to have co-morbidities on admission such as pneumonia and clinical signs of sepsis (p<0.05 in all cases). In multivariable logistic regression, SAM, clinical sepsis, and pneumonia were independent risk factors for NTS bacteremia compared with <i>S</i>. Typhi bacteremia (p<0.05 in all cases). Notably, we found marked differences in antibiotic susceptibilities, including NTS strains resistant to antibiotics commonly used for empiric therapy of patients suspected to have typhoid fever.</p><p>Conclusions/Significance</p><p>Diarrheal patients with NTS bacteremia more often presented with co-morbidities and had a higher case fatality rate compared to those with typhoidal bacteremia. Clinicians in regions where both typhoid and NTS bacteremia are prevalent need to be vigilant about the possibility of both entities, especially given notable differences in antibiotic susceptibility patterns.</p></div

Characteristics of NTS bacteremia cases who expired in hospital.

<p>Characteristics of NTS bacteremia cases who expired in hospital.</p

Sensitivity pattern of NTS versus typhoidal <i>Salmonella</i> spp. recovered from blood.

<p>S: susceptible, I: intermediate susceptible, R: resistant</p><p>Sensitivity pattern of NTS versus typhoidal <i>Salmonella</i> spp. recovered from blood.</p

Logistic regression: NTS bacteremia vs. <i>Salmonella</i> typhi bacteremia.

<p>Logistic regression: NTS bacteremia vs. <i>Salmonella</i> typhi bacteremia.</p

Clinical and laboratory characteristics of patients with NTS bacteremia versus NTS gastroenteritis.

<p>Figures represent n (%), unless specified. OR: odds ratio. CI: confidence interval, SD: Standard deviation, IQR: Intra quartile range, SAM: severe acute malnutrition, AWD: acute watery diarrhea, ** After Bonferroni-Holm correction.</p><p>Clinical and laboratory characteristics of patients with NTS bacteremia versus NTS gastroenteritis.</p