Bacteremia during diarrhea: Incidence, etiology, risk factors, and outcome

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), Staphylwmcus 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 contrd patients without bacteremia, bacteremic patients were significantly (p < 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 casefatality rate was 29.7% in bacteremic patients versus 7.8% in controls (relative risk (RR) = 3.8, p < 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. © 1991 by The Johns Hopkins University School of Hygiene and Public Health.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Death in shigellosis: Incidence and risk factors in hospitalized patients

The total number of admissions and deaths of patients with shigellosis were ascertained at the Dhaka Treatment Centre of the International Centre for Diarrhoeal Disease Research, Bangladesh, 1974–1988, and the characteristics of 67 patients who died were compared with those of 134 discharged alive. Of 9780 Shigella-infected inpatients, 889 (9.1%) died; 32.3% of deaths occurred in children >1 year of age. Fatality rates were highest (10.3%)in Shigella sonnei-infected patients and lowest (6.7%) in Shigella dysenteriae type 1-infected patients. Age <1 year, lack of breast feeding in patients 1–2 years of age, hypothermia, severe malnutrition, severe dehydration, altered consciousness, abdominal distension, thrombocytopenia, hypoproteinemia, hyponatremia, hypoglycemia, renal failure, and bacteremia were all significantly more common in case patients. In a multivariate analysis, younger age, decreased serum protein, altered consciousness, and thrombocytopenia were predictive of death. Thus in Bangladesh the fatality rate for hospitalized patients infected with any species of Shigella remains high despite relatively intensive inpatient care, and young, hypoproteinemic patients are at greatest risk of fatal illness. © 1990, University of Chicago. All rights reserved.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Efficacy of Ciprofloxacin for Treatment of Cholera Associated with Diminished Susceptibility to Ciprofloxacin to Vibrio cholerae O1.

We identified a poor clinical response to treatment of cholera with a single 1 g dose of ciprofloxacin, a standard treatment for cholera.To determine reasons for the poor response and better therapeutic approaches we examined the minimal inhibitor concentration (MIC, n = 275) and disc-diffusion zone sizes (n = 205) for ciprofloxacin and nalidixic acid of V. cholerae O1 strains isolated in Bangladesh from 1994 to 2012, and reexamined data from 161 patients infected with Vibrio cholerae O1 recruited in four clinical trials who received single- or multiple-dose ciprofloxacin for treatment of cholera and compared their clinical response to the V. cholerae O1 susceptibility.Although all 275 isolates of V. cholerae O1 remained susceptible to ciprofloxacin using standard MIC and disc-diffusion thresholds, the MIC90 to ciprofloxacin increased from 0.010 in 1994 to 0.475 μgm/ml in 2012. Isolates became frankly resistant to nalidixic with the MIC90 increasing from 21 μgm/ml in 1994 to >256 μgm/ml and 166 of 205 isolates from 1994 to 2005 being frankly resistant using disc-diffusion testing. Isolates resistant to nalidixic acid by disc-diffusion testing had a median ciprofloxacin MIC of 0.190 μgm/ml (10th-90th centiles 0.022 to 0.380); nalidixic acid-susceptible isolates had a median ciprofloxacin MIC of 0.002 (0.002 to 0.012).The rate of clinical success with single-dose ciprofloxacin treatment for nalidixic acid-susceptible strains was 94% (61 of 65 patients) and bacteriologic success 97% (63/65) compared to 18% (12/67) and 8% (5/67) respectively with nalidixic acid-resistant strains (P<0.001 for both comparisons). Multiple-dose treatment with ciprofloxacin had 86% and 100% clinical and bacteriologic success rates respectively in patients infected with nalidixic acid-susceptible strains of V. cholerae O1 compared to clinical success 67% and bacteriologic success 60% with nalidixic acid-resistant strains.Single-dose ciprofloxacin is not effective for treating cholera caused by V. cholerae O1 with diminished susceptibility to ciprofloxacin, and nalidixic acid disc-diffusion testing effectively screens for such isolates

Clinical and bacteriologic response to single-dose or multiple-dose ciprofloxacin therapy in patients infected with nalidixic acid-resistant strains of <i>V</i>. <i>cholerae</i> O1.

<p>Values are median (25^th–75^th centile) unless noted.</p><p>* Based on weight discharge</p><p>Clinical and bacteriologic response to single-dose or multiple-dose ciprofloxacin therapy in patients infected with nalidixic acid-resistant strains of <i>V</i>. <i>cholerae</i> O1.</p

Admission characteristics and response to ciprofloxacin therapy in 161 patients infected with nalidixic acid-susceptible and nalidixic acid-resistant strains of <i>V</i>. <i>cholerae</i> O1.

<p>Values are median (25^th, 75^th centiles) unless noted</p><p>* Based on disc-diffusion method</p><p>^‡ Based on discharge weight</p><p>Admission characteristics and response to ciprofloxacin therapy in 161 patients infected with nalidixic acid-susceptible and nalidixic acid-resistant strains of <i>V</i>. <i>cholerae</i> O1.</p

Randomized controlled trials from which 161 adult patients infected with <i>V</i>. <i>cholerae</i> O1;treated with ciprofloxacin and completed 5day study were included in this analysis.

<p>There were 580 patients in total in these four studies, of whom 161 (28%) were infected with <i>V</i>.<i>cholerae</i> O1; treated with ciprofloxacin and completed 5 day study</p><p>Randomized controlled trials from which 161 adult patients infected with <i>V</i>. <i>cholerae</i> O1;treated with ciprofloxacin and completed 5day study were included in this analysis.</p

Nalidixic acid and ciprofloxacin MIC⁵⁰and MIC⁹⁰ of 275 isolates of <i>V cholerae</i> O1 by year and source of strains obtained.

<p>Values are (μg/ml)</p><p>CT–Clinical trial; CLS–Clinical Laboratory Services, icddr,b</p><p>Nalidixic acid and ciprofloxacin MIC⁵⁰and MIC⁹⁰ of 275 isolates of <i>V cholerae</i> O1 by year and source of strains obtained.</p

Clinical and bacteriologic response to single-dose or multiple-dose ciprofloxacin therapy in patients infected with nalidixic acid-resistant strains of <i>V</i>. <i>cholerae</i> O1.

<p>Values are median (25^th–75^th centile) unless noted.</p><p>* Based on weight discharge</p><p>Clinical and bacteriologic response to single-dose or multiple-dose ciprofloxacin therapy in patients infected with nalidixic acid-resistant strains of <i>V</i>. <i>cholerae</i> O1.</p

Clinical and bacteriologic response to single-dose or multiple-dose ciprofloxacin therapy in patients infected with nalidixic acid-susceptible strains of <i>V</i>. <i>cholerae</i> O1.

<p>Values are median (25^th–75^th centiles) unless noted</p><p>* Based on discharge weight</p><p>Clinical and bacteriologic response to single-dose or multiple-dose ciprofloxacin therapy in patients infected with nalidixic acid-susceptible strains of <i>V</i>. <i>cholerae</i> O1.</p