Factors Associated with Klebsiella

Although Klebsiella bacteremia in children is perceived to be associated with fatal consequences, data are scarce on those children presenting with diarrhea. We evaluated the factors associated with Klebsiella bacteremia in such children. In this retrospective chart analysis, data of all diarrheal children was retrieved from electronic medical record system (named as SHEBA) of Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), from January 1, 2010, to December 31, 2012, who had their blood culture done. This was a study having a case-control design where comparison of clinical and laboratory characteristics was done among children with Klebsiella bacteremia (cases = 30) and those without any bacteraemia (controls = 90). Controls were selected randomly. The cases more often had fatal outcome (p<0.001). In logistic regression analysis, after adjusting for potential confounders such as young age, severe dehydration, severe wasting, abnormal mentation, hypotension, and fast breathing, the cases were independently associated with hospital-acquired infection and positive stool growth (for all, p<0.05). The study highlights the importance of obtaining blood cultures in hospitalized children under five years old with diarrheal illness in the presence of either hospital-acquired infection or positive stool culture to have better outcome

COVID-19 among staff and their family members of a healthcare research institution in Bangladesh between March 2020 and April 2021 : a test-negative case–control study

Objective To identify factors associated with COVID- 19 positivity among staff and their family members of icddr,b, a health research institute located in Bangladesh. Setting Dhaka, Bangladesh. Participants A total of 4295 symptomatic people were tested for SARS-CoV-2 by reverse-transcription PCR between 19 March 2020 and 15 April 2021. Multivariable logistic regression was done to identify the factors associated with COVID- 19 positivity by contrasting test positives with test negatives. Result Forty-three per cent of the participants were tested positive for SARS-CoV-2. The median age was high in positive cases (37 years vs 34 years). Among the positive cases, 97% were recovered, 2.1% had reinfections, 24 died and 41 were active cases as of 15 April 2021. Multivariable regression analysis showed that age more than 60 years (adjusted OR (aOR)=2.1, 95% CI 1.3 to 3.3; pwere tested negative. Conclusions The study findings suggest that older age, fever, cough and anosmia were associated with COVID- 19 among the study participants.publishedVersionPeer reviewe

Vaccination following the expanded programme on immunization schedule could help to reduce deaths in children under five hospitalized for pneumonia and severe pneumonia in a developing country

BackgroundWorldwide, pneumonia is the leading cause of mortality in children under the age of five. An expanded program on immunization (EPI) is one kind of evidence-based tool for controlling and even eradicating infectious diseases.ObjectivesThis study aimed to explore the impact of EPI vaccination, including BCG, DPT-Hib-Hep B, OPV, IPV, and PCV-10, among children from the age of 4 to 59 months hospitalized for pneumonia and severe pneumonia. Additionally, we evaluated the role of 10 valent pneumococcal conjugate vaccines alone on clinical outcomes in such children.MethodsIn this retrospective chart review, children from the age of 4 to 59 months with WHO-defined pneumonia and severe pneumonia admitted to the Dhaka Hospital of the International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) between August 2013 and December 2017 who had the information on immunization as per EPI schedule by 4 months of age were included in the analysis. A comparison was made between the children who were fully immunized (immunization with BCG, DPT-Hib-Hep B, OPV, and IPV from 2013 to 2015 and PCV-10 from 2015 to 2017) and who were not immunized (consisting of partial immunization and no immunization) during the study period.ResultsA total of 4,625 children had pneumonia and severe pneumonia during the study period. Among them, 2,605 (56.3%) had received the information on immunization; 2,195 (84.3%) were fully immunized by 4 months of age according to the EPI schedule and 410 were not immunized. In the log-linear binomial regression analysis, immunization of children from 4 to 59 months of age was found to be associated with a lower risk of diarrhea (p = 0.033), severe pneumonia (p = 0.001), anemia (p = 0.026), and deaths (p = 0.035). Importantly, the risk of developing severe pneumonia (1054/1,570 [67%] vs. 202/257 [79%], p &lt; 0.001) and case-fatality rate (57/1,570 [3.6%] vs. 19/257 [7.4%], p = 0.005) was still significantly lower among those who were immunized with PCV-10 than those who were not.ConclusionChildren immunized as per the EPI schedule were at a lower risk of diarrhea, severe pneumonia, anemia, and death, compared to unvaccinated children. In addition, PCV-10 was found to be protective against severe pneumonia and deaths in vaccinated children. The overall results underscored the importance of the continuation of immunization, scrupulously adhering to the EPI schedule to reduce the risk of morbidities and mortalities in children, especially in resource-limited settings

Percent of children required inpatient admission.

Percent of children required inpatient admission.</p

Associated or risk factors of prolonged diarrhea (ProD) (diarrhea for > 7 to 13 days) and acute diarrhea (AD) (diarrhea for ≤ 7 days) by logistic regression (enter method).

Associated or risk factors of prolonged diarrhea (ProD) (diarrhea for > 7 to 13 days) and acute diarrhea (AD) (diarrhea for ≤ 7 days) by logistic regression (enter method).</p

Stool isolates (%) in children with prolonged and acute diarrhea by warmer or less warm/cooler season.

Stool isolates (%) in children with prolonged and acute diarrhea by warmer or less warm/cooler season.</p

Case fatality rate (%) of children with prolonged diarrhea and acute diarrhea.

Case fatality rate (%) of children with prolonged diarrhea and acute diarrhea.</p

Children (%) with prolonged diarrhea and acute diarrhea by year.

Children (%) with prolonged diarrhea and acute diarrhea by year.</p

Differential features of under-five children with prolonged diarrhea (ProD) (diarrhea for > 7 to 13 days) and acute diarrhea (AD) (diarrhea for ≤ 7 days).

Differential features of under-five children with prolonged diarrhea (ProD) (diarrhea for > 7 to 13 days) and acute diarrhea (AD) (diarrhea for ≤ 7 days).</p

Percent of children with different stool organisms by prolonged diarrhea and acute diarrhea.

Percent of children with different stool organisms by prolonged diarrhea and acute diarrhea.</p