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

The objective of this study was to evaluate risk factors for death due to diarrhoea among hospitalized children at the Aga Khan University Hospital (AKUH), Karachi. We conducted a retrospective case-control study of all diarrhoea deaths at AKUH over the period 1988-93. For each death, the next two consecutive admissions matched for gender and type of diarrhoea were identified as controls, Data were analysed by univariate methods and logistic regression analysis. A total of 42 deaths and 84 matched controls were identified. Blood cultures at admission were obtained in all deaths and 94% of controls. The rates of isolation of organisms from blood cultures were significantly higher among deaths [38 versus 9%, odds ratio (OR) 6.5, 95% confidence interval (CI) 2.2-19.9], the majority of which were Gram-negative Enterobacteriaceae (94 versus 57%, Fisher's exact test p < 0.02). Conditional logistic regression revealed that several clinical and laboratory features of systemic infection were associated with a significantly increased risk of mortality, such as anorexia (OR 3.9, 95% CI 1.4-10.9), drowsiness (OR 4.4, 95% CI 1.3-15.3), respiratory distress (OR 7.0, 95% CI 1.4-36.6), anaemia (OR 5.8, 95% CI 2.0-16.6) and a positive blood culture (OR 8.7, 95% CI 2.5-30.7). Our data suggest that bacteraemia with Enterobacteriaceae is common among hospitalized malnourished children with diarrhoea and systemic infection may be an important risk factor for mortality.