CONCOMITANT BACTEREMIA AS A RISK FACTOR FOR DIARRHEAL 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 H ospital (AKUH), Karachi. We conducted a retrospective case-control stu dy of all diarrhoea deaths at AKUH over the period 1988-93. For each d eath, the next two consecutive admissions matched for gender and type of diarrhoea were identified as controls, Data were analysed by univar iate methods and logistic regression analysis. A total of 42 deaths an d 84 matched controls were identified. Blood cultures at admission wer e obtained in all deaths and 94% of controls. The rates of isolation o f 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 regre ssion revealed that several clinical and laboratory features of system ic infection were associated with a significantly increased risk of mo rtality, 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), a naemia (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 Enterobacter iaceae is common among hospitalized malnourished children with diarrho ea and systemic infection may be an important risk factor for mortalit y.