{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T11:29:35Z","timestamp":1775561375053,"version":"3.50.1"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,2]],"date-time":"2020-12-02T00:00:00Z","timestamp":1606867200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009054","name":"icddr,b","doi-asserted-by":"crossref","award":["Gr-00233"],"award-info":[{"award-number":["Gr-00233"]}],"id":[{"id":"10.13039\/501100009054","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Diarrhea is one of the leading causes of mortality in children under five globally. When it is associated with bacteremia, mortality is even higher. However, bacteraemia in diarrheal children has gained little attention in spite of its deleterious impact in under-five mortality. So, we aimed to evaluate associated clinical and laboratory factors for death in under-five children hospitalized with both diarrhea and bacteremia.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>In this retrospective cross-sectional study, we used patients\u2019 electronic database of Dhaka Hospital of \u2018icddr,b\u2019, and enrolled all under-five children with diarrhea and bacterial growth in their blood samples on admission between June-2014 and May-2017. Clinical and laboratory characteristics were compared between those who died and who survived with a special attention to bacterial pathogens related to deaths and their sensitivity pattern.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>In a total of 401 diarrheal children with bacteraemia, 45 (11%) died. Although <jats:italic>Salmonella<\/jats:italic> Typhi (34%) was the most predominant isolate followed by <jats:italic>Staphylococcus<\/jats:italic> species (16%) and <jats:italic>Pseudomonas<\/jats:italic> species (9%), children who died more often had <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic> (OR = 5.69, 95% CI = 2.42\u201313.39, p = &lt;0.001) and <jats:italic>Klebsiella<\/jats:italic> bacteraemia (OR = 4.59, 95% CI = 1.84\u201311.46, p = 0.001) compared to those who survived. However, none of them was significantly associated with deaths in regression analysis when adjusted with other potential confounders. <jats:italic>E<\/jats:italic>. <jats:italic>coli<\/jats:italic> was 100% resistant to ampicillin, 41% to gentamicin, and 73% to ceftriaxone and <jats:italic>Klebsiella<\/jats:italic> species was 96% resistant to ampicillin, 42% to gentamicin, and 62% to ceftriaxone. Study children who died had significantly higher overall resistance pattern shown in World Health Organization (WHO) recommended one of the first line antibiotics in treating childhood sepsis such as ampicillin (80% vs. 50%, p = 0.001) and in second line antibiotic such as ceftriaxone (49% vs. 22%, p = 0.001) compared to the survivors. In logistic regression analysis, after adjusting for potential confounders, we found that clinical sepsis (aOR 3.79, 95% CI 1.60\u20138.96, p = 0.002), hypoxemia (aOR 4.20, 95% CI 1.74\u201310.12, p = 0.001), and hyperkalaemia (aOR 2.69, 95% CI 1.05\u20136.91, p = 0.039) were found to be independent predictors of deaths and receipt of sensitive antibiotic (aOR 0.42, 95% CI 0.18\u20130.99, p = 0.048) was revealed as the independent protective factor for deaths in this population.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion and significance<\/jats:title>\n<jats:p>The results of our data suggest that diarrheal children with bacteremia who died more often had gram negative bacteremia compared to those who survived and these pathogens are highly resistant to WHO recommended first line and second line antibiotics. The results further emphasize the critical importance of early identification of important clinical problems such as clinical sepsis, hypoxemia and hyperkalaemia in diarrheal children and treat them with potential sensitive antibiotic(s) in order to reduce bacteremia related mortality in children with diarrhea, especially in resource limited settings.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0243128","type":"journal-article","created":{"date-parts":[[2020,12,2]],"date-time":"2020-12-02T19:02:22Z","timestamp":1606935742000},"page":"e0243128","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":15,"title":["Clinical and laboratory characteristics of children under five hospitalized with diarrhea and bacteremia"],"prefix":"10.1371","volume":"15","author":[{"given":"K. M.","family":"Shahunja","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tahmeed","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Md. Iqbal","family":"Hossain","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Md. Munirul","family":"Islam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahmuda Begum","family":"Monjory","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7759-974X","authenticated-orcid":true,"given":"Abu Sadat Mohammad Sayeem Bin","family":"Shahid","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abu Syed Golam","family":"Faruque","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9958-3071","authenticated-orcid":true,"given":"Mohammod Jobayer","family":"Chisti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2020,12,2]]},"reference":[{"key":"pone.0243128.ref001","unstructured":"UNICEF. Diarrhoea. Report. https:\/\/www.unicef.org\/health\/index_92007.html, Accessed on 04 April 2018; 2016."},{"issue":"2","key":"pone.0243128.ref002","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1097\/INF.0000000000001381","article-title":"Hospital-based Surveillance for Rotavirus Gastroenteritis Among Young Children in Bangladesh: Defining the Potential Impact of a Rotavirus Vaccine Program","volume":"36","author":"SM Satter","year":"2017","journal-title":"Pediatr Infect Dis J"},{"issue":"1","key":"pone.0243128.ref003","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1097\/PCC.0b013e3181b063e1","article-title":"Predictors of bacteremia in infants with diarrhea and systemic inflammatory response syndrome attending an urban diarrheal treatment center in a developing country","volume":"11","author":"MJ Chisti","year":"2010","journal-title":"Pediatr Crit Care Med"},{"issue":"5","key":"pone.0243128.ref004","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1093\/oxfordjournals.aje.a115912","article-title":"Bacteremia during diarrhea: incidence, etiology, risk factors, and outcome","volume":"133","author":"MJ Struelens","year":"1991","journal-title":"Am J Epidemiol"},{"issue":"5","key":"pone.0243128.ref005","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1016\/0035-9203(93)90090-D","article-title":"Bacteraemia and meningitis among hospital patients with diarrhoea","volume":"87","author":"AK Mitra","year":"1993","journal-title":"Transactions of the Royal Society of Tropical Medicine and Hygiene"},{"issue":"5","key":"pone.0243128.ref006","first-page":"e0154777","volume":"11","author":"ASMSB Shahid","year":"2016","journal-title":"Factors Associated with Streptococcal Bacteremia in Diarrheal Children under Five Years of Age and Their Outcome in an Urban Hospital in Bangladesh"},{"issue":"9","key":"pone.0243128.ref007","first-page":"e0004066","volume":"9","author":"K Shahunja","year":"2015","journal-title":"Factors associated with non-typhoidal Salmonella bacteremia versus typhoidal Salmonella bacteremia in patients presenting for care in an urban diarrheal disease hospital in Bangladesh"},{"key":"pone.0243128.ref008","first-page":"2016","author":"S Akhter","year":"2016","journal-title":"Factors associated with Klebsiella bacteremia and its outcome in under-five children admitted with diarrhea"},{"key":"pone.0243128.ref009","volume-title":"Annual Report 2017","author":"icddr b. icddr,b","year":"2018"},{"issue":"5","key":"pone.0243128.ref010","doi-asserted-by":"crossref","first-page":"e0005603","DOI":"10.1371\/journal.pntd.0005603","article-title":"Ileus in children presenting with diarrhea and severe acute malnutrition: A chart review","volume":"11","author":"MJ Chisti","year":"2017","journal-title":"PLoS neglected tropical diseases"},{"issue":"6","key":"pone.0243128.ref011","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1086\/502584","article-title":"Determining the clinical significance of coagulase-negative staphylococci isolated from blood cultures","volume":"26","author":"SE Beekmann","year":"2005","journal-title":"Infection Control & Hospital Epidemiology"},{"issue":"7","key":"pone.0243128.ref012","doi-asserted-by":"crossref","first-page":"1923","DOI":"10.1128\/JCM.36.7.1923-1926.1998","article-title":"Blood cultures positive for coagulase-negative staphylococci: antisepsis, pseudobacteremia, and therapy of patients","volume":"36","author":"D Souvenir","year":"1998","journal-title":"Journal of clinical microbiology"},{"issue":"2","key":"pone.0243128.ref013","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1086\/650201","article-title":"Blood culture contamination rates after skin antisepsis with chlorhexidine gluconate versus povidone-iodine in a pediatric emergency department","volume":"31","author":"L Marlowe","year":"2010","journal-title":"Infection Control & Hospital Epidemiology"},{"key":"pone.0243128.ref014","article-title":"The treatment of diarrhoea: a manual for physicians and other senior health workers","author":"Organization WH","year":"1995","journal-title":"The treatment of diarrhoea: a manual for physicians and other senior health workers: World Health Organization"},{"key":"pone.0243128.ref015","volume-title":"Pocket book for hospital care of children: guidelines for the management of common illness with limited resources","author":"WHO","year":"2005"},{"issue":"1","key":"pone.0243128.ref016","first-page":"106","article-title":"Clinical predictors and outcome of hypoxaemia among under\u2010five diarrhoeal children with or without pneumonia in an urban hospital, Dhaka, Bangladesh. Tropical Medicine &","volume":"17","author":"MJ Chisti","year":"2012","journal-title":"International Health"},{"key":"pone.0243128.ref017","volume-title":"Pocket Book Of Hospital care for children","author":"WHO","year":"2013","edition":"2"},{"key":"pone.0243128.ref018","volume-title":"Performance Standards for Antimicrobial Susceptibility Testing","author":"CLSI","year":"2017"},{"issue":"9168","key":"pone.0243128.ref019","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.1016\/S0140-6736(98)07499-6","article-title":"Mortality in severely malnourished children with diarrhoea and use of a standardised management protocol","volume":"353","author":"T Ahmed","year":"1999","journal-title":"The Lancet"},{"issue":"4","key":"pone.0243128.ref020","doi-asserted-by":"crossref","first-page":"e0006408","DOI":"10.1371\/journal.pntd.0006408","article-title":"Laboratory and molecular surveillance of paediatric typhoidal Salmonella in Nepal: Antimicrobial resistance and implications for vaccine policy","volume":"12","author":"CD Britto","year":"2018","journal-title":"PLoS neglected tropical diseases"},{"issue":"1","key":"pone.0243128.ref021","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1056\/NEJMoa040275","article-title":"Bacteremia among children admitted to a rural hospital in Kenya","volume":"352","author":"JA Berkley","year":"2005","journal-title":"New England Journal of Medicine"},{"issue":"4","key":"pone.0243128.ref022","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1097\/00006454-200004000-00010","article-title":"Bacteremia in febrile Malawian children: clinical and microbiologic features","volume":"19","author":"AL Walsh","year":"2000","journal-title":"The Pediatric infectious disease journal"},{"issue":"1","key":"pone.0243128.ref023","doi-asserted-by":"crossref","first-page":"e54714","DOI":"10.1371\/journal.pone.0054714","article-title":"Epidemiology, microbiology and mortality associated with community-acquired bacteremia in northeast Thailand: a multicenter surveillance study","volume":"8","author":"M Kanoksil","year":"2013","journal-title":"PloS one"},{"key":"pone.0243128.ref024","doi-asserted-by":"crossref","first-page":"h3017","DOI":"10.1136\/bmj.h3017","article-title":"Sepsis in children","volume":"350","author":"A Plunkett","year":"2015","journal-title":"bmj"},{"issue":"1","key":"pone.0243128.ref025","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1097\/01.PCC.0000149131.72248.E6","article-title":"International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics","volume":"6","author":"B Goldstein","year":"2005","journal-title":"Pediatric critical care medicine"},{"issue":"5","key":"pone.0243128.ref026","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1164\/rccm.200207-682OC","article-title":"The epidemiology of severe sepsis in children in the United States","volume":"167","author":"RS Watson","year":"2003","journal-title":"American journal of respiratory and critical care medicine"},{"issue":"07","key":"pone.0243128.ref027","doi-asserted-by":"crossref","first-page":"709","DOI":"10.4236\/fns.2013.47090","article-title":"Predictors of death in under-five children with sepsis attending an urban diarrheal treatment centre in Bangladesh","volume":"4","author":"K Shahunja","year":"2013","journal-title":"Food and Nutrition Sciences"},{"issue":"7","key":"pone.0243128.ref028","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1097\/PCC.0b013e3182917fad","article-title":"Trends in the epidemiology of pediatric severe sepsis","volume":"14","author":"ME Hartman","year":"2013","journal-title":"Pediatric Critical Care Medicine"},{"issue":"9","key":"pone.0243128.ref029","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1097\/PCC.0000000000000254","article-title":"Pediatric severe sepsis: current trends and outcomes from the Pediatric Health Information Systems database","volume":"15","author":"A Ruth","year":"2014","journal-title":"Pediatric Critical Care Medicine"},{"issue":"9","key":"pone.0243128.ref030","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1097\/PCC.0000000000000225","article-title":"Pediatric severe sepsis in US children\u2019s hospitals","volume":"15","author":"F Balamuth","year":"2014","journal-title":"Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies"},{"issue":"4","key":"pone.0243128.ref031","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S1473-3099(09)70071-4","article-title":"The prevalence of hypoxaemia among ill children in developing countries: a systematic review","volume":"9","author":"R Subhi","year":"2009","journal-title":"The Lancet infectious diseases"},{"issue":"6","key":"pone.0243128.ref032","first-page":"511","article-title":"Hypoxaemia in children with severe pneumonia in Papua New Guinea [oxygen therapy in children]","volume":"5","author":"T Duke","year":"2001","journal-title":"The International Journal of Tuberculosis and Lung Disease"},{"issue":"9998","key":"pone.0243128.ref033","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1016\/S0140-6736(15)60249-5","article-title":"Bubble continuous positive airway pressure for children with severe pneumonia and hypoxaemia in Bangladesh: an open, randomised controlled trial","volume":"386","author":"MJ Chisti","year":"2015","journal-title":"The Lancet"},{"issue":"3","key":"pone.0243128.ref034","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1007\/s00467-010-1699-3","article-title":"Pathogenesis, diagnosis and management of hyperkalemia","volume":"26","author":"A Lehnhardt","year":"2011","journal-title":"Pediatr Nephrol"},{"key":"pone.0243128.ref035","volume-title":"StatPearls [Internet]","author":"MFH Leslie V Simon","year":"2020"},{"key":"pone.0243128.ref036","first-page":"2333794X17754005","article-title":"Hyperkalemia Was an Independent Risk Factor for Death While Under Mechanical Ventilation Among Children Hospitalized With Diarrhea in Bangladesh","volume":"5","author":"F Chowdhury","year":"2018","journal-title":"Glob Pediatr Health"},{"issue":"1","key":"pone.0243128.ref037","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1186\/s13054-017-1696-z","article-title":"Timing of appropriate empirical antimicrobial administration and outcome of adults with community-onset bacteremia","volume":"21","author":"C-C Lee","year":"2017","journal-title":"Crit Care"},{"issue":"1","key":"pone.0243128.ref038","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1186\/s12879-017-2233-z","article-title":"Impact of appropriate empirical antibiotic treatment on recurrence and mortality in patients with bacteraemia: a population-based cohort study","volume":"17","author":"KO Gradel","year":"2017","journal-title":"BMC Infect Dis"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0243128","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,2]],"date-time":"2020-12-02T19:02:53Z","timestamp":1606935773000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0243128"}},"subtitle":[],"editor":[{"given":"Monica","family":"Cartelle Gestal","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2020,12,2]]},"references-count":38,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12,2]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0243128","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,2]]}}}