{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T18:11:38Z","timestamp":1759947098800,"version":"build-2065373602"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Government of Bangladesh"},{"DOI":"10.13039\/501100000023","name":"Government of Canada","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000023","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>Bacteremia remains a significant concern among under-five children with diarrheal diseases, particularly in resource-limited settings. Distribution of bacteremia patterns across the patient\u2019s nutritional status and outcomes have never been analyzed. This study aimed to investigate the association between nutritional status and bloodstream infections caused by <jats:italic><jats:italic>Salmonella enterica<\/jats:italic><\/jats:italic> serovar Typhi compared to other pathogenic bacteria in children with diarrheal diseases.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A retrospective case-control study was conducted using electronic medical records from icddr,b (Dhaka, Bangladesh) between 2019\u221220. Cases were defined as children (&lt; 60 months) hospitalized with diarrheal disease and diagnosed with <jats:italic><jats:italic>Salmonella<\/jats:italic><\/jats:italic> Typhi bacteremia; controls included children with bloodstream infections caused by other than typhoidal bacteria, including <jats:italic><jats:italic>Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa<\/jats:italic><\/jats:italic>, and <jats:italic><jats:italic>Streptococcus<\/jats:italic><\/jats:italic> spp. Nutritional status was categorized as well-nourished, Moderate Acute Malnutrition (MAM), or Severe Acute Malnutrition (SAM). Descriptive statistics and multiple logistic regression models were used to assess associations between nutritional status, bacteremia type, and clinical outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Among 162 children with confirmed bloodstream infections, 74 (45.68%) had <jats:italic><jats:italic>Salmonella<\/jats:italic><\/jats:italic> Typhi bacteremia, while 88 (54.32%) had bacteremia caused by other bacterial isolates. SAM was more prevalent among children with other bacteremia (78.12%) than caused by <jats:italic><jats:italic>Salmonella<\/jats:italic><\/jats:italic> Typhi. Conversely, well- nourished children were more likely to develop <jats:italic><jats:italic>Salmonella<\/jats:italic><\/jats:italic> Typhi bacteremia (66.13%) compared to MAM (32.61%) and SAM (21.88%) cases. After adjusting for comorbidities and prior antibiotics use, logistic regression analysis found malnourished children had significantly lower odds of developing <jats:italic><jats:italic>Salmonella<\/jats:italic><\/jats:italic> Typhi bacteremia compared to well-nourished children (SAM: aOR 0.157, 95% CI: 0.045\u20130.548, p\u2009=\u20090.004; MAM: aOR 0.238, 95% CI: 0.089\u20130.640, p\u2009=\u20090.004). Mortality rates were significantly higher among controls (11.73%) compared to <jats:italic><jats:italic>Salmonella<\/jats:italic><\/jats:italic> Typhi cases (1.35%), particularly for infections caused by <jats:italic><jats:italic>Klebsiella pneumoniae<\/jats:italic><\/jats:italic> (66.67%) and <jats:italic><jats:italic>E. coli<\/jats:italic><\/jats:italic> (31.25%).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Malnourished children are at higher risk for severe bloodstream infections caused by other bacterial species, leading to higher mortality rates and increased antimicrobial resistance. However, <jats:italic><jats:italic>Salmonella<\/jats:italic><\/jats:italic> Typhi bacteremia occurred more frequently in well-nourished children. These sort of distribution of bacteremia patterns across patients\u2019 nutritional status can provide insights and improve clinical management.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0333580","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T17:34:07Z","timestamp":1759944847000},"page":"e0333580","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nutritional status and bacteremia patterns in children with diarrheal diseases: A comparative analysis of bacteremia from Salmonella Typhi versus other pathogens"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9107-1506","authenticated-orcid":true,"given":"Md Rezaul","family":"Hossain","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monira","family":"Sarmin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6747-8223","authenticated-orcid":true,"given":"Irin","family":"Parvin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mst Mahmuda","family":"Ackhter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4887-6236","authenticated-orcid":true,"given":"Afsan","family":"Bulbul","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chidozie Declan","family":"Iwu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohammod Jobayer","family":"Chisti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5676-3280","authenticated-orcid":true,"given":"Lubaba","family":"Shahrin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"key":"pone.0333580.ref001","first-page":"1","article-title":"Infectious diseases as a cause of global childhood mortality and morbidity: Progress in recognition, prevention, and treatment","volume":"5","author":"L Frenkel","year":"2018","journal-title":"Adv Pediatr Res"},{"issue":"4","key":"pone.0333580.ref002","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1016\/j.pcl.2017.03.006","article-title":"The Burden and Etiology of Diarrheal Illness in Developing Countries","volume":"64","author":"KL Kotloff","year":"2017","journal-title":"Pediatr Clin North Am"},{"issue":"3","key":"pone.0333580.ref003","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1001\/archinte.1978.03630270047018","article-title":"Typhoid fever. 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