1887

Abstract

We investigated the clinical features of intensive care unit (ICU) patients with concomitant severe dengue infection and bacteraemia to identify risk factors for this comorbidity. The records of all ICU dengue patients admitted during the period of 31 July–30 November 2015 were reviewed. Patients with ‘concurrent bacteremia’ (positive bacterial blood culture within 72 h of ICU admission) were identified. ICU admission was required for 142 patients, of which 22 (15.5 %) had concurrent bacteraemia. Species of the genus Streptococcus was the most common pathogens, followed by Escherichia coli then species of the genus Staphylococcus. Patients with a severe dengue infection and bacteraemia had higher APACHE II and TISS scores, C-reactive protein (CRP) levels and leukocyte counts, positive fluid balances, longer activated partial thromboplastin times (APTTs), higher lactate levels and more kidney failure, but controls (severe dengue patients without bacteraemia) had higher Glasgow Coma Scale (GCS) scores, higher albumin levels and more abdominal pain (all P<0.05). Patients with bacteraemia had a higher mortality rate than did ontrols (40.9 vs 18.3 %; P=0.018). Multiple logistic regression analysis showed that bacteraemia was significantly positively associated with the following independent predictors: higher CRP levels [adjusted odds ratio (aOR): 1.026; 95 % confidence interval (CI): 1.008–1.044; P=0.005], and longer APTTs (aOR: 1.034; 95 CI: 1.004–1.065; P=0.027). Concurrent bacteraemia is not uncommon in severe dengue patients in the ICU, and it is associated with high mortality. Higher CRP levels and longer APTTs were two independent risk factors associated with bacteraemia.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000388
2016-12-16
2019-10-22
Loading full text...

Full text loading...

/deliver/fulltext/jmm/65/12/1505.html?itemId=/content/journal/jmm/10.1099/jmm.0.000388&mimeType=html&fmt=ahah

References

  1. Amâncio F. F., Heringer T. P., de Oliveira C. C., Fassy L. B., de Carvalho F. B., Oliveira D. P., de Oliveira C. D., Botoni F. O., Magalhães F. C. et al.( 2015;). Clinical profiles and factors associated with death in adults with dengue admitted to intensive care units, Minas Gerais, Brazil. . PLoS One10:e0129046.
    [Google Scholar]
  2. Chai L. Y., Lim P. L., Lee C. C., Hsu L. Y., Teoh Y. L., Lye D. C., Krishnan P., Leo Y. S..( 2007;). Cluster of Staphylococcus aureus and dengue co-infection in Singapore. . Ann Acad Med Singapore36:847–850.[PubMed]
    [Google Scholar]
  3. Guzman M. G., Harris E..( 2015;). Dengue. . Lancet385:453–465. [CrossRef][PubMed]
    [Google Scholar]
  4. Hadinegoro S. R..( 2012;). The revised WHO dengue case classification: does the system need to be modified?. Paediatr Int Child Health32:33–38. [CrossRef][PubMed]
    [Google Scholar]
  5. Horstick O., Tozan Y., Wilder-Smith A..( 2015;). Reviewing dengue: still a neglected tropical disease?. PLoS Negl Trop Dis9:e0003632. [CrossRef][PubMed]
    [Google Scholar]
  6. Lahiri M., Fisher D., Tambyah P. A..( 2008;). Dengue mortality: reassessing the risks in transition countries. . Trans R Soc Trop Med Hyg102:1011–1016. [CrossRef][PubMed]
    [Google Scholar]
  7. Lee I. K., Liu J. W., Yang K. D..( 2005;). Clinical characteristics and risk factors for concurrent bacteremia in adults with dengue hemorrhagic fever. . Am J Trop Med Hyg72:221–226.[PubMed]
    [Google Scholar]
  8. Leo Y. S., Thein T. L., Fisher D. A., Low J. G., Oh H. M., Narayanan R. L., Gan V. C., Lee V. J., Lye D. C..( 2011;). Confirmed adult dengue deaths in Singapore: 5-year multi-center retrospective study. . BMC Infect Dis11:123. [CrossRef][PubMed]
    [Google Scholar]
  9. Murray N. E., Quam M. B., Wilder-Smith A..( 2013;). Epidemiology of dengue: past, present and future prospects. . Clin Epidemiol5:299–309. [CrossRef][PubMed]
    [Google Scholar]
  10. Ong A., Sandar M., Chen M. I., Sin L. Y..( 2007;). Fatal dengue hemorrhagic fever in adults during a dengue epidemic in Singapore. . Int J Infect Dis11:263–267. [CrossRef][PubMed]
    [Google Scholar]
  11. Premaratna R., Dissanayake D., Silva F. H., Dassanayake M., de Silva H. J..( 2015;). Secondary bacteraemia in adult patients with prolonged dengue fever. . Ceylon Med J60:10–12. [CrossRef][PubMed]
    [Google Scholar]
  12. Simmons C. P., Farrar J. J., Nguyen v. V., Wills B..( 2012;). Dengue. . N Engl J Med366:1423–1432. [CrossRef][PubMed]
    [Google Scholar]
  13. Stanaway J. D., Shepard D. S., Undurraga E. A., Halasa Y. A., Coffeng L. E., Brady O. J., Hay S. I., Bedi N., Bensenor I. M. et al.( 2016;). The global burden of dengue: an analysis from the global burden of disease study 2013. . Lancet Infect Dis16:712–723. [CrossRef][PubMed]
    [Google Scholar]
  14. Thein T. L., Ng E. L., Yeang M. S., Leo Y. S., Lye D. C..( 2015;). Risk factors for concurrent bacteremia in adult patients with dengue. . J Microbiol Immunol Infect, http://dx.doi.org/10.1016/j.jmii.2015.06.008. [CrossRef][PubMed]
    [Google Scholar]
  15. WHO( 2009;). Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control. Geneva, Switzerland:: WHO;.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.000388
Loading
/content/journal/jmm/10.1099/jmm.0.000388
Loading

Data & Media loading...

Supplements

Supplementary File 1

PDF
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error