Correlation of Clinical Outcomes With Multiplex Molecular Testing of Stool From Children Admitted to Hospital With Gastroenteritis in Botswana.

TitleCorrelation of Clinical Outcomes With Multiplex Molecular Testing of Stool From Children Admitted to Hospital With Gastroenteritis in Botswana.
Publication TypeJournal Article
Year of Publication2016
AuthorsPernica JM, Steenhoff AP, Welch H, Mokomane M, Quaye I, Arscott-Mills T, Mazhani L, Lechiile K, Mahony J, Smieja M, Goldfarb DM
JournalJ Pediatric Infect Dis Soc
Volume5
Issue3
Pagination312-8
Date Published2016 Sep
ISSN2048-7207
KeywordsAnti-Bacterial Agents, Botswana, Child, Preschool, Diarrhea, Infantile, Feces, Female, Gastroenteritis, Hospitalization, Humans, Infant, Male, Malnutrition, Multiplex Polymerase Chain Reaction, Prospective Studies, Treatment Outcome
Abstract

BACKGROUND: Diarrheal disease is a leading cause of death for young children. Most pediatric gastroenteritis is caused by viral pathogens; consequently, current recommendations advocate against routine antibacterial therapy if children present without bloody stools.

METHODS: In this prospective cohort study, we enrolled children with severe acute gastroenteritis admitted to hospital in Botswana. Details of presenting history, physical examination, and course in the hospital were recorded. Stool samples were characterized using a 15 pathogen polymerase chain reaction assay.

RESULTS: There were 671 participants with a median age of 8.3 months; 77 (11%) had severe acute malnutrition. Only 74 children had bloody stools, of whom 48 (65%) had a detectable bacterial pathogen, compared to 195 of 592 (33%) of those without. There were 26 deaths (3.9%). Covariates associated with death in multivariable logistic regression were the detection of any of Campylobacter/Shigella/enterotoxigenic Escherichia coli (odds ratio [OR] 2.57, 95% confidence interval [CI] 1.07-6.17), severe acute malnutrition (OR 4.34, 95% CI 1.79-10.5), and antibiotic therapy (OR 8.82, 95% CI 2.03-38.2). There was no significant association between bloody stools and death, and the effect of Campylobacter/Shigella/enterotoxigenic E. coli infection on death was not modified by the presence of bloody stools.

CONCLUSIONS: Detection of bacterial enteropathogens is associated with increased mortality in children in sub-Saharan Africa. Unfortunately, most children with these infections do not have bloody stools, and bloody dysentery was not found to be associated with worse outcomes. Clinical trials evaluating outcomes associated with more aggressive diagnostic strategies in children presenting with severe acute gastroenteritis in sub-Saharan Africa should be undertaken.

DOI10.1093/jpids/piv028
Alternate JournalJ Pediatric Infect Dis Soc
PubMed ID26407262
PubMed Central IDPMC5125452
Grant ListP30 AI045008 / AI / NIAID NIH HHS / United States