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.
Highlights
Dengue is a common arthropod-borne virual disease in tropical and subtropical regions (Horstick et al, 2015; Stanaway et al, 2016)
Pathology results showed that the level of procalcitonin was 12.6±29.3 mg lÀ1, and that of C-reactive protein (CRP) was 49.3±70.9 mg lÀ1
Our study and that of Leo et al (2011) included only patients who required admission to the intensive care unit (ICU) or who died because of a dengue infection; both studies had a higher rate of concurrent bacteraemia
Summary
Dengue is a common arthropod-borne virual (arbovirus) disease in tropical and subtropical regions (Horstick et al, 2015; Stanaway et al, 2016). Based on the World Health Organization’s estimation, the annual incidence of dengue infection. The true number of dengue infections is probably much higher because of a lack of adequate global surveillance of the disease and because it is easy to misdiagnose. The initial symptoms and signs of dengue disease are nonspecific, and fever is one of the most common clinical manifestations of dengue infections (Simmons et al, 2012). The clinical presentations of dengue infections can be asymptomatic or mild, or severe in cases that require admission to the intensive care unit (ICU) (Guzman & Harris, 2015)
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