Risk factors for death in hospitalized dysentery patients in Rwanda.

Hdl Handle:
http://hdl.handle.net/10144/18783
Title:
Risk factors for death in hospitalized dysentery patients in Rwanda.
Authors:
Legros, D; Paquet, C; Dorlencourt, F; Saoult, E
Journal:
Tropical Medicine & International Health
Abstract:
To evaluate the management of severe dysentery cases in in-patient facilities during an epidemic of Shigella dysenteriae type 1 (Sd1), and to identify the factors associated with the risk of death, we conducted a prospective cohort study in 10 Rwandese hospitals between September and December 1994. Data were obtained from 849 cases admitted to hospitals with diarrhoea and visible blood in stools. The proportion of patients with persistent bloody diarrhoea was 51.0% at treatment day 3 and 27.9% at treatment day 5. At discharge, 79.9% had improved or were cured. The case fatality ratio was 13.2%, higher for patients treated with nalidixic acid than for those treated with ciprofloxacin (12.2% vs. 2.2%, RR = 5.80, 95% CI = 0.83-40.72). In a logistic regression model three risk factors were significantly associated with an increased risk of death during hospitalization: severe dehydration on admission (adjusted OR = 2.79, 95% CI = 1.46-5.33), age over 50 (adjusted OR vs. 5-49 age group = 3.22, 95% CI = 1.70-6.11) and prescription of nalidixic acid (adjusted OR vs. ciprofloxacin = 8.66, 95% CI = 1.08-69.67). Those results were consistent with reported high levels of resistance of Sd1 to the commonest antibiotics, including nalidixic acid. Patients belonging to groups with a higher risk of dying should be given special medical attention and supportive care. In areas of high resistance to nalidixic acid, severe cases of dysentery should be treated with fluoroquinolones in order to reduce the mortality associated with these epidemics.
Affiliation:
EPICENTRE, Paris, France.
Publisher:
Wiley-Blackwell
Issue Date:
Jun-1999
URI:
http://hdl.handle.net/10144/18783
PubMed ID:
10444318
Additional Links:
http://www.blackwell-synergy.com/loi/tmi
Language:
en
ISSN:
1360-2276
Appears in Collections:
Research Methods

Full metadata record

DC FieldValue Language
dc.contributor.authorLegros, D-
dc.contributor.authorPaquet, C-
dc.contributor.authorDorlencourt, F-
dc.contributor.authorSaoult, E-
dc.date.accessioned2008-02-21T12:55:10Z-
dc.date.available2008-02-21T12:55:10Z-
dc.date.issued1999-06-
dc.identifier.citationRisk factors for death in hospitalized dysentery patients in Rwanda. 1999, 4 (6):428-32 Trop. Med. Int. Healthen
dc.identifier.issn1360-2276-
dc.identifier.pmid10444318-
dc.identifier.urihttp://hdl.handle.net/10144/18783-
dc.description.abstractTo evaluate the management of severe dysentery cases in in-patient facilities during an epidemic of Shigella dysenteriae type 1 (Sd1), and to identify the factors associated with the risk of death, we conducted a prospective cohort study in 10 Rwandese hospitals between September and December 1994. Data were obtained from 849 cases admitted to hospitals with diarrhoea and visible blood in stools. The proportion of patients with persistent bloody diarrhoea was 51.0% at treatment day 3 and 27.9% at treatment day 5. At discharge, 79.9% had improved or were cured. The case fatality ratio was 13.2%, higher for patients treated with nalidixic acid than for those treated with ciprofloxacin (12.2% vs. 2.2%, RR = 5.80, 95% CI = 0.83-40.72). In a logistic regression model three risk factors were significantly associated with an increased risk of death during hospitalization: severe dehydration on admission (adjusted OR = 2.79, 95% CI = 1.46-5.33), age over 50 (adjusted OR vs. 5-49 age group = 3.22, 95% CI = 1.70-6.11) and prescription of nalidixic acid (adjusted OR vs. ciprofloxacin = 8.66, 95% CI = 1.08-69.67). Those results were consistent with reported high levels of resistance of Sd1 to the commonest antibiotics, including nalidixic acid. Patients belonging to groups with a higher risk of dying should be given special medical attention and supportive care. In areas of high resistance to nalidixic acid, severe cases of dysentery should be treated with fluoroquinolones in order to reduce the mortality associated with these epidemics.en
dc.language.isoenen
dc.publisherWiley-Blackwell-
dc.relation.urlhttp://www.blackwell-synergy.com/loi/tmi-
dc.rightsArchived on this site with the kind permission of Wiley-Blackwellen
dc.subject.meshAdolescenten
dc.subject.meshAdulten
dc.subject.meshAnti-Infective Agentsen
dc.subject.meshCiprofloxacinen
dc.subject.meshDysentery, Bacillaryen
dc.subject.meshFemaleen
dc.subject.meshHospitalizationen
dc.subject.meshHumansen
dc.subject.meshLength of Stayen
dc.subject.meshLogistic Modelsen
dc.subject.meshMaleen
dc.subject.meshMiddle Ageden
dc.subject.meshNalidixic Aciden
dc.subject.meshProspective Studiesen
dc.subject.meshQuestionnairesen
dc.subject.meshRisk Factorsen
dc.subject.meshRwandaen
dc.subject.meshShigella dysenteriaeen
dc.subject.meshTreatment Outcomeen
dc.titleRisk factors for death in hospitalized dysentery patients in Rwanda.en
dc.contributor.departmentEPICENTRE, Paris, France.en
dc.identifier.journalTropical Medicine & International Healthen

Related articles on PubMed

All Items in MSF are protected by copyright, with all rights reserved, unless otherwise indicated.