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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.
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
refterms.dateFOA2019-03-04T09:26:57Z
html.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.


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