Identification of concurrent bacterial infection in adult patients with dengue

Abstract

We aim to construct a diagnostic model for bacterial coinfection in dengue patients (Dengue Dual Infection Score [DDIS]); 2,065 adult dengue patients (mean age = 41.9 ± 17.2 years, 58.4% male, 83 patients with bacterial coinfection) seen at a university hospital from January of 2005 to February of 2010 were studied. The DDIS was created by assigning one point to each of five risk factors for bacterial coinfection: pulse rate ≥ 90 beats/minute, total white cell count ≥ 6 × 10(9)/L, hematocrit < 40%, serum sodium < 135 mmol/L, and serum urea ≥ 5 mmol/L. The DDIS identified bacterial coinfection (derivation set area under the curve = 0.793, 95% confidence interval = 0.732-0.854; validation set area under the curve = 0.761, 95% confidence interval = 0.637-0.886). A DDIS of ≥ 4 had a specificity of 94.4%, whereas a DDIS of ≥ 1 had a sensitivity of 94.4% for bacterial coinfection. The DDIS can help to select dengue patients for early bacterial cultures and empirical antibiotics.

Figure 1.

Using DDIS for the identification of bacterial infection (N = 1,299 patients in the derivation set with complete data and 60 patients with bacterial infection).

Figure 2.

Using DDIS for the identification of bacterial infection (N = 536 patients in the validation set with complete data and 18 patients with bacterial infection).