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Clinical Trial
. 2024 Apr 11;8(1):e002448.
doi: 10.1136/bmjpo-2023-002448.

Clinical and nutritional correlates of bacterial diarrhoea aetiology in young children: a secondary cross-sectional analysis of the ABCD trial

Sarah Somji  1   2 , Per Ashorn  3 , Karim Manji  4 , Tahmeed Ahmed  5 , Md Chisti  5 , Usha Dhingra  6 , Sunil Sazawal  6 , Benson Singa  6 , Judd L Walson  7   8   9 , Patricia Pavlinac  7   8 , Naor Bar-Zeev  10 , Eric Houpt  11 , Queen Dube  12 , Karen Kotloff  13   14 , Samba Sow  15 , Mohammad Tahir Yousafzai  16 , Farah Qamar  16 , Rajiv Bahl  17 , Ayesha De Costa  17 , Jonathon Simon  17 , Christopher R Sudfeld #  18 , Christopher P Duggan #  18   19 ; ABCD Study Group
Collaborators, Affiliations
Clinical Trial

Clinical and nutritional correlates of bacterial diarrhoea aetiology in young children: a secondary cross-sectional analysis of the ABCD trial

Sarah Somji et al. BMJ Paediatr Open. .

Abstract

Objective: The objective was to assess the association between nutritional and clinical characteristics and quantitative PCR (qPCR)-diagnosis of bacterial diarrhoea in a multicentre cohort of children under 2 years of age with moderate to severe diarrhoea (MSD).

Design: A secondary cross-sectional analysis of baseline data collected from the AntiBiotics for Children with Diarrhoea trial (NCT03130114).

Patients: Children with MSD (defined as >3 loose stools within 24 hours and presenting with at least one of the following: some/severe dehydration, moderate acute malnutrition (MAM) or severe stunting) enrolled in the ABCD trial and collected stool sample.

Study period: June 2017-July 2019.

Interventions: None.

Main outcome measures: Likely bacterial aetiology of diarrhoea. Secondary outcomes included specific diarrhoea aetiology.

Results: A total of 6692 children with MSD had qPCR results available and 28% had likely bacterial diarrhoea aetiology. Compared with children with severe stunting, children with MAM (adjusted OR (aOR) (95% CI) 1.56 (1.18 to 2.08)), some/severe dehydration (aOR (95% CI) 1.66 (1.25 to 2.22)) or both (aOR (95% CI) 2.21 (1.61 to 3.06)), had higher odds of having likely bacterial diarrhoea aetiology. Similar trends were noted for stable toxin-enterotoxigenic Escherichia coli aetiology. Clinical correlates including fever and prolonged duration of diarrhoea were not associated with likely bacterial aetiology; children with more than six stools in the previous 24 hours had higher odds of likely bacterial diarrhoea (aOR (95% CI) 1.20 (1.05 to 1.36)) compared with those with fewer stools.

Conclusion: The presence of MAM, dehydration or high stool frequency may be helpful in identifying children with MSD who might benefit from antibiotics.

Keywords: epidemiology; infant.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart of children aged 2–23 months presenting with moderate to severe diarrhoea. ‘Likely’ diarrhoea associated aetiology was determined by Ct value cut-offs for specific enteropathogens. Ct values greater than these cut-offs but <35 were considered ‘possible’ aetiologies while Ct value >35 was considered ‘unlikely’ aetiology. qPCR, quantitative PCR.
See this image and copyright information in PMC

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