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Identification of Concurrent Bacterial Infection in Adult Patients with Dengue

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  • University Medicine Cluster, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

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 × 109/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.

Author Notes

* Address correspondence to Kay C. See, Division of Respiratory and Critical Care Medicine, University Medicine Cluster, 1E Kent Ridge Road, NUHS Tower Block Level 10, Singapore 119228. E-mail: Kay_Choong_SEE@nuhs.edu.sg

Authors' addresses: Kay C. See, Jason Phua, Hwee S. Yip, Leong L. Yeo, and Tow K. Lim, University Medicine Cluster, National University Hospital, Singapore and Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, E-mails: Kay_Choong_SEE@nuhs.edu.sg, Jason_PHUA@nuhs.edu.sg, Hwee_Seng_YIP@nuhs.edu.sg, Leonard_LL_YEO@nuhs.edu.sg, and Tow_Keang_LIM@nuhs.edu.sg.

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