A prospective study of community-acquired bloodstream infections among febrile adults admitted to Mulago Hospital in Kampala, Uganda.

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A prospective study of community-acquired bloodstream infections among febrile adults admitted to Mulago Hospital in Kampala, Uganda.

J Acquir Immune Defic Syndr Hum Retrovirol. 1998 Dec 15;19(5):484-9. Unique Identifier : AIDSLINE MED/99075305
Ssali FN; Kamya MR; Wabwire-Mangen F; Kasasa S; Joloba M; Williams D; Mugerwa RD; Ellner JJ; Johnson JL; Department of Medicine, Mulago Hospital and Makerere University,; Kampala, Uganda.

Abstract: Septicemia is a frequent cause of death in HIV-infected adults in developing countries. Additional prospective studies are needed to determine the etiology of bloodstream infections (BSI) in febrile HIV-infected adults and guide initial evaluation and treatment in this setting. We assessed the prevalence and etiology of community-acquired BSI among 299 consecutive febrile adult medical admissions to Mulago Hospital, Kampala, Uganda, over a 4-month period in 1997. The median age of our patients was 30 years, 159 (53%) were male, and 227 (76%) HIV-1-seropositive. Overall, prevalence of bacteremia or fungemia (1 patient) was 24%. Bacteremia was more frequent in HIV-infected than in uninfected patients (27% versus 15%, respectively; p = .04). Mycobacterium tuberculosis (n = 28), Streptococcus pneumoniae (n = 15) and Salmonella species (n = 13) were the most frequent isolates. All Salmonella and mycobacterial isolates were recovered from HIV-infected patients. Pneumococcal bacteremia was not associated with HIV seropositivity. M. avium complex and M. simiae were isolated from two HIV-infected patients. The rate of mycobacteremia among febrile HIV-infected adults presenting for hospitalization was 13%. Bacteremia and disseminated tuberculosis are frequent causes of morbidity in febrile HIV-infected Ugandan adults. Initial empiric antibiotic coverage in this setting should be targeted toward the pneumococcus and gram-negative enteric bacilli, especially nontyphi Salmonella species. All patients presenting with chronic cough should be evaluated for tuberculosis.

Keywords: JOURNAL ARTICLE Adolescence Adult Community-Acquired Infections/COMPLICATIONS/EPIDEMIOLOGY/ETIOLOGY Drug Resistance, Microbial Female Fever Human HIV Infections/*COMPLICATIONS/EPIDEMIOLOGY Male Microbial Sensitivity Tests Middle Age Prevalence Prospective Studies Septicemia/COMPLICATIONS/*EPIDEMIOLOGY/ETIOLOGY Support, U.S. Gov't, P.H.S. Uganda/EPIDEMIOLOGY
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A9930895

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